Are Autism Diet Benefits Just a Placebo Effect?

Are Autism Diet Benefits Just a Placebo Effect?
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The original randomized, controlled trials of gluten- and casein-free diets may have been complicated by parental expectation bias.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The first randomized, controlled trial to put a gluten-free, casein-free diet to the test for children with autism reported significant improvements in attention problems, less aloofness, fewer needs for routines and rituals, and improved response to learning after a year on the diet—whereas, there was no significant difference reported before or after in the control group.

Same with improvements in social and emotional factors; significantly fewer problems with relationships with their peers, less anxiety, more empathy, and more acceptance of physical contact—but again, no significant changes reported in the control group.

Significantly fewer communication problems too; more facial expression, better eye contact, responsiveness, and fewer things like meaningless word repetition in the diet group—whereas, no significant changes in the control group.

And, in terms of cognitive factors and movement, after a year on the diet, there was significant improvement in the ability to judge dangerous situations, expanded personal interests, and lower likelihood of being inordinately restless or passive.

Now, the problem with this study is that they relied mostly on parental report. They asked parents questions like these, before and after the year-long trial, to see if they detected any differences.

Why is that a problem? I mean, who better knows the day-to-day functioning of children than their parents? Yeah, they could have had some impartial observer come in before and after to make assessments, blind to which group the children were in, but those would just be like snapshots in time. Who better than the parents to know what was going on with their children?

The problem is the placebo effect. I mean, here the parents are investing “a great deal of time and effort” to maintain these strict diets. I mean, there’s wheat and dairy in so many products that it’s a big shift for most families—and so, they have this hopeful expectation of an effect. So, while the families in the control group did nothing special that year, and reported no significant changes before and after, the families in the diet group put all this work in, and so, when asked if their kids appeared better, their opinions may have been “impacted” by their expectations of benefit. In other words, “placebo effects may have been at play.”

Oh, come on, though; are parents that gullible? Well, “the power of suggestion on the part of parents can be very strong in situations affecting their children’s behavior.” For example, there was this famous study in which all the children were given “a drink with artificial sweetener,” but half of the parents were told that the drink was sweetened with a boatload of sugar. And, “[t]he parents who thought their children had received the sugar-drink rated their [own] children’s behavior as significantly worse…”

So, in these autism studies, “[it’s] possible that parents [were unconsciously] looking for positive changes in behavior and ignor[ing] or explain[ing] away negative [changes].” So, ideally, what we need are double-blind studies—where kids are given foods made to look and taste the same, but one food has gluten and casein, and the other doesn’t. The kids don’t know which is which; the parents don’t know which is which. Even the researchers, at first, don’t know which is which—until they break the code at the end. “In this way, the behaviors recorded after the [food] challenges could not be impacted by preconceived ideas or biases.”

Okay. So, why didn’t this study do that? “With regard to design”, the researchers conceded, “it might be argued that a double blind…study might have been ideal. With all children on [the] diet, gluten and casein could have been [secretly] administered, for example, in capsules [with wheat flour or powdered milk] during specific altering periods. Then, “[p]arents and caretakers would…have been blind to who was [still] on [the] diet and who” was, unbeknownst to them, actually off the diet, secretly getting gluten and casein. Then, we could eliminate the placebo effect, eliminate that expectation bias. So, why didn’t they do it?

The researchers refused to do it because they were so convinced that gluten and casein were harmful, that from an “ethical” viewpoint, they just couldn’t bring themselves to give these kids gluten or casein. The kids in the diet group seemed to be doing so much better, and they had seen cases in which kids appeared to relapse when those proteins were reintroduced back into their diet. And so, they just couldn’t bring themselves to slip them any on the sly.

I understand that, but if they were really so certain that gluten and casein were bad, then by designing a less-than-ideal study, they were potentially dooming scores of other children by failing to provide the strongest possible evidence. Thankfully, four years later, other researchers stepped in and published the first double-blind clinical trial of diet and autism. We’ll find out what they found, next.

