Lies, Edzard Ernst, and Research: Don't Believe Everything You Read

There have been several articles published in medical research journals which are pointing out just how flawed, biased, and just plain wrong biomedical research has become. Such studies can cause serious harm. Paxil was used as a teen anti-depressant  for years, largely based on a study which massaged the data to come to absolutely false conclusions about its safety and efficacy. Vioxx, the miracle painkiller that killed, was allowed on the market due to research designed to hide its deadly side effects.  As far back as 2003, bias was noted in the biomedical reesarch literature, but little has been done to change things. At most, some journals ask investigators to self-report any conflicts of interest they may have. Of course, few do.

The fact of the matter is, that pharmaceutical companies control the vast majority of grant money going to research institutions, and as an investigator, your livelihood can be put on the line if your grant money dries up.

Not surprisingly, bias and hidden agendas come up in the research on alternative medicine and chiropractic in particular. Mostly this occurs in the form of journal articles using research that has been hand-crafted to make chiropractic spinal manipulation appear dangerous -- when, in fact, you have a higher risk of serious injury while driving to your chiropractor's office than you do of any treatment you receive while you're there.

A case in point is the article, "Adverse effects of spinal manipulation: a systematic review," authored by Edzard Ernst, and published in the Journal of the Royal Society of Medicine in 2007. Ernst concludes that, based on his review, "in the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation."

This conclusion throws up several red flags, beginning with the fact that it flies in the face of most of the already-published, extensive research which shows that chiropractic care is one of the safest interventions, and in fact, is  safer than medical alternatives.

For example, an examination of injuries resulting from neck adjustments over a 10-year period found that they rarely, if ever, cause strokes, and lumbar adjustments by chiropractors have been deemed by one of the largest studies ever performed to be safer and more effective than medical treatment.

So the sudden appearance of this study claiming that chiropractic care should be stopped altogether seems a bit odd.

As it turns out, the data is odd as well.

In 2012, a researcher at Macquarie University in Australia, set out to replicate Ernst's study. What he found was shocking.

This subsequent study stated that "a review of the original case reports and case series papers described by Ernst found numerous errors or inconsistencies," including changing the sex and age of patients, misrepresenting patients' response to adverse events, and claiming that interventions were performed by chiropractors, when no chiropractor was even involved in the case.

"In 11 cases of the 21...that Ernst reported as [spinal manipulative therapy] administered by chiropractors, it is unlikely that the person was a qualified chiropractor," the review found.

What is interesting here is that Edzard Ernst is no rookie in academic publishing. In fact, he is a retired professor and founder of two medical journals. What are the odds that a man with this level of experience could overlook so many errors in his own data?

The likelihood of Ernst accidentally allowing so many errors into his article is extremely small. It is far more likely that Ernst selected, prepared, and presented the data to make it fit a predetermined conclusion.

So, Ernst's article is either extremely poor science, or witheringly inept fraud. I'll let the reader draw their own conclusion.

Interestingly enough, being called out on his antics has not stopped Ernst from disseminating equally ridiculous research in an unprofessional manner. Just a few days ago, Ernst frantically called attention to another alleged chiropractic mishap, this one resulting in a massive brain injury.

Not only has he not learned his lesson yet, Ernst tried the same old sleight of hand again. The brain injury, as it turns out, didn't happen until a week after the "chiropractic" adjustment, making it highly unlikely, if not impossible, for the adjustment to have caused the injury in the first place. Secondly, the adjustment wasn't even performed by a chiropractor. As the original paper points out, "cervical manipulation is still widely practiced in massage parlors and barbers in the Middle East."  The original article makes no claim that the neck adjustment (which couldn't have caused the problem in the first place) was actually performed by a chiropractor.

It is truly a shame that fiction published by people like Ernst has had the effect of preventing many people from getting the care they need. I can only hope that someday the biomedical research community can shed its childish biases so that we all might be better served by their findings.

5 Reasons You Can't Trust Nutrition Research, Part I

If I had a nickel for every time a patient had told me that they  cannot have certain foods, because of an article they saw or their MD told them, I would be a rich man.

A case in point is salt. For years, I have been telling my patients with high blood pressure that salt is the least of their concerns, particularly when they have been scared off of it from their MD. I’ve had patients eating foods that were terrible for their hearts, because their cardiologist had put them on a salt-free diet, and as a result, worsening their condition instead of improving it.

Just last week, “new” research has been reported on which now shows that salt is not an important risk factor for high blood pressure.

The fact of the matter is that physicians such as myself who specialize in nutrition have known for years that only a very small part of the population with high blood pressure is sensitive to dietary salt. That research was done a long time ago.

But the news really never caught on with the popular press, and it clearly didn’t reach the ears of most medical doctors, who have been pressing the no-salt diet for years.

As I read the news online last week, I noted in the comments that several other readers were saying that the research on nutrition is so flighty that they no longer trust any of it, and will just eat whatever they want to.

I have noted before that much of the mainstream medical research cannot be trusted. The majority of it has been tainted by big money from the pharmaceutical industry which has the money to hire its own research organizations and produce “scientific research” that, unsurprisingly, perfectly supports drug marketing plans.

Nutritional research becomes similarly warped, although on a smaller scale and for slightly different reasons.

