After I woke up this morning, the haze induced by feasting and hanging out with family only slowly clearing, I debated about whether I wanted to post anything at all today. After all, in much of the English-speaking world, it’s still a holiday, Boxing Day. Although not an official holiday here in the US, when Christmas is on a Thursday, as it was this year, Boxing Day becomes an unofficial holiday that the majority of people not working in the retail sector seem to take off, the better to produce a four or five day weekend, depending upon whether they took Christmas Eve off as well. Also, it doesn’t help that Christmas Day is usually the lowest traffic day of the year and thus few people are reading.
Still, there were things I had wanted to write about but somehow hadn’t gotten around to. It happens. No blogger, not even one as prolific as I, can keep up with everything of interest. So I didn’t worry too much about it, even though one of these neglected topics was about one of my bêtes noires, Dr. Mehmet Oz, whom, if you type his name in the search box of this blog, you will find I have a great many problems with. However, bloggers I respect had already covered the story, namely a study in the BMJ that demonstrated that less than half of the medical advice offered up by the cardiothoracic surgeon turned talk show host is actually supported by the medical literature, such as Steve Novella. So, given the holiday and other stuff, I didn’t see a compelling need to comment further.
Until everyone’s favorite quack and conspiracy theorist, Mike Adams, gave me a Christmas present that I failed to notice before Christmas (it does happen sometimes) in the form of an article entitled, Mainstream media panics over Dr. Oz teaching disease prevention and nutritional self-care. Adams, remember, is now quite smitten with Dr. Oz since Dr. Oz made the horrific mistake of having Adams as a guest on his show and presenting him as a “food safety” activist. Since then, Adams has let loose his singularly unhinged rhetorical skills in the service of defending Dr. Oz from his imagined evil pharma shills trying to destroy him. This is no different. But, first, let’s briefly look at the study itself.
Basically, the BMJ study involved watching 40 randomly selected episodes each of The Dr. Oz Show and The Doctors (another horrible daytime medical show that I cannot stand to watch) and having a group of group of experienced evidence reviewers independently searching for, and evaluating as a team, evidence to support 80 randomly selected recommendations from each show.
Surprise! Surprise! Both shows were found quite wanting:
We could find at least a case study or better evidence to support 54% (95% confidence interval 47% to 62%) of the 160 recommendations (80 from each show). For recommendations in The Dr Oz Show, evidence supported 46%, contradicted 15%, and was not found for 39%. For recommendations in The Doctors, evidence supported 63%, contradicted 14%, and was not found for 24%. Believable or somewhat believable evidence supported 33% of the recommendations on The Dr Oz Show and 53% on The Doctors. On average, The Dr Oz Show had 12 recommendations per episode and The Doctors 11. The most common recommendation category on The Dr Oz Show was dietary advice (39%) and on The Doctors was to consult a healthcare provider (18%). A specific benefit was described for 43% and 41% of the recommendations made on the shows respectively. The magnitude of benefit was described for 17% of the recommendations on The Dr Oz Show and 11% on The Doctors. Disclosure of potential conflicts of interest accompanied 0.4% of recommendations.
Right off the bat, you know that the reviewers were giving these shows every benefit of the doubt, given that they were willing to consider case studies as the minimum form of evidence to support a recommendation. That’s a really low bar. By that standard, you could say that there is some evidence to support the idea that the MMR vaccine is associated with autism, given that Andrew Wakefield’s infamous 1998 study—now retracted—was a case series. Actually, since it was retracted, you couldn’t use Wakefield’s study, but there are plenty of other case reports and bad studies by antivaccine-sympathetic doctors and researchers out there that one could cite. In any case, that’s how bad Dr. Oz did, given how low a bar a case study is. When the authors raised the bar and used the slightly higher threshold of “Believable or somewhat believable evidence” then only 33% of recommendations on The Dr. Oz Show met that standard and 53% of the advice on The Doctors.