Please consider volunteering to help out on the site.

Image credit: Providence Doucet. Image has been modified.

Motion graphics by Avocado Video

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The first randomized, controlled trial to put a gluten-free, casein-free diet to the test for children with autism reported significant improvements in attention problems, less aloofness, fewer needs for routines and rituals, and improved response to learning after a year on the diet—whereas, there was no significant difference reported before or after in the control group.

Same with improvements in social and emotional factors; significantly fewer problems with relationships with their peers, less anxiety, more empathy, and more acceptance of physical contact—but again, no significant changes reported in the control group.

Significantly fewer communication problems too; more facial expression, better eye contact, responsiveness, and fewer things like meaningless word repetition in the diet group—whereas, no significant changes in the control group.

And, in terms of cognitive factors and movement, after a year on the diet, there was significant improvement in the ability to judge dangerous situations, expanded personal interests, and lower likelihood of being inordinately restless or passive.

Now, the problem with this study is that they relied mostly on parental report. They asked parents questions like these, before and after the year-long trial, to see if they detected any differences.

Why is that a problem? I mean, who better knows the day-to-day functioning of children than their parents? Yeah, they could have had some impartial observer come in before and after to make assessments, blind to which group the children were in, but those would just be like snapshots in time. Who better than the parents to know what was going on with their children?

The problem is the placebo effect. I mean, here the parents are investing “a great deal of time and effort” to maintain these strict diets. I mean, there’s wheat and dairy in so many products that it’s a big shift for most families—and so, they have this hopeful expectation of an effect. So, while the families in the control group did nothing special that year, and reported no significant changes before and after, the families in the diet group put all this work in, and so, when asked if their kids appeared better, their opinions may have been “impacted” by their expectations of benefit. In other words, “placebo effects may have been at play.”

Oh, come on, though; are parents that gullible? Well, “the power of suggestion on the part of parents can be very strong in situations affecting their children’s behavior.” For example, there was this famous study in which all the children were given “a drink with artificial sweetener,” but half of the parents were told that the drink was sweetened with a boatload of sugar. And, “[t]he parents who thought their children had received the sugar-drink rated their [own] children’s behavior as significantly worse…”

So, in these autism studies, “[it’s] possible that parents [were unconsciously] looking for positive changes in behavior and ignor[ing] or explain[ing] away negative [changes].” So, ideally, what we need are double-blind studies—where kids are given foods made to look and taste the same, but one food has gluten and casein, and the other doesn’t. The kids don’t know which is which; the parents don’t know which is which. Even the researchers, at first, don’t know which is which—until they break the code at the end. “In this way, the behaviors recorded after the [food] challenges could not be impacted by preconceived ideas or biases.”

Okay. So, why didn’t this study do that? “With regard to design”, the researchers conceded, “it might be argued that a double blind…study might have been ideal. With all children on [the] diet, gluten and casein could have been [secretly] administered, for example, in capsules [with wheat flour or powdered milk] during specific altering periods. Then, “[p]arents and caretakers would…have been blind to who was [still] on [the] diet and who” was, unbeknownst to them, actually off the diet, secretly getting gluten and casein. Then, we could eliminate the placebo effect, eliminate that expectation bias. So, why didn’t they do it?

The researchers refused to do it because they were so convinced that gluten and casein were harmful, that from an “ethical” viewpoint, they just couldn’t bring themselves to give these kids gluten or casein. The kids in the diet group seemed to be doing so much better, and they had seen cases in which kids appeared to relapse when those proteins were reintroduced back into their diet. And so, they just couldn’t bring themselves to slip them any on the sly.

I understand that, but if they were really so certain that gluten and casein were bad, then by designing a less-than-ideal study, they were potentially dooming scores of other children by failing to provide the strongest possible evidence. Thankfully, four years later, other researchers stepped in and published the first double-blind clinical trial of diet and autism. We’ll find out what they found, next.

Please consider volunteering to help out on the site.

