[ed. note: We feature the writings of Doc Gumshoe, our favorite medical writer, every few weeks here at Stock Gumshoe. He is not a doctor, but we value his insight, research, contrariness and skepticism … and, most importantly, his ability to explain complex health issues for our readers. He generates a lot of discussion with his pieces, so today he decided to share some longer responses to a few of the questions and comments that have come up in recent weeks. As always, his words and opinions are his own and we continue to welcome feedback on Doc Gumshoe’s commentaries or on any of our other work.]
Where do I get off expressing my views on current medical knowledge? No, as I’ve said numerous times, I am not an MD, nor yet do I have any academic medical credentials. I have been a medical writer for 30 plus years, and the treatment areas I have done the most work in are: cardiovascular disease, autoimmune diseases (including rheumatoid arthritis, psoriasis and psoriatic arthritis, lupus, etc), diabetes, neurologic disorders (including epilepsy, Parkinson’s disease, and migraine), behavioral disorders, and infectious diseases. I have written or co-authored papers in peer-reviewed professional medical journals, and written entire journal supplements. I have developed many continuing medical education (CME) programs, both for physicians who need CME hours and for other health professionals, such as physician assistants (PAs) and nurse practitioners (NPs). I have created material for many advisory board meetings sponsored by pharmaceutical companies.
I wouldn’t dream of giving specific treatment advice to a patient, other than the advice to consult a competent physician. At the same time, I have confidence in my capacity to read and understand the professional medical literature. I bet I read more journal papers during the course of a year than most physicians. And, by nature I am curious, skeptical (but not cynical!) and, mostly, optimistic. My response to stuff I don’t immediately understand is, think harder!
Resveratrol versus (Moderate!) Alcohol Consumption
Lots of people had comments about this. Some made the point that resveratrol’s potential benefits should not be dismissed; others made the point that the harms of alcohol, especially for women, should not be underestimated. Okay, let it be known that I yield both points!
My main point in that piece was that the benefits of wine drinking – as in the so-called “French Paradox” – could not be attributed to resveratrol. There are two big boulders over which the resveratrol hypothesis stumbles. The first is that, although resveratrol demonstrated benefit in studies in mice, the doses of resveratrol that were used in these studies would translate to immense amounts of wine in humans – somewhere between 60 and 900 liters per day. And the second boulder is that resveratrol has not demonstrated similar benefits in humans – at least, not so far.
On the other hand, the benefits of moderate alcohol consumption have been demonstrated again and again. And these benefits are not limited to red wine. And, on top of that, the actual mechanisms through which alcohol confers these benefits are pretty well known and understood. Of course, the harms of alcohol are also well known, and should not be blithely ignored. Note – the benefits, as well as the harms, are dose-related, and the dose at which alcohol starts doing more harm than good is probably lower for women than for men, because it’s largely based on body size.
As an optimist, I continue to hope that there will be evidence – the emphasis is on the word “evidence” – that resveratrol itself does indeed have some health benefits as a supplement.
To the readers who wanted more about those resveratrol studies, here are the citations:
- Gliemann L, Schmidt JF, Olesen J, Biensø RS, Peronard SL, Grandjean SU, Mortensen SP, Nyberg M, Bangsbo J, Pilegaard H, Hellsten Y. Resveratrol Blunts the Positive Effects of Exercise Training on Cardiovascular Health in Aged Men. J Physiol. 2013 Jul 22. [Epub ahead of print]
- Poulsen MM, Vestergaard PF, Clasen BF, Radko Y, Christensen LP, Stødkilde-Jørgensen H, Møller N, Jessen N, Pedersen SB, Jørgensen JO. High-dose resveratrol supplementation in obese men: an investigator-initiated, randomized, placebo-controlled clinical trial of substrate metabolism, insulin sensitivity, and body composition. Diabetes. 2013 Apr;62(4):1186-95. doi: 10.2337/db12-0975. Epub 2012 Nov 28.
