That’s the message from University of Sydney researchers whose recent analysis shows widespread bias – and therefore inaccuracy – in industry-funded research into fake sugars.

The review, published in the latest edition of PLOS ONE  journal, analysed 31 studies into artificial sweeteners between 1978 and 2014. The studies considered both the potentially beneficial effects of artificial sweeteners, such as weight loss, as well as harmful effects like diabetes.

• For more on this topic see our editorial Sugar, sweeteners and science for sale

The statement which drew a line in the sand and which has grown in importance and prominence since that time and has now been published in a scientific journal.

According to the eminent scientists behind it, the joint statement shows that this claimed ‘consensus’ is “an artificial construct that has been falsely perpetuated through diverse fora.”

In other words it’s a lie that has been uncritically parroted, and spread far and wide by a disreputable assortment of biotech companies and lobbyists, professional sceptics and rent-a-quote scientists.

Standing in the way of good science

For decades, the safety of GMOs has been a hotly controversial topic that has been much debated around the world. Published results, as they can be in any field of study, are contradictory, and there are several reasons for this including:

• the range of different research methods employed
• the inadequacies of available procedures
• differences in the analysis and interpretation of data

Rigorous assessment of GMO safety has also been hampered by the lack of funding for independent scientists. Research for the public good has been further constrained by property rights issues – biotech companies who own the patents on GM material are unwilling to make these materials available for other to study and when they do these materials often come with unacceptable terms such as requiring researchers to sign contractual agreements which give the biotech companies control over publication of the results. Because of this reputable independent scientists can find studying GMOs difficult if not impossible.

These are amongst the issues tackled in the recent Letter from America initiative which showed what will happen to the UK if it continues to embrace GMOs the way the US has. We urge all of our US followers to sign it!

No agreement on what ‘safe’ means

There is likewise no international agreement on what constitutes a ‘safe’ GMO which is why policymakers from over 160 countries – in line with the UN’s Cartagena Biosafety Protocol and the Guidelines of the Codex Alimentarius – have agreed that the most rational way to proceed is to look at the authorisation of GMOs on case-by-case basis to determine whether they meet the national criteria for `safe’.

For more on this see Beyond GM’s article Who says GMOs are safe? (and who says they’re not).

This valuable joint statement neither affirms nor denies the safety of GMOs. Instead it concludes that the scarcity and contradictory nature of the scientific evidence published to date prevents conclusive claims of safety, or of lack of safety, of GMOs.

GMO media-watchers will know that very recently there has been a biotech PR onslaught, the goal of which is to juxtapose the words ‘GMOs’ and ‘safe’ in such a way they the two concepts become ‘normalised’ as being associated with one another.

Nothing could be further from the truth and we must do all we can to challenge this assumption.

Let’s hope it will bring some balance back to the debate.

• Thanks to Beyond GM for this story – read the full version here.

In a new study a team of University of Iowa scientists has  discovered that tomatidine, a compound from green tomatoes, has a potent muscle-building activity and may even help protect against muscle atrophy [sarcopenia].

Muscle atrophy, or wasting, is caused by aging and a variety of illnesses and injuries, including cancer, heart failure, and orthopedic injuries, to name a few. It makes people weak and fatigued, impairs physical activity and quality of life, and predisposes people to falls and fractures.

In the US alone, it affects more than 50 million Americans annually, including 30 million over age 60, and often forces people into nursing homes or rehabilitation facilities.

“Muscle atrophy causes many problems for people, their families, and the health care system in general,” says lead researcher Christopher Adams, MD, PhD, UI associate professor of internal medicine and molecular physiology and biophysics. “However, we lack an effective way to prevent or treat it. Exercise certainly helps, but it’s not enough and not very possible for many people who are ill or injured.”

More muscle, less fat

The research, published in the Journal of Biological Chemistry, found that tomatidine works at a molecular level, generating changes in gene expression that are essentially opposite to the changes that occur in muscle cells when people are affected by muscle atrophy.

Instead of destroying muscle tissue tomatidine actually stimulated growth of cultured muscle cells from humans.