Image credit: Providence Doucet. Image has been modified.

Motion graphics by Avocado Video

Doctor's Note

This is the fourth video in a six-part series on the role of gluten- and dairy-free diets in the treatment of autism. Here are the first three:

Stay tuned for:

And in 2018 I added a few more: 

For videos about gluten-free diets in general, see Is Gluten Sensitivity Real? and How to Diagnose Gluten Intolerance.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

44 responses to “Are Autism Diet Benefits Just a Placebo Effect?

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  1. Seems like a balanced approach video.

    But if I were the parent of an autistic child, I wouldn’t wait for the results of the double blind study. After all, there appears to be no dounside to feeding the gluten free, casein free diet.




    12
      1. That said, we do of course see stories like this

        http://www.dailymail.co.uk/health/article-149500/Autism-diet-cured-son.html

        Perhaps, a six-month experiment might be worthwhile,

        However, unless there is clear evidence of benefit I would think that long term adherence to a gluten free diet might in a worst case scenario even constitute self-harm.
        https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2017-05-04-low-gluten-diet-linked-to-heart-attack-risk/




        2
    1. There are quite a few serious downsides to feeding the child a GFCF diet. For one, it is very expensive (in many parts of the world). And it can create serious problems in the child’s overall feeding and nutrition (even to the point of creating deficiencies) especially if you consider some autistic children are super fussy eaters.

      As a parent of an autistic child, you might want to put it on the diet to feel good about yourself. Is that a reason good enough, if you consider that the child will probably unmask its ineffectiveness? This is the reason we absolutely need objective data.




      2
      1. YIKES! Are you saying the CDC has reports of death from a gluten free, casein free diet for autistic children? If so, by all means err on the side of caution.

        If not, then I say try any and everything that could help such a child.




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    2. The expense, time, effort, stress that come with it may be enough of a deterrence for some, simply knowing an objective truth is usually good enough for the rest.




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  2. What an epic ethical failure, good that there are better researchers out there. Sometimes you see the same wimpiness in research about fasting, where they give “small meals” out of pitty for those poor people and in the process destroying the value of their own study.




    2
  3. Now that they cannot prove that a diet free of casein and gluten can improve autism conditions then they blame it on the inability to conduct double blind test because it is “unethical” to feed kids with “poison”. Poison? Alright, billions of kids with autism are already eaten foods with gluten or dairy, and the worse thing is that their autism conditions get worse, but it is not fatal to the point of calling them poison. So is this a case that when something cannot be proven then just call it that the trial cannot be conducted due to ethical reason, and poof it’s accepted as a fact?




    3
  4. “. . . Just a Placebo Effect”?

    “Just”?

    While I realize that it seems vitally important to separate objective from subjective effects, with regard to evaluating the helpfulness or harmfulness of different medical therapies, in practice the still belittled placebo not only has a “statistically significant” effect, but in fact often does far more real good than the medical therapy that purportedly has the “real” effect does. Especially given the plethora of useless or even harmful drugs and medical treatments out there, for which a placebo effect may provide the only saving grace. (With respect to effectiveness of the top ten highest grossing drugs in the U.S. see this Nature article at http://www.nature.com/news/personalized-medicine-time-for-one-person-trials-1.17411 and scroll down to see the Imprecision Medicine Chart.)

    The placebo effects even applies to common surgical procedures, in which “when put to the test” fake surgical procedures work just as well as real surgery at reducing pain and other symptoms. (See for example this 2013 NEJM study for patients suffering from torn knee cartilage, “putting to the test” one of the most common orthopedic operations. ( http://www.nejm.org/doi/full/10.1056/NEJMoa1305189#t=article )

    Experiments in modern physics have repeatedly shown that consciousness plays a fundamental role, even to the extent that some physicists have concluded that the universe seems primarily mental, not physical. And with respect to the body, research has repeatedly confirmed that our minds can, and do, have profound effects on our bodies, that go far beyond the predictions of the prevailing medical model. In some cases, the often belittled placebo
    effect has cured cancer, while in others, the nocebo (negative placebo) effect has lead to illness, and even death. (For more on this, see Dr. Bernard Lown’s – a noted cardiologist and Nobel Prize winner – book The Lost Art of Healing. I especially recommend the two chapters titled “Words that Harm”, and Words that Heal”.)