- Yoshino J, Conte C, Fontana L, Mittendorfer B, Imai S, Schechtman KB, Gu C, Kunz I, Rossi Fanelli F, Patterson BW, Klein S. Resveratrol supplementation does not improve metabolic function in nonobese women with normal glucose tolerance. Cell Metab. 2012 Nov 7;16(5):658-64. doi: 10.1016/j.cmet.2012.09.015. Epub 2012 Oct 25.
A Short Word About the Health Benefits of Natural Stuff
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I am not a denier of the potential benefits of natural supplements. But I am a skeptic, and here’s why:
- When we learn, through experience, that a certain natural food seems to bring health benefits, we aren’t always sure what particular molecule in that natural food confers the benefit. It can take a long time, and a lot of painstaking research, to pin down the specific health-giving component. In the meantime, we might be better off eating or drinking the food in its natural state.
- Supplements vary all over the map with regard to the concentration of the key ingredient. It’s very hard to know what you’re getting, and how much of it.
- Unlike drugs, supplements don’t need to be tested for such important questions as how they’re metabolized, how long they remain in the body, or what concentrations they need to attain to produce any particular effect.
Testimonials about supplements abound. And I have no doubt that the people behind those testimonials are by and large honest. But the fact that Peter testifies that a certain plant extract “cured” his sciatica might only mean that he took the plant extract and after that his sciatica went away. And it doesn’t mean that it would work for Paul.
What I want is evidence, and the best evidence we have is a randomized, blinded, placebo-controlled trial. That means that neither Peter nor Paul know which treatment they’re getting, and neither do the folks administering the treatment. If at the conclusion of this trial, the Peter-cohort does “significantly” better than the Paul-cohort, then I begin to believe that there might be something to the treatment, pending further evidence.
A Bit More About Prostate Cancer
Some readers questioned why I should object to the National Cancer Institute’s proposal to rename some cancers with another label in order to avoid scaring people into seeking, or demanding, treatment which in many cases might prove to be unnecessary. My vehement objections are NOT based on indifference to the realities of unnecessary treatment. However, I continue to be skeptical about the possibility of identifying which patients need treatment and which ones do not.
My objections are based on the sheer dishonesty of the proposal. What they’re saying is, “We’ll call it something else so they won’t get scared and demand treatment, and, as we know, a considerable proportion of those patients won’t need treatment, so we’ll save them the pain and suffering, and in the meantime, we’ll save billions to the health-care system.”
The only problem with that is that at the moment, neither the NCI nor anybody else knows for sure which those patients who “won’t need treatment” are, until they either die from other causes or, bad luck, do turn out to need treatment.
In the meantime, prostate cancer will kill nearly 30,000 men in the US this year!
I shouldn’t get too worked up over this, because I genuinely doubt that competent and honest urologists will fall for this. They’ll tell patients, “You have an indolent lesion of epithelial origin. It’s what we used to call prostate cancer.”
What About Finasteride as a Treatment to Prevent Prostate Cancer?
I’m not ready to discuss this in any depth at this point. Finasteride (Proscar), from Merck (MRK) is commonly used to treat benign prostatic hyperplasia (BPH), whose main symptom is to make urination difficult. It’s been known for some time that men who took finasteride had a somewhat lower incidence of prostate cancer, but there was one big problem with prescribing it to prevent prostate cancer. The problem was that men taking finasteride for BPH apparently had a higher incidence of advanced prostate cancers. A recent study seems to mitigate that danger signal – yes, more advanced prostate cancers were found, but there is no evident difference in mortality rates between the men who take finasteride and those who do not. So this suggests that maybe, yes, finasteride might be potential prostate cancer prophylaxis.
There are reasons – always! – to be skeptical, however. One is that the increased incidence of advanced prostate cancers in men who take finasteride may be due to the simple fact that when the prostate gland itself diminishes in size – the reversal of the BPH disease process – it may be easier to detect the tumors. So it’s not that the finasteride cohort actually has more advanced tumors than the non-finasterides, but that they might be more readily diagnosed.