“That result was important because we are looking for something that can help people,” Adams says.

As part of their study they also added tomatidine to the diet of mice. They found that healthy mice supplemented with tomatidine grew bigger muscles, became stronger and could exercise longer. They found that tomatidine prevented and treated muscle atrophy.

Interestingly, while mice fed tomatidine had larger muscles, their overall body weight did not change due to a corresponding loss of fat, suggesting that the compound may also have potential for treating obesity.

A new novel supplement

An attractive aspect of tomatidine is that it is a natural compound derived from tomatoes. It is produced when alpha-tomatine, which is found in tomato plants and in green tomatoes in particular, is digested in the gut.

We still don’t know how many green tomatoes a person would need to eat to get a dose of tomatidine similar that used in this study. The researchers have set their sights on answering that and other questions, but feel that tomatadine has real potential to be a useful natural supplement.

• Follow this link for a great recipe for Green tomato chutney

The new guidelines, issued by the American Academy of Neurology (AAN), are based on a review of the evidence for several CAM therapies.

Multiple sclerosis is a progressive neurological disease characterised by disrupted communication between the brain and the body, resulting in symptoms ranging from blurred vision to muscle weakness and pain.

Most people experience first MS symptoms between the ages of 20 and 40. There is currently no cure, and the conventional therapies available often have serious side effects. Thus there is deep unmet need for additional therapies that help patients deal with distressing symptoms on a day to day basis as well as to treat progressive forms of disease for which there are few treatment options.

The review pointed to four therapies which could fit the bill: oral cannabis extracts, tetrahydrocannabinol (THC), and a cannabinoid mouth spray, it said, could be useful in relieving spasticity and pain; magnetic therapy and Gingko biloba may alleviate fatigue; and reflexology could ease paresthesia.

A comprehensive review

The panel comprehensively reviewed studies investigating a long list of CAM therapies used in MS — everything from cannabinoids, bee venom therapy, and low-fat diet with omega-3 supplements to Ginkgo biloba, magnetic therapy, and reflexology. It’s research findings were published in the journal Neurology.

The therapies were divided into individual categories: cannabinoids, mind-body medicine (for example, biofeedback, hypnosis), biologically based practices (glucosamine, linoleic acid), manipulative and body-based practices (yoga, massage therapy), and energy medicine (naturopathic practices).

The search uncovered 9 good quality studies investigating cannabis therapies, which suggested different benefits for use and benefits.

In patients with relapsing-remitting (RR), secondary progressive (SP), and primary progressive (PP) types of MS, the panel concluded that oral cannabis extracts was effective for reducing both patient-reported spasticity symptoms and pain unrelated to central neuropathic pain.

It also found that THC could probably be effective for reducing patient-reported symptoms of spasticity and non-neuropathic pain (level B). The benefit for both may continue for 1 year.

On the whole, cannabinoids were well tolerated. Mild or moderate adverse effects were reported by 50% to 80% of study participants in both treatment and placebo groups. Central nervous system adverse effects, such as dizziness, drowsiness, and difficulty concentrating, were more common in participants taking cannabinoids. Dizziness was the most common such adverse effect, affecting 15% to 50% of participants.

There is not enough evidence, say the researchers, that smoking cannabis would produce the same benefits.

CAM use is high

The number of patients with MS using 1 or more CAM therapies is “huge, easily up to 80%,” said lead researchers Dr. Vijayshree Yadav of Oregon Health & Science University in Portland, though this study did not find they were all effective.

Among the other CAM therapies that were, Ginkgo biloba was found to be possibly effective over 4 weeks in reducing fatigue in patients with RR, SP, and PP forms of MS. However, it did not appear effective for improving cognitive function. The researchers noted that quality of gingko products may be a factor in the effectiveness of this therapy.

 The reviewers evaluated 4 studies of reflexology, which involves applying manual pressure to specific points on the feet. They concluded that reflexology was likely to be effective for reducing MS-associated paresthesias over 11 weeks but that data are inadequate to assess its use for pain, quality of life, disability, spasticity, fatigue, cognition, bowel or bladder function, depression, anxiety, or insomnia in MS.