This is really bad. Pathetic, actually. The only thing that disappointed me about the study is that they didn’t look at what percentage of advice from Dr. Oz is based on pure fantasy (such as his episodes on homeopathy, using psychic mediums like John Edward and “Long Island Medium” Theresa Caputo) as therapists, faith healing, and the like). We take what we can get. Overall, the study was quite devastating, and I wonder how representative the sample was; to be honest, I had expected it to be worse.
Be that as it may, Mike Adams is incensed. (Of course, he’s always incensed, but this time he was a bit more incensed than even his highly incensed usual.) Get a load of how he starts out:
The pro-pharma, anti-nutrition mainstream media is engaged in an all-out panic over the success of Dr. Oz in teaching nutrition and disease prevention to the American public. Not surprisingly, all the usual suspects — media outlets funded by Big Pharma advertising money — have unleashed a wave of hit pieces against Dr. Oz, claiming his advice is “unproven.”
It couldn’t possibly be that Dr. Oz is coming in for criticism because his advice actually is “unproven” and, let’s face it, often disproven. Oh, no. To Adams, it has to be because there’s a conspiracy by big pharma to take Oz down. To make his point further, Adams mangles the concept of number needed to treat:
This is rather hilarious from the outset, considering the irrefutable fact that nearly all the most popular drugs don’t work on most people. The FDA will approve a drug for a disease based on a mere 5% efficacy rate, meaning the drug doesn’t work for 95% of subjects. Flu shots, even when they do work unlike the failed flu shots formulated this year, only prevent the flu in about 1 out of 100 people who receive the shots. So almost 99% of the people who take them receive no benefit (but they do get the extra bonus of mercury, as flu shots administered in the USA still contain this toxic heavy metal which is intentionally added to the formulations). I verified this myself via ICP-MS laboratory instrumentation that conducts mass spectrometry elemental analysis using a quadrupole mass analyzer. (See Labs.NaturalNews.com)
At least, I think he’s mangling the idea of number needed to treat (NNT). I can’t figure out if he’s referring to that or the use of p < 0.05 as the general level to determine statistical significance in most medical studies. In any case, the concept of number needed to treat (NNT) or, in the case of screening tests, the number needed to screen (NNS) describes how many people out of 100 or 1,000 will receive the expected help from a treatment or, in the case of a screening test, will have death or serious complications averted due to earlier detection of disease. It's heavily dependent upon the prevalence of a disease in the population. The fewer people who normally get a disease, the higher the NNT will be.
For instance, what is Adams talking about with respect to the flu vaccine? I think it's best described in this article, which starts out by pointing out that in a typical flu season, there’s about 3-4% of the population will get the flu:
Statistically, in well-matched years in the US, the average likelihood of getting the flu is around 4%, or one in twenty people. If you get your flu shot in well-matched years, you reduce your risk of getting the flu to 1%, or one in a hundred. In other words, it is still possible to get the flu even though you were immunized, but you have reduced your risk by 75%…A total of three people out of 100 did not come down with the flu because they were vaccinated.
So, in well-matched years, if we divide 100 people who got the flu shot by the three people who benefitted, we get a Number Needed to Treat of 33. In well-matched years, for every 33 people who get immunized, one will benefit by not getting a bout of influenza she otherwise would have suffered.
A NNT of 33 is, by the way, a fantastically good therapy. This is far better than the NNT to benefit of many, many other common therapies, like, for example, anti-depressants, anti-hypertensive drugs and prostate cancer screening.
So where did Adams’ “1 in 100″ figure come from? It probably came from the fact that this year the flu vaccine is not as well matched as we would like, which could mean:
In not well-matched years, the overall risk of getting the flu drops to 2 people out of 100. The flu vaccine cuts that number in half, for a 50% risk reduction. If you do the math, one person out of 100 benefits from the flu shot, making the NNT in not well-matched years 100.
What’s the NNT of homeopathy? Or of the various bogus Ebola “biodefense” preventatives promoted by Adams and his ilk? Infinity and beyond?
As for the the bit about “toxic heavy metals,” that’s pure hilarity, as I described several months ago. Basically, it’s a case of a scientific ignoramus going wild with an expensive piece of equipment that he has no clue what he’s doing with.