    So while I understand that double-blind studies seem necessary to separate the wheat from the chaff, in dealing with patients, rather than discounting the placebo effect or even trying to eliminate it, it seems to me that physicians would do far better to look into finding the best ways of most effectively putting it into practice, so as to optimize its effects.




    14
    1. Yes. Just a Placebo Effect. You seem deluded on many levels.

      First, you seem to be concerned about differentiating between subjective and objective effects, but health and disease are inherently very subjective, because its the subject who doesn’t feel well, not eg. his x-ray images. In that sense, caring for subjective improvements is actually good and in fact, since we don’t have an objective definition of health, all health studies use some kind of objective surrogate for it, which isn’t the real thing.

      Second, you misconstrue the Imprecision Medicine Chart – it certainly doesn’t show that the medicines in question work as placebo. They actually show the drugs do work, and NNT 4 or 5 (as shown for some of them) is actually very good. The NNT for statins, on the other hand, is super misleading as it depends crucially on time of the treatment course considered; the longer you take them, the bigger their benefit. NNT is always influenced by factors such as how good our diagnosis is (or how stringent the study entry criteria are) and how “lethal” the condition is more than the actual drug effectiveness, but for statins in particular this is exceptional.

      Third, the study of knee arthroscopy don’t show that “placebo effects even applies to common surgical procedures”, but more accurately, that placebo effects apply to the study of common surgical procedures. Also, it shows common surgical procedures can be ineffective, even if they are in principle very plausible.

      The real problem with placebo effects is that they are, indeed, often non-effects, illusions and lies. Examinations in medicine are rarely black or white, and there’s always a possibility to emphasize the positive in those who you believe should have been helped, and do the converse for the others. Ie. making the patient feel good by placebo effect may be one thing, but faking the effect by the caregiver/doctor is another thing and both comes under the term “placebo effect”.




      2
      1. My response to your points.

        “First, you seem to be concerned about differentiating between subjective and objective effects, but health and disease are inherently very subjective, because its the subject who doesn’t feel well, not eg. his x-ray images. In that sense, caring for subjective improvements is actually good and in fact, since we don’t have an objective definition of health, all health studies use some kind of objective surrogate for it, which isn’t the real thing.”

        Actually I agree with that point. However, although placebos certainly do have subjective effects, they also have objective, by which I mean objectively measurable, effects. People do not just “feel” better, or healthier, their blood chemistries change in ways that support these claims. Placebos do not just reduce (subjective) symptoms but can cause measurable biochemical and physiological changes.

        “Second, you misconstrue the Imprecision Medicine Chart – it certainly doesn’t show that the medicines in question work as placebo.”

        I never said it did. I wrote – “(With respect to effectiveness of the top ten highest grossing drugs in the U.S. see this Nature article at http://www.nature.com/news/personalized-medicine-time-for-one-person-trials-1.17411 and scroll down to see the Imprecision Medicine Chart.” I did not write that the medicines work as placebos (although certainly the placebo effect plays a role in how they work, as they do for any medical therapies in which the patients belief or disbelief plays a part.) I provided the chart, from Nature, which many consider the most reliable and prestigious scientific journal in the world, to illustrate the effectiveness of these drugs, and as I understand it, this chart has already taken into account placebo effects. On this chart the most effective drugs had NNT’s (number needed to treat for one person to benefit) of 4, which means that 3 out of 4 people get no benefit from taking the drug, though they may suffer harm, the odds for that indicated by another number, the NNH, (number needed to harm). And if 1 in 4 seems the best, 1 in 25 seems the worst, with the NNT for all ten averaging out at 1 in 12. Which means that on average that out of 12 people who take these drugs, potentially suffer from the side effects, and adding insult to injury also pay $$$ for them, that only one person benefits. Clearly you have a very different idea as to what constitutes effectiveness than I do.