Magnetic therapy could be effective for fatigue but not for depression, the panel concluded.

Given the controversial nature of the findings – particularly with respect to cannabis – the researchers presented their findings in a highly qualified way. They noted that the cannabis oral extract and spray reviewed aren’t currently available in the US, and that overall evidence for CAM is somewhat sparse.

Currently only THC – dronabinol (Marinol, AbbVie) – is approved only for chemotherapy-related nausea and vomiting in patients with cancer, and for boosting appetite in HIV-infected patients.

Yadaz also claims of the pain relief experienced by patients that was “only subjective changes as reported by patients” though it’s worth asking why patients’ perception of their own levels of pain and relief is being dismissed so lightly.

Still unknowns

The Cari Loder regimen (the lofepramine tricyclic antidepressant plus phenylalanine and vitamin B12), bee venom, and low-fat diet with omega-3 supplements, were not found to be effective.

As for the other CAM therapies the panel investigated, there was no evidence that they were effective, either, said Dr. Yadav. But he stressed that at the present time many therapies are poorly researchers, or not researched at all, which does not mean they’re not effective; it’s just that evidence is not there about their efficacy.

However new evidence from Canadian researchers, published in the journal Neuron,  has found that this nutrient is essential for normal brain development. Its benefits are specific to the brain and do not appear to be necessary for other organs.

“The cells of the body can do without it because they use asparagine provided through diet. Asparagine, however, is not well transported to the brain via the blood-brain barrier,” said senior co-author of the study Dr. Jacques Michaud, who found that brain cells depend on the local synthesis of asparagine to function properly.

Spurred on by tragedy

The discovery of the essential nature of asparagine arose out of tragedy. In April 2009, a Quebec family lost one of their sons to a rare genetic disease causing congenital microcephaly, intellectual disability, cerebral atrophy, and refractory seizures. The event was even more tragic because this child was the third infant in this family to die from the same disease.

This tragedy led Dr. Michaud and his team to study the genetic abnormality responsible for this developmental disorder.

The team identified the gene affected by the mutation code for asparagine synthetase, the enzyme responsible for synthesizing the amino acid asparagine. Their work was the first to associate a specific genetic variant with a deficiency of this enzyme.

“In healthy subjects, it seems that the level of asparagine synthetase in the brain is sufficient to supply neurons,” Michaud said. “In individuals with the disability, the enzyme is not produced in sufficient quantity, and the resulting asparagine depletion affects the proliferation and survival of cells during brain development.”

A potential treatment

Children who are carriers of this mutation suffer, to varying degrees, from a variety of symptoms, including intellectual disability and cerebral atrophy, which can lead to death.

Knowledge about gene mutations can be used to develop treatments. “Our results not only open the door to a better understanding of the disease,” Michaud said, “but they also give us valuable information about the molecular mechanisms involved in brain development, which is important for the development of new treatments.”

For example, asparagine supplement could be given to at risk infants to ensure an adequate level of asparagine in the brain and the latter’s normal development. “The amount of supplementation remains to be determined, as well as its effectiveness,” says Michaud.

He adds that since these children are already born with neurological abnormalities, it is still uncertain whether this supplementation would correct the neurological deficits.

Nevertheless the discovery shows we still have much to learn about the complex and subtle interplay of nutrients in maintaining health and driving normal development.

Natural sources

Given a good diet the body can generally make its own asparagine. However, it is also found in both animal and plant foods such as:

• Animal sources Dairy, whey, beef, poultry, eggs and  seafood
• Plant sources Asparagus, potatoes, legumes, nuts, seeds, soya and whole grains

Not everything about asparagine is good however. A reaction between asparagine and certain sugars or reactive molecules produces carcinogenic acrylamide  in food when heated at high temperatures.

Acrylamide is not present in the raw foods and is not formed during steaming or boiling or (with some exceptions) microwaving. It is formed when foods are fried, roasted or baked at high temperatures.