One of the key problems with nutritional research is funding. Unlike drugs, which have a phenomenal return on investment, herbs and nutrients cannot be patented. So nobody is likely to get rich from, say, a paper which demonstrates that Vitamin C effectively combats the common cold. The return on investment on non-patentable health solutions is pretty low, so research investors are few and far between.

Nonetheless, the research is influenced by greed in a different way. While it is hard to find the money to prove a nutritional intervention is positively therapeutic, there is a tremendous amount of money available for research which will demonstrate that certain nutritional interventions are useless and/or dangerous.

And there is also a tremendous amount of political pressure which can be brought to bear on nutritional therapies, if they are thought to be a threat to pharmaceuticals.

Not but not least in the financial parade are the people which can make money directly by distorting the research. This is the group I am the most familiar with, so they get to be number one in our list:

1. The media: Not getting it right on a daily basis.

It is a poorly-kept secret that, prior to becoming a physician, I was a journalist. In fact, I was a science and technical journalist. My background in the sciences gave me the ability to explain complex technical topics in easily-accessible ways to non-geeks. So I’m familiar with the ways in which reporters, editors and publishers will, both consciously and unconsciously, bend their coverage to suit their needs.

The major problem with the reporting of nutritional research is that the findings of any study are sensationalized to increase the page hits. A relatively minor study of salt and hypertension, for example, becomes the health section’s page 1 news -- and then, for the next 25 years, both diet and medical recommendations are misdirected.

Another problem with nutritional research reporting stems from the reporter’s inability to understand the science itself, or unfamiliarity with the field. It can be difficult to explain scientific-y stuff to a general audience, and to do so well, you must thoroughly understand the science yourself. Too few reporters have more than a basic grasp of the life sciences, much less a basic understanding of nutritional physiology, and fundamentally important data in a study gets flattened, misreported or simply ignored because of the reporter’s ignorance.

Finally, there are a few reporters who have been reported to consciously misconstrue the results of studies on alternative medicine in general.

New York Times health and medicine reporter Gina Kolata is a case in point. The author of hundreds of articles for the Times, Kolata has been uncovered by The Nation and others as using her articles to press her own agenda -- a profitable one, at that. On one occasion, Kolata published an article which strongly hyped a couple of cancer drugs (an article which turned out to be erroneous, to boot) and within hours was floating a book proposal based on buzz generated by her own hype. While this is an ingenious feedback loop for a reporter hungry for a book contract, it is hardly impartial reporting.

Imagine how nutritional research is reported by a writer with the reputation of Kolata, with one hand on the keyboard and the other reaching for the pocket of the pharmacuetical company. It won’t be the unbiased story that many would imagine it to be.

2. Oops, we used the wrong vitamin.

For some reason I've never been able to fathom, the world of mainstream medicine has always been very faddish about vitamins and minerals. One vitamin or another is always "hot" with MDs. When I started practice a couple of decades ago, Vitamin C was the one being recommended by every MD and his brother. I suspect this was based largely on the later work of Linus Pauling, who already had accredited status with the mainstream medical community for his groundbreaking work in molecular biology.

Vitamin C has since cooled considerably since its days as the go-to vitamin for almost everything. Today, that role is fulfilled by Vitamin D. which is currently being touted by the medical community as a second-class cure-all for everything from fatigue to fibromyalgia to heart disease to depression to joint pain (it remains a second-class cure because in mainstream medicine, nothing is better than a pharmaceutical, natch).

Interestingly enough, 10 years ago, before D got big, it was being maligned on many fronts as being a near-useless nutrient which was only being touted by quacks as a remedy for fatigue and fibromyalgia and depression...you get the idea.

Many of these studies suffered from one very significant, very undisclosed flaw: The researchers were using the wrong form of Vitamin D.

The legal definition of Vitamin D includes 2 forms: Vitamin D2 and Vitamin D3. Both are equally useful in preventing rickets in children, which is what all Vitamin D was once thought to be good for. However, when it comes to its effects on the cardiovascular, immune and other systems, the D3 form is much more potent than D2, which often has little to no effect at all in these systems.

However, researchers investigating Vitamin D often neglected to note the difference. Thus, studies would report that Vitamin D was ineffective at treating a certain disorder -- when actually, it was the ineffectual form of Vitamin D that was being used.

A variation on the "wrong vitamin" error is the "lousy vitamin" error. As most people know, there is a great deal of variability among vitamin products. Much of that variability results from how the vitamin is packaged in the tablet -- particularly how well that tablet survives the gastrointestinal tract to dissolve at the right time. Many vitamins just are not digested well, and I have seen on x-rays, vitamin tablets residing unmolested in the large intestine, waiting to be moved out of the body without having given up the slightest amount of the nutrient they were supposed to disseminate. "Pharmaceutical-grade" nutrients tend to be no better in this regard than what you may pick up over the counter at a chain pharmacy store.

So if you are testing the efficacy of a certain nutrient, and not monitoring whether that nutrient is actually getting into the patient's bloodstream, your results are going to reflect more the failure of the nutrient packaging than of the nutrient itself. It has happened more often than you would like to believe.

Coming up in Part II: Dodgy Dosages and Dietary Dilutions.