        You also wrote: Third, the study of knee arthroscopy don’t show that “placebo effects even applies to common surgical procedures”, but more accurately, that placebo effects apply to the study of common surgical procedures. Also, it shows common surgical procedures can be ineffective, even if they are in principle very plausible.”

        You might want to look at Figure 2, that shows that both groups, both operated on and sham operated on, showed significant IMPROVEMENTS on three different measures. To quote: “The mean changes (improvements) in the primary outcome measures were as follows: Lysholm score, 21.7 points in the partial-meniscectomy group as compared with 23.3 points in the sham-surgery group (between-group difference, −1.6 points; 95% confidence interval [CI], −7.2 to 4.0); WOMET score, 24.6 and 27.1 points, respectively (between-group difference, −2.5 points; 95% CI, −9.2 to 4.1); and score for knee pain after exercise, 3.1 and 3.3 points, respectively (between-group difference, −0.1; 95% CI, −0.9 to 0.7). There were no significant differences between groups in the number of patients who required subsequent knee surgery (two in the partial-meniscectomy group and five in the sham-surgery group) or serious adverse events (one and zero, respectively).” By this criterion, both procedures seemed equally and objectively EFFECTIVE, not ineffective.

        To settle this issue definitively they would have needed to include a third group of matched individuals to whom the researchers did nothing, other than to take measurements over the same period of time.

        You wrote: “The real problem with placebo effects is that they are, indeed, often non-effects, illusions and lies.” Obviously I disagree,

        Not that this seems likely to change your mind, but you or others might want to check out Dr. Jo Marchant’s book, Cure: A Journey into the Science of Mind Over Body, described as “A rigorous, skeptical, deeply reported look at the new science behind the mind’s surprising ability to heal the body.” She has a doctorate in genetics and medical microbiology and writes for the New Scientist, Nature and Smithsonian, and has a position with respect to mind-body effects in between your position and mine.

        A review: https://www.kirkusreviews.com/book-reviews/jo-marchant/cure-journey/




        4
  5. “Experiments in modern physics have repeatedly shown that consciousness plays a fundamental role, even to the extent that some physicists have concluded that the universe seems primarily mental, not physical.”

    Your mind needs more fiber.




    8
    1. One example:

      “All matter originates and exists only by virtue of a force which brings the particle of an atom to vibration and holds this most minute solar system of the atom together. We must assume behind this force the existence of a conscious and intelligent mind. This mind is the matrix of all matter.”

      “I regard consciousness as fundamental. I regard matter as derivative from consciousness. We cannot get behind consciousness.”

      ― Max Planck, the originator of modern quantum theories and one of the most important German physicists of the late 19th and early 20th centuries, winner of the Nobel Prize in Physics. https://en.wikipedia.org/wiki/Max_Planck




      6
        1. With respect to refuting the usual assumptions made by reductionist materialists, this paper describes six:

          http://deanradin.com/evidence/Radin2012doubleslit.pdf You can find many more described in Dean Radin’s book, Entangled Minds, with descriptions and references.

          As far as the nature of the Universe goes, in his Simulation Argument using logic alone Oxford philosopher Nick Bostrum makes a compelling case that we almost certainly live in the equivalent to a computer simulation. MIT physicist Max Tegmark in his Mathematical Universe Hypothesis proposes that that while physical reality exists it does so not as we perceive it, but as an abstract mathematical structure like a code. More radically, U.C. Irvine cognitive scientist Donald Hoffman argues in his non-physicalist theory of Conscious Realism that consciousness seems fundamental, rather than incidental, and that matter and all of time and space simply appear as perceived representations of interacting hierarchies of “conscious agents,” entities that he rigorously defines in mathematical terms. Historically others have taken similar positions on the primacy of mind rather than matter, ranging from ancient Hindu sages to Nobel prize winning physicists such as Max Plank, who I quoted above.