Potato and cereal food products tend to have the highest amounts of acrylamide; meat products are lower in this substance because they have lower levels of the elements necessary for its formation. Thus acrylamide is most commonly found in things like French fries, potato chips, and crusty or toasted bread.

So how do you know if a test, treatment of procedure is appropriate and helpful? An interesting new initiative in the US called Choosing Wisely aims to promote conversations between physicians and patients by helping patients choose care that is:

• Supported by evidence
• Not duplicative of other tests or procedures already received
• Free from harm
• Truly necessary

The initiative challenged 17 national organisations representing different medical specialities to identify five tests or procedures commonly used in their field, whose necessity should be questioned.

The resulting lists of Five Things Physicians and Patients Should Question, which are available to download, are fascinating and applicable to medical practice throughout the world. They should spark discussion about the need – or lack thereof – for many frequently ordered tests or treatments.

Included amongst the lists are:

• Taking antibiotics for sinus infections. Most are caused by viruses, which aren’t affected by antibiotics.
• Induced labour or caesarean section.  Unless there’s a proven medical necessity, babies should go to full term and be delivered naturally, since those delivered before 39 weeks can have lung problems, learning disabilities, and other problems.
• Stress tests if you have no symptoms of heart disease. Asymptomatic, low-risk patients account for up to 45% of unnecessary screening.
• Routine annual Pap test if you’re under age 21 or over age. Once every three years is fine unless you’ve had an abnormal test result.
• DEXA (dual-energy X-ray absorptiometry) screening for osteoporosis in women under 65 or men under 70. Unnecessary unless there are signs of bone loss.
• CT scans for children with minor head injuries: Commonly used, but unnecessary.
• EEG (electroencephalography) for patients with recurrent headaches. It has no advantage over clinical evaluation in diagnosing headache, does not improve outcomes and increases cost.
• Imaging for lower back pain. Unnecessary unless the pain has lasted more than six weeks or special circumstances like neurological deficits are involved.
• Antibiotics for pinkeye (conjunctivitis). This is usually a viral disease, so won’t respond to antibiotic treatment.
• PET or CT scans to screen for cancer in healthy people. There is little chance such tests will detect anything.

Consumer friendly information sheets are currently being developed from this early data. In the meantime more than 35 speciality societies have now joined the campaign, and these first 17 lists complete with references and rationales for the choices made,  represent the beginning of an important conversation about evidence based medicine.

However, according to a recent review, doctors are not entirely at fault. Prominent medical societies have failed to lay out comprehensive guidelines for physicians on when and how to disclose a conflict of interest when utilizing social media.

In a commentary published online in the Journal of General Internal Medicine, Dr Matthew DeCamp, at Johns Hopkins University School of Medicine’s Division of General Internal Medicine, argues that some physicians use social media to give advice to patients and the public without revealing drug industry ties or other information that may bias their opinions.

Consumers in the dark

Without serious efforts to divulge such information – standard practice when publishing in medical journals and recommended in one-on-one contacts with patients – DeCamp says consumers are left in the dark.

“As physicians and patients increasingly interact online, the standards of appropriate behaviour become really unclear,” says DeCamp, who also holds a fellowship at the Johns Hopkins Berman Institute of Bioethics. “In light of norms of disclosure accepted throughout medicine, it’s surprising that major medical guidelines fail to adequately address this issue.”

Among the national organizations that have issued social media guidelines are the American Medical Association and the Federation of State Medical Boards.

The need for boundaries

DeCamp acknowledges that use of social media has the potential to improve patient care and trust by increasing patient access to information, but vigorous online “boundaries” are needed to not only assure privacy and confidentiality, but also to protect patients from misinformation and biased advice.

In an office setting, for example, when doctors prescribe a blood pressure medication, professional guidelines say they are ethically bound to tell patients if they have any financial relationship – such as receipt of consulting fees – with the company that manufactures the drug.

Guidelines also call for disclosure when they publish studies about blood pressure medication, and medical journals require them to fill out a detailed disclosure form. But online, it’s  clearly an unacceptably grey area.

How much can you say in 140 characters?