Next up is a prolonged rant about the bad things big pharma has been caught doing. That’s all very well and nice, but, even if each and every depredation of big pharma described happened exactly and absolutely the way Adams describes, it wouldn’t have anything to do with the lack of scientific support for Dr. Oz’s recommendations, nor would it “prove” that the recent criticism of Dr. Oz is all a big pharma plot to discredit him. Actually, Dr. Oz does a fine job of discrediting himself, which is perhaps why Adams trotted out the old trope that hospitals and medicine are supposedly the number one cause of death.
Even more hilariously, Adams can’t resist bringing up the whole “CDC whistleblower” affair, as though that demonstrated anything. As I pointed out before, all it showed was that Andrew Wakefield was wrong about the MMR vaccine being associated with autistic enterocolitis, thanks to an utterly incompetent analysis by a man named Brian Hooker (since retracted) and the utter betrayal of a rather credulous, high strung CDC psychologist. It’s a story that has quite properly faded into the oblivion that it so richly deserved, having failed to get anyone other than antivaccine reporters like Sharyl Attkisson the least bit interested.
Adams concludes:
It is people like Dr. Oz who offer advice that can help people eliminate their need for dangerous medications and even prevent disease so they never need the meds in the first place.
Without a doubt, Dr. Oz is saving lives. Big Pharma is destroying lives, and the pro-pharma publications are co-conspirators in the shameless exploitation of human life for profit. Dr. Oz is a great American hero. He’s a beacon of truth standing out like a lighthouse above a sea of lies and deception spewed out by a pharma-funded media that has no qualms about promoting an industry that preys upon human suffering and sickness. We should all support Dr. Oz in his effort to teach people food wisdom, nutritional therapies, self-care and how to make healthy decisions that prevent disease and eliminate dependence on the corrupt medical cartels.
You know, I wonder if there’s a conflict of interest here. Adams has his lips so far up Dr. Oz’s posterior, that he’s tickling Oz’s tonsils. No doubt Adams wants to be a guest on Oz’s show again.
from ScienceBlogs http://ift.tt/1roxuJl
After I woke up this morning, the haze induced by feasting and hanging out with family only slowly clearing, I debated about whether I wanted to post anything at all today. After all, in much of the English-speaking world, it’s still a holiday, Boxing Day. Although not an official holiday here in the US, when Christmas is on a Thursday, as it was this year, Boxing Day becomes an unofficial holiday that the majority of people not working in the retail sector seem to take off, the better to produce a four or five day weekend, depending upon whether they took Christmas Eve off as well. Also, it doesn’t help that Christmas Day is usually the lowest traffic day of the year and thus few people are reading.
Still, there were things I had wanted to write about but somehow hadn’t gotten around to. It happens. No blogger, not even one as prolific as I, can keep up with everything of interest. So I didn’t worry too much about it, even though one of these neglected topics was about one of my bêtes noires, Dr. Mehmet Oz, whom, if you type his name in the search box of this blog, you will find I have a great many problems with. However, bloggers I respect had already covered the story, namely a study in the BMJ that demonstrated that less than half of the medical advice offered up by the cardiothoracic surgeon turned talk show host is actually supported by the medical literature, such as Steve Novella. So, given the holiday and other stuff, I didn’t see a compelling need to comment further.
Until everyone’s favorite quack and conspiracy theorist, Mike Adams, gave me a Christmas present that I failed to notice before Christmas (it does happen sometimes) in the form of an article entitled, Mainstream media panics over Dr. Oz teaching disease prevention and nutritional self-care. Adams, remember, is now quite smitten with Dr. Oz since Dr. Oz made the horrific mistake of having Adams as a guest on his show and presenting him as a “food safety” activist. Since then, Adams has let loose his singularly unhinged rhetorical skills in the service of defending Dr. Oz from his imagined evil pharma shills trying to destroy him. This is no different. But, first, let’s briefly look at the study itself.
Basically, the BMJ study involved watching 40 randomly selected episodes each of The Dr. Oz Show and The Doctors (another horrible daytime medical show that I cannot stand to watch) and having a group of group of experienced evidence reviewers independently searching for, and evaluating as a team, evidence to support 80 randomly selected recommendations from each show.