          If you want something to chew on, try these:

          Nick Bostrom , (2003), Philosophical Quarterly, Vol. 53, No. 211, pp. 243-255.
          http://www.simulation-argument.com/

          Max Tegmark (2008), “The Mathematical Universe”, Foundations of Physics 38:101–50. https://arxiv.org/PS_cache/arxiv/pdf/0704/0704.0646v2.pdf

          Donald D. Hoffman (2008), Mind & Matter Vol. 6(1), pp. 87–121.
          http://cogsci.uci.edu/~ddhoff/ConsciousRealism2.pdf

          I especially recommend Donald Hoffman’s work for an overview, though he does not seem a physicist, but a cognitive neuroscientist.

          And although physics has moved on with respect to how the universe actually works, for the most part doctors and medical researchers still hold onto the outdated and invalidated assumptions of 19th century Newtonian reductionist–materialist science. In a practical sense, does this matter? In many instances, probably not, but in the case of the placebo, and other formerly flatly disbelieved and now repeatedly confirmed mind-body effects, I would argue otherwise.




          4
          1. Thanks for the references. Very interesting.

            Of course, this is a very old debate in many ways. It reminds me of Bishop Berkeley’s philosophy and Dr Johnson’s response

            “After we came out of the church, we stood talking for some time together of Bishop Berkeley’s ingenious sophistry to prove the nonexistence of matter, and that every thing in the universe is merely ideal. I observed, that though we are satisfied his doctrine is not true, it is impossible to refute it. I never shall forget the alacrity with which Johnson answered, striking his foot with mighty force against a large stone, till he rebounded from it — “I refute it thus.”
            Boswell: Life




            4
              1. Perhaps he would have observed that neither of these things demonstrated the immateriality of the Universe?

                I confess that these sorts of speculation, while fascinating, are far too complex for my limited intelligence. “Speculations” because, like much medical research, while the findings may be correct (and replicated), it is the interpretation and meaning that we ascribe to them that is often speculative.

                Of course, it has been somewhat of a commonplace that a minority of doctors have prescribed (placebo) sugar pills to harness this very effect. One might even therefore describe it as.mainstream medicine ….. although I accept that that is stretching things .

                “..In one survey, only three percent of U.S. physicians reported using actual sugar pills as placebos, but 41 percent said they had used over-the-counter painkillers and 38 percent said they had used vitamins as placebos for their patients. Sixty-eight percent of physicians described the placebo to their patients as a potentially beneficial medicine, and roughly two-thirds of the doctors felt the practice was ethical.4”
                .https://www.drugs.com/article/placebo-effect.html.




                3
                1. “Perhaps he would have observed that neither of these things demonstrated the immateriality of the Universe?”

                  True enough. But these and other experiments in physics have thoroughly invalidated in fundamental ways the material universe in which Johnson – and even most physicists until about a century ago – believed in and took for granted. “Matter” in 21st century physics has little in common with “matter” as Dr. Johnson conceived of it, or even of “matter” as most people – including most doctors – conceive of it still.

                  Dr. Max Tegmark, and MIT physicist ( http://web.mit.edu/physics/people/faculty/tegmark_max.html ) who still sees himself – somehow! – as a reductionist materialist – wrote:

                  “I argue that with a sufficiently broad definition of mathematics, it implies the Mathematical Universe Hypothesis (MUH) that our physical world is an abstract mathematical structure. I discuss various implications of the ERH and MUH, ranging from standard physics topics like symmetries, irreducible representations, units, free parameters, randomness and initial conditions to broader issues like consciousness, parallel universes and Gödel incompleteness. I hypothesize that only computable and decidable (in Gödel’s sense) structures exist, which alleviates the cosmological measure problem and may help explain why our physical laws appear so simple. I also comment on the intimate relation between mathematical structures, computations, simulations and physical systems.”