One reason may be difficulty in determining just how to disclose within the constraints of the online world, DeCamp notes. The popular social media tool Twitter, for example, allows each entry to be just 140 characters long. But a generic disclosure  such as “The author has no conflict of interest to report related to this tweet” is 70 characters – leaving little room to discuss the actual research.

DeCamp says one solution is the use of electronic tags that disclose conflicts of interest and follow the information tweeted – and re-tweeted – by a physician. At the very least, he says, doctors should post potential conflicts in their online profiles, and consumers should be wary of posts and advice from anyone claiming to be a doctor.

A problem on specialist sites too

The problem isn’t just confined to sites used by the public. One social networking website known as Sermo.com is open to physicians only and is designed to facilitate discussions of treatment options.

But DeCamp says the relative anonymity of the site means users don’t know about the potential conflicts of peers they encounter there, and whether information is biased because of financial conflicts. Although the site recommends voluntary disclosure, it is not required or monitored, he says.

Healthtap.com is billed as a free virtual “house call” service linking patients with physicians who quickly provide online answers to patients’ questions. Although physicians are identified by name, and the site terms require physicians to disclose, studies suggest physicians sometimes fail to disclose in the online realm. Patients again might be unable to tell whether conflicts have biased the answer.

Wanted: transparency

The absence of stricter guidelines for online doctor-patient interactions is especially puzzling given the move to ever-stricter disclosure requirements offline. There has been a movement from simple disclosure to better efforts to manage and eliminate conflicts.

While some professional guidelines do recommend disclosure in social media, DeCamp says, they don’t lay out how it should be done, while many ignore the topic altogether.

“The history of conflict of interest in medicine is such that you don’t want to be late to the table You need to be proactive so that your undisclosed conflict doesn’t end up on the front page of The New York Times. Conflicts need to be disclosed and it’s surprising that we have so far to go regarding disclosure and management on social media.”

Two US researchers have offered a new perspective on a component of the immune system known as the ‘acute-phase response’, a series of systemic changes in metabolic function, physiology and blood protein levels that sometimes occurs when infection takes hold.

This normal response to invasion by bacteria, viruses or other pathogens, puts healthy cells and tissue under serious stress, and is actually the cause of many of the symptoms we associate with being sick.

A healing crisis

Practitioners of alternative medicine sometimes call this experience a ‘healing crisis’.

The question is why would the body evolve to produce symptoms of sickness when it is actively involved in healing?

The authors of this new analysis believe the answer becomes clear when we view the acute-phase response and its symptoms in terms of what they have dubbed “immune brinksmanship.”

Immune brinksmanship according says co-author Edmund LeGrand of the University of Tennessee, Knoxville, is a gamble the body takes that its immune responses will harm the invading pathogen morethan itself.

A biological ‘trade dispute’

The concept, he explains, is akin to what happens in international trade disputes. When one country places trade sanctions on another, both countries’ economies take a hit, but the sanctioning country is betting that its opponent will be hurt more.

“One of our contributions here is to pull together the reasons why pathogens suffer more from systemic stress,” LeGrand says.

The acute-phase response creates stress in several ways. It raises body temperature and causes loss of appetite and mild anaemia. At the same time, certain vital nutrients like iron, zinc, and manganese are partially sequestered away from the bloodstream.

Some of these components are quite puzzling. For example, why reduce food intake just when one would expect more energy would be needed to mount a strong immune response?

Likewise, zinc is essential for healthy immune function. Why pull it out of the bloodstream when the immune system is active?

The benefits of a stressor-like fever are fairly well known; heat has been shown to inhibit bacterial growth and cause infected cells to self-destruct. But what hasn’t been clear is why pathogens should be more susceptible to this stress than the host.

LeGrand and and co-author Joe Alcock (University of New Mexico) offer some answers.

The body has the upper hand

For an infection to spread, pathogens need to multiply, whereas host cells can defer replication. Replication makes DNA and newly forming proteins much more susceptible to damage. It also requires energy and nutrients – which helps explain the benefits of restricting food and sequestering nutrients.

The act of invading a body also requires bacteria to alter their metabolism, which can make them more vulnerable to all kinds of stress, including heat.