Surprise! Surprise! Both shows were found quite wanting:
We could find at least a case study or better evidence to support 54% (95% confidence interval 47% to 62%) of the 160 recommendations (80 from each show). For recommendations in The Dr Oz Show, evidence supported 46%, contradicted 15%, and was not found for 39%. For recommendations in The Doctors, evidence supported 63%, contradicted 14%, and was not found for 24%. Believable or somewhat believable evidence supported 33% of the recommendations on The Dr Oz Show and 53% on The Doctors. On average, The Dr Oz Show had 12 recommendations per episode and The Doctors 11. The most common recommendation category on The Dr Oz Show was dietary advice (39%) and on The Doctors was to consult a healthcare provider (18%). A specific benefit was described for 43% and 41% of the recommendations made on the shows respectively. The magnitude of benefit was described for 17% of the recommendations on The Dr Oz Show and 11% on The Doctors. Disclosure of potential conflicts of interest accompanied 0.4% of recommendations.
Right off the bat, you know that the reviewers were giving these shows every benefit of the doubt, given that they were willing to consider case studies as the minimum form of evidence to support a recommendation. That’s a really low bar. By that standard, you could say that there is some evidence to support the idea that the MMR vaccine is associated with autism, given that Andrew Wakefield’s infamous 1998 study—now retracted—was a case series. Actually, since it was retracted, you couldn’t use Wakefield’s study, but there are plenty of other case reports and bad studies by antivaccine-sympathetic doctors and researchers out there that one could cite. In any case, that’s how bad Dr. Oz did, given how low a bar a case study is. When the authors raised the bar and used the slightly higher threshold of “Believable or somewhat believable evidence” then only 33% of recommendations on The Dr. Oz Show met that standard and 53% of the advice on The Doctors.
This is really bad. Pathetic, actually. The only thing that disappointed me about the study is that they didn’t look at what percentage of advice from Dr. Oz is based on pure fantasy (such as his episodes on homeopathy, using psychic mediums like John Edward and “Long Island Medium” Theresa Caputo) as therapists, faith healing, and the like). We take what we can get. Overall, the study was quite devastating, and I wonder how representative the sample was; to be honest, I had expected it to be worse.
Be that as it may, Mike Adams is incensed. (Of course, he’s always incensed, but this time he was a bit more incensed than even his highly incensed usual.) Get a load of how he starts out:
The pro-pharma, anti-nutrition mainstream media is engaged in an all-out panic over the success of Dr. Oz in teaching nutrition and disease prevention to the American public. Not surprisingly, all the usual suspects — media outlets funded by Big Pharma advertising money — have unleashed a wave of hit pieces against Dr. Oz, claiming his advice is “unproven.”
It couldn’t possibly be that Dr. Oz is coming in for criticism because his advice actually is “unproven” and, let’s face it, often disproven. Oh, no. To Adams, it has to be because there’s a conspiracy by big pharma to take Oz down. To make his point further, Adams mangles the concept of number needed to treat:
This is rather hilarious from the outset, considering the irrefutable fact that nearly all the most popular drugs don’t work on most people. The FDA will approve a drug for a disease based on a mere 5% efficacy rate, meaning the drug doesn’t work for 95% of subjects. Flu shots, even when they do work unlike the failed flu shots formulated this year, only prevent the flu in about 1 out of 100 people who receive the shots. So almost 99% of the people who take them receive no benefit (but they do get the extra bonus of mercury, as flu shots administered in the USA still contain this toxic heavy metal which is intentionally added to the formulations). I verified this myself via ICP-MS laboratory instrumentation that conducts mass spectrometry elemental analysis using a quadrupole mass analyzer. (See Labs.NaturalNews.com)
At least, I think he’s mangling the idea of number needed to treat (NNT). I can’t figure out if he’s referring to that or the use of p < 0.05 as the general level to determine statistical significance in most medical studies. In any case, the concept of number needed to treat (NNT) or, in the case of screening tests, the number needed to screen (NNS) describes how many people out of 100 or 1,000 will receive the expected help from a treatment or, in the case of a screening test, will have death or serious complications averted due to earlier detection of disease. It's heavily dependent upon the prevalence of a disease in the population. The fewer people who normally get a disease, the higher the NNT will be.