                  2
          2. Let’s accept, for the sake of argument, that the placebo effect has lasting changes on a patient’s view of their health. Let’s say, for example, that a patient experiences less chest pain when they are ‘told’ that they are placed on a statin. Is the patient’s atherosclerosis improving? No, it is likely getting worse.

            Is your statement to be taken as “Autism is merely a construct of perspective, has no physical effects, and no tangible causes”? If that is not what you are saying, then “making the patient feel better” about the condition when we have a shot at actually improving the condition is an ethically compromising position to take. There is already a market for the placebo effect. You can find that in every corner of the internet and all they need is your credit card number and email address. Mass-marketing placebos in terms of treatment by the medical community is not the best path to public confidence in medical practitioners or in the scientific method.




            1
          3. There are many control systems in place which could implement real, measurable placebo effects without exotic physics as well. Sympathetic/parasympathetic, stress/inflammation, vagus nerve, many things are outside of immediate conscious control but react to mindset. If you inherently are looking for new or novel things, if you think novelty is found in recovering from illness, you do better.




            0
  6. I’m currently working through a data science statistics course that talks about the following 6 sampling biases -> 1. selection bias, 2. non-response bias, 3. voluntary response bias, 4. publication bias, 5. survivorship bias, 6. response [ aka social desirability ] bias.

    This one being called out in video I think falls under 6. response [ aka social desirability ] bias which I expect is really common in medical treatment trials given peoples hope for something to work will cause them to report better subjective based results. Is that what Dr. Michael Greger is saying?




    6
    1. For those who want to go a bit further down into this rabbit hole:

      Freedman, D.H., (2010) “Lies, Damned Lies, and Medical Science,” The Atlantic, November. https://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/30826

      Turner E.H. et al, (2008) “Selective publication of antidepressant trials and its influence on apparent efficacy.” N Engl J Med., 358(3), pp 252-60, Jan 17. http://www.nejm.org/doi/full/10.1056/NEJMsa065779#t=article

      Ioannidis, J.P.A., (2005) “Why Most Published Research Findings Are False,” PLoS Medicine, 2(8), pp 0696 – 0701, August. http://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.0020124&type=printable

      Horton, R. (2015) “Offline: What is medicines’ 5 sigma?”, The Lancet 385 (9976) p 1380, April 11. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60696-1/fulltext?rss%25253Dyes

      and a very interesting video news story clip on medical research fraud (from 2 minutes – 10.5 minutes):

      http://fullmeasure.news/news/full-episodes/full-measure-may-07-2017

      It pretty much sums up this rather sorry situation – and not just for medical research, but for ANY area of scientific research – where big money has a vested interest in a specific result can do buy and publish the research results they want. And not just to promote their own products – but to invalidate the competition. I really appreciated the comments of Dr. Marcia Angell of Harvard, as well as the views of the current editor of Lancet, Dr. Richard Horton.

      One quote:
      “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as editor of The New England Journal of Medicine.”

      – Dr. Marcia Angell, a physician and longtime editor-in-chief of the NEJM




      5
      1. Hi @alef1, thanks for the response with set of related links.

        Their contents raise very concerning matter and l would think associated with “4. publication bias” as well as “5. survivorship bias” discussed in course i’m taking where people only publish study sample statistics that serve their goals and review of quality of publications doesn’t take into account aspects of those that never got published. The comment that study publications are more like advertising than trustable evidence is a big problem. I also like the chocolate diet hoax that one person experimented with to see if/when any media would eventually look past simply perpetuating the story to achieve their daily content goals.

        I have a neighbor who was recently had been sharing with me numerous new England medical journal [nejm] articles on studies that are now saying wrt prostate cancer in most cases if you are over the age of 55-60 then you are better off just leaving it be as you’ll likely die from something else. The thinking being if you do something about the prostate cancer you’ll end up with one or more of the side effects and still end up likely dying from something else. I’m having hard time coming up with scenarios for how studies and reports on them like that could be negatively biased given it doesn’t serve surgical or pharmaceutical interests.