Another reason pathogens are more vulnerable to stress is that the immune system is already pummelling them with white blood cells and related stressors at the site of the infection.

That means that pathogens are already under local stress when systemic stressors are piled on. “In many ways, the acute-phase response reinforces the stress inflicted on pathogens locally at the infection site,” LeGrand says.

An intelligent risk

As the term “brinksmanship” implies, there’s an inherent risk in a  strategy that involves harming oneself to hurt the enemy within.

This self-harm leaves the body more vulnerable to other dangers, including other infections. Additionally, it is possible for the immune stressors to do more damage than required to control the pathogens.

But in general, say the authors, systemic stressors when properly regulated do more preferential harm to invaders, which may be why not only humans, but other mammals, reptiles, fish, and even invertebrates experience a similar response to healing.

The article appears in the Quarterly Review of Biology.

The paper appears in the prestigious Journal of the American Medical Association (JAMA) and discusses the potential harms of screening tests and reviewed the attitudes about these harms, which has shifted within medicine in recent years.

These include iatrogenic, or medically induced complications (for example perforation from colonoscopy), anxiety over abnormal results, and a cascade of follow-up tests and treatments. Screening can also precipitate over-diagnosis and therefore unnecessary drug and surgical treatments.

“People assume that getting screened for a disease is a ‘no-brainer,’” said co-author Steven H. Woolf, MD, MPH, professor in the Virginia Commonwealth University Department of Family Medicine and director of the VCU Center on Human Needs.

“There is presumably much to gain and little to lose by detecting diseases early. A common perception is that anyone objecting to screening must be worrying about costs, but most guidelines that set limits on screening are concerned about potential harms,” he said.

Not always good for your health

According to Woolf, the article draws attention to the “stark reality that screening tests are not always good for public health,” as well as discussing the increasing concerns being raised by the American Cancer Society and other professional organizations about screening tests.

“Being more mindful of limitations and downsides will make patients more informed consumers,” Woolf said. “They may still choose to be screened, but being armed with the full story will prepare them should they experience complications or later discover that the disease went undetected even with screening.”

Even breast cancer screening can cause harm

The JAMA study comes at the same time as the publication of a new book ‘Mammography Screening Truth Lies and Controversy’ by Prof Peter Gøtzsche, director of the Nordic Cochrane Centre, Copenhagen. In his new book Prof Gøtzsche argues that women undergoing breast cancer screening are being “misinformed” and are not told about the risks of over-diagnosis.

In September 2011 Gøtzsche co-authored a paper published in the Journal of the Royal Society of Medicine, (JRSM).

The paper, ‘The Breast Screening Programme and Misinforming the Public’, which looked specifically at breast screening programmes in the UK called for “more honesty” from the NHS. It argued that harm has been “downplayed” and that the information given to women about screening has remained largely unaffected by “repeated criticism and pivotal research” which has questioned its benefits and documented how it can lead to substantial over-diagnosis.

Doctors stuck in the past

The paper noted that many doctors beliefs had not changed in 25 years and that the lack of accurate balanced information means that, “Women therefore cannot make an informed choice whether to participate in screening.”

“The claim that death rates have fallen ‘in part from earlier diagnosis associated with screening’ is astonishingly misleading,” says Gøtzsche.

“Deaths from breast cancer are falling because treatment is improving. There’s been a similar fall in the age-groups not invited to screening.” What is more, he added, “Danish data has demonstrated that because of over-diagnosis, screening increases the use of mastectomies substantially.”

In one article in Perspectives on Psychological Science, a journal published by the Association for Psychological Science, the authors say that 21^st century demands for quantity over quality have radically changed the way researchers ‘do’ science – for the worse.

Focusing on trends in psychological research, the authors, Marco Bertamini of the University of Liverpool and Marcus Munafò of the University of Bristol, have called the trend “bite-size science”– papers based on one or a few studies and small sample sizes and with little or no context or reference to previous work.

They say the demand for quick turnover often means smaller sample sizes. And, in their opinion, the smaller the experimental sample the greater the statistical deviations– that is, the greater the inaccuracy of the findings.