For instance, what is Adams talking about with respect to the flu vaccine? I think it's best described in this article, which starts out by pointing out that in a typical flu season, there’s about 3-4% of the population will get the flu:
Statistically, in well-matched years in the US, the average likelihood of getting the flu is around 4%, or one in twenty people. If you get your flu shot in well-matched years, you reduce your risk of getting the flu to 1%, or one in a hundred. In other words, it is still possible to get the flu even though you were immunized, but you have reduced your risk by 75%…A total of three people out of 100 did not come down with the flu because they were vaccinated.
So, in well-matched years, if we divide 100 people who got the flu shot by the three people who benefitted, we get a Number Needed to Treat of 33. In well-matched years, for every 33 people who get immunized, one will benefit by not getting a bout of influenza she otherwise would have suffered.
A NNT of 33 is, by the way, a fantastically good therapy. This is far better than the NNT to benefit of many, many other common therapies, like, for example, anti-depressants, anti-hypertensive drugs and prostate cancer screening.
So where did Adams’ “1 in 100″ figure come from? It probably came from the fact that this year the flu vaccine is not as well matched as we would like, which could mean:
In not well-matched years, the overall risk of getting the flu drops to 2 people out of 100. The flu vaccine cuts that number in half, for a 50% risk reduction. If you do the math, one person out of 100 benefits from the flu shot, making the NNT in not well-matched years 100.
What’s the NNT of homeopathy? Or of the various bogus Ebola “biodefense” preventatives promoted by Adams and his ilk? Infinity and beyond?
As for the the bit about “toxic heavy metals,” that’s pure hilarity, as I described several months ago. Basically, it’s a case of a scientific ignoramus going wild with an expensive piece of equipment that he has no clue what he’s doing with.
Next up is a prolonged rant about the bad things big pharma has been caught doing. That’s all very well and nice, but, even if each and every depredation of big pharma described happened exactly and absolutely the way Adams describes, it wouldn’t have anything to do with the lack of scientific support for Dr. Oz’s recommendations, nor would it “prove” that the recent criticism of Dr. Oz is all a big pharma plot to discredit him. Actually, Dr. Oz does a fine job of discrediting himself, which is perhaps why Adams trotted out the old trope that hospitals and medicine are supposedly the number one cause of death.
Even more hilariously, Adams can’t resist bringing up the whole “CDC whistleblower” affair, as though that demonstrated anything. As I pointed out before, all it showed was that Andrew Wakefield was wrong about the MMR vaccine being associated with autistic enterocolitis, thanks to an utterly incompetent analysis by a man named Brian Hooker (since retracted) and the utter betrayal of a rather credulous, high strung CDC psychologist. It’s a story that has quite properly faded into the oblivion that it so richly deserved, having failed to get anyone other than antivaccine reporters like Sharyl Attkisson the least bit interested.
Adams concludes:
It is people like Dr. Oz who offer advice that can help people eliminate their need for dangerous medications and even prevent disease so they never need the meds in the first place.
Without a doubt, Dr. Oz is saving lives. Big Pharma is destroying lives, and the pro-pharma publications are co-conspirators in the shameless exploitation of human life for profit. Dr. Oz is a great American hero. He’s a beacon of truth standing out like a lighthouse above a sea of lies and deception spewed out by a pharma-funded media that has no qualms about promoting an industry that preys upon human suffering and sickness. We should all support Dr. Oz in his effort to teach people food wisdom, nutritional therapies, self-care and how to make healthy decisions that prevent disease and eliminate dependence on the corrupt medical cartels.
You know, I wonder if there’s a conflict of interest here. Adams has his lips so far up Dr. Oz’s posterior, that he’s tickling Oz’s tonsils. No doubt Adams wants to be a guest on Oz’s show again.
from ScienceBlogs http://ift.tt/1roxuJl
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