As for the lower incidence of the earlier-stage cancers, finasteride tends to lower the PSA score, so that may be due to a difference in diagnostic sensitivity as well. Fewer men have PSA scores that move them to the next diagnostic level, so they just don’t get diagnosed. Whether that’s a bad thing or a good thing, I’m holding off on voting.
Relative Risk versus Absolute Risk
There have been several comments that touched on this. Without going into detail on any of the specific instances where this came up, the general point is that it can be deceptive to focus too much on those percentage numbers that get reported in the medical journals and then amplified in the media. Those increased relative risk numbers are certainly arithmetically correct. Yes, the difference in relative heart attack risk between women who took HRT and those who did not was 23%, but that only amounted to an additional 7 cases per 10,000 patient years – not much real increase in absolute risk. If my risk of being struck by a meteorite is one in ten million, and it doubles to two in ten million during the Perseids (I have no idea if this is true!), it’s still a tiny risk and not worth staying indoors to avoid, but it’s still a 100% increase in relative risk. On the other hand, if my risk of developing diabetes is about 7% (that’s the prevalence among adults in my state of Connecticut), anything that would double that risk to 14% would be a huge increase in terms of absolute risk, and it would definitely be worth doing whatever I could to avoid that increase. It wouldn’t be the 100% increase in relative risk that would trouble me, but the 7% increase in absolute risk.
Many readers pop questions about supplements, and mostly I don’t know much about them, but I welcome the chance to cram more bits of information into my hippocampus. Astaxanthin, it turns out, is a carotenoid found in algae, and it provides the reddish coloration in lots of seafoods – salmon, shrimp, and many others. Like other carotenoids, it is an antioxidant, and it has been studied as a potential antagonist to a number of diseases including cancers and heart disease. There are over a thousand published preclinical studies in astaxanthin, mostly laboratory studies, but some in small animals (fruit flies, mice, hamsters), and some studies that relate to use in humans, such as in human aqueous humour (the stuff inside your eyeballs) and human sperm. So far, no studies in living human beings.
My views on astaxanthin would be much the same as on many other supplements: we might be better off eating the salmon itself, in which case we would also get the benefit of those omega-3 fatty acids.
And Yet More Miracle Cures!
A reader tipped Doc Gumshoe to another highly enticing (or entrapping, depends on how you look at it) inducement to learn about secret miracle cures. This one is from the Health Sciences Institute – a more reputable-sounding name would be hard to dream up. They are touting another book, supposedly revealing secrets from three “cultures” whose populations never succumb to the diseases that plague Western civilizations. Naturally, establishment medicine will go to any lengths to prevent us from learning about these secrets, because if we did, we would not need ever again to avail ourselves of their useless treatments and they would go broke. In fact, establishment medicine has even enlisted the U. S. Government in its conspiracy of silence, such that this miraculous book may be banned! Without acquiring this amazing tome, I cannot comment on these secrets, and I don’t even know how much this book costs, because I didn’t listen to the spiel all the way to the end. But the Health Sciences Institute has published another miraculous book, entitled Underground Cures: The Most Urgent Health Secrets (Edition IV) described below:
Agora Health Books has once again partnered with the brilliant minds at the Health Sciences Institute to bring together 31 “underground” cures from the world’s most advanced health clinics and research labs. These breakthrough alternatives and cutting edge solutions have yet to be discovered by the mainstream or even the alternative medical communities. In fact, these treatments for conditions including Alzheimer’s disease, cancer, heart disease, varicose veins, macular degeneration, libido loss, high blood pressure, diabetes, kidney stones, and irritable bowel syndrome may not reach your neighbors for decades, but these potent secrets for living a healthier and happier life are available to you now in Underground Cures.
If anyone is interested, it’s available used from Amazon for $3.74.
Best to all, Michael Jorrin, (aka Doc Gumshoe)