Playing on ignorance

Likewise strict word limits, increasingly imposed by publications,  mean cutting the details about previous research. Because of this the published results can sound not only surprising but novel. The authors note, ironically, that: “A bit of ignorance helps in discovering ‘new’ things.”

These surprising, “novel” results are exactly what editors find exciting and newsworthy and what even the best journals seek to publish, they say. The mainstream media pick up the “hot” stories, and its journalists rarely do the background checks to confirm whether a result is new or not. This is how misconceptions and wrong results about medicine and health proliferate.

“We’re not against concision,” says Bertamini. “But there are real risks in this trend toward shorter papers. The main risk is the increased rates of false alarms that are likely to be associated with papers based on less data.”

In the age of twitter, facebook and dwindling attention spans, proponents argue that shorter science papers are easier to read.

Perhaps, say the authors, but more articles mean more to keep up with, more reviewing and editing – but not less work.

Proponents say authors gain increased recognition and influence from publishing more papers. Perhaps say Bertamini and Munafò, again. But two short papers may not have twice the scientific value of a longer one. Indeed, because of inattention to detail they might add up to less.

“Scientists are skeptics by training,” says Bertamini. But the trend toward bite-size science leaves no time or space for that crucial caution. And that, argue the authors, is antithetical to good science.

Missing data

Elsewhere experts in the British Medical Journal have called for an end to “incomplete data disclosure” and more robust regulation of information in clinical trials. The British Medical Journal website has released several papers investigating the issues of unpublished evidence – that is the data that gets left out of papers published in medical journals – to support their argument.

The editorial written by Dr Richard Lehman, of Oxford University, and clinical epidemiology editor of the BMJ, Dr Elizabeth Loder, notes that:

“Clinical medicine involves making decisions under uncertainty. Clinical research aims to reduce this uncertainty, usually by performing experiments on groups of people who consent to run the risks of such trials in the belief that the resulting knowledge will benefit others.”

However, what Lehman and Loder call a “culture of haphazard publication” – where inconvenient or unresolvable details are left out – means that decisions are not made using the best evidence.

They add: “Most clinicians assume that the complex regulatory systems that govern human research ensure that this knowledge is relevant, reliable and properly disseminated. It generally comes as a shock to clinicians, and certainly to the public, to learn that this is far from the case.”

Unlikely to be beneficial?

Shocking yes, unless you have been paying attention all along. For instance, the BMJ’s Clinical Evidence group, which is engaged in reviewing the clinical effectiveness of medical procedures, shows that 66% of all treatments fall into the categories: ‘Trade off between benefits and harms’, ‘Unlikely to be beneficial’, ‘Likely to be ineffective or harmful’ and of ‘Unknown effectiveness’.

What is interesting about these critiques of so-called evidence-based medicine from a natural health perspective is the exposed hypocrisy. Many opponents of complementary and alternative medicine criticise the research evidence for these therapies as relying on too small a study population, or too short an observation period, or for leaving out crucial data.

The notion of evidence-based medicine is increasingly coming under fire – not because medicine shouldn’t be based on evidence, but because of the nature of the evidence we rely on (for some interesting if technical views see here, and here, and here). The gold standard of  the randomised double-blind  placebo-controlled trial (RCT) misleads in many ways, not the least because its design, which takes large groups of people and looks for what they have in common, furthers the belief that the body is a machine and health is simply a matter of finding a magic bullet that works for all. Very often it the differences – the very inconvenient data that is getting left out of trials – is where the key to understanding health and illness lies.

And the question has to be asked, if the RCT is such an outstanding  medium for understanding health and directing our healthcare choices, how is it that so many of them are either ineffective or downright harmful?

The truth is inaccurate data lets us all – those opt for conventional medicine and those who opt for natural medicine – down. It is particularly galling, however, when well-funded, but shoddy conventional science into pharmaceutical and surgical ‘solutions’ to health is held up as representing an inalienable truth at the expense of a broader understanding of health that recognises the individual needs of patients and focuses on prevention instead of ineffective ‘cures’.