        I am encouraged and grateful by the existence of folks like dr. michael greger, his work and nutritionfacts.org site, where he openly states it serves no personal or advertiser incentives similar to others like dr. neal barnard’s work and pcrm.org site. As much as I think they both deserve to make a great living off the important work they are doing and initiatives they are driving it would seem that as soon as anyone could associate significant and direct personal gain it equips those who would like to try and stop it to call into question the presence of bias. Would be nice if there was a way to address that so smart people with genuine interest in helping society can make a good living and provide for their family doing that work.




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        1. @David E Johnson, thanks for the correction on the first link reference. Contents of that article very insightful and frustrating. Wondering how Dr. Michael Greger and others who parse published results of tests & studies for us laypeople weed out the biased ones from the genuine and correctly executed ones.




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          1. “Wondering how Dr. Michael Greger and others who parse published results of tests & studies for us laypeople weed out the biased ones from the genuine and correctly executed ones.”

            Hi mysurn –

            Now I see this as a really important subject, and one that I hope at some point Dr. Greger will personally address for NFO in a video or even a series of videos.

            As someone who has published a fair amount of scientific research myself (I earned my Ph.D. in biochemistry) if I had the time I’d feel tempted to write a detailed essay on this topic myself, but I can at least give a few tips. Begin by looking at:

            1. The reputability of the authors, including at least their present academic or professional affiliations.

            2. The reputability of the journal, in which the research appeared.

            3. Who funded the study, and what sort of conflicts of interests that authors may have had – or at least admitted to. This can seem pretty tricky, as authors often still do not disclose this information, and the original funding sources may seem disguised. Independent, neutral, or government sources usually seem best – corporate sources – especially from large companies or industry’s with money to burn – the worst.

            4. The quality of the study. Even professionals can not determine this from an abstract, but actually need to read the paper, especially the materials and methods section, paying close attention to whether the researchers included the proper controls. Even the most impressive statistical results, whether positive or negative, mean very little, if the research protocols have serious flaws.

            5. Does the research support a currently popular theory, or provide information that invalidates it? Published unexpected results, especially in prestigious peer reviewed journals, have a lot more credibility in my mind than research that supports popularly accepted scientific dogma, if only because in order to get published, they had to pass a far more rigorous process in order to get a passing grade from skeptical peer reviewers.

            6. Look out for your own bias. If a research paper supports what you already believe, look out! Applying a more critical mindset becomes even more important in cases like these, where uncritical acceptance seems the natural tendency.

            6. Finally, the more of the above criteria with a “passing grade” that a research paper has, the higher the combined score, and none of these criteria, in themselves guarantees anything. Research published by a group from Harvard can prove totally bogus (for example Dr. Frederick Stare’s research on sugar), as can research published in the most prestigious journals. And visa-versa. Caveat Emptor!




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            1. Hi Alef1 and Happy Thanksgiving!. This is Dr. Daniela Sozanski, PhD in Natural Medicine, Functional practitioner in Atlanta GA and Moderator for Nutritionfacts. I am writing to express my appreciation for the quality of your note. This is the kind of scrutiny everyone should have in every moment we scout the web for information. Cheers, Daniela




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              1. Thanks – I appreciate the information!

                And as far as scouting the web for information goes, I do worry about what I call the Google effect, how it supercharges and facilitates “confirmation bias,” that makes it more more likely that we will seek out, notice, and remember evidence that supports what we already believe. Search engines allow people to easily and rapidly find compelling evidence that supports what they already believe in – no matter WHAT they believe in – from presumably authoritative sources. ( http://rationallyspeaking.blogspot.com/2010/01/is-google-making-us-less-rational.html )

                And as far as scouting the web for information, and what this has done to us with regard to our ability to think critically and deeply, you might want to check out this somewhat alarming but entertaining Atlantic article:

                https://www.theatlantic.com/magazine/archive/2008/07/is-google-making-us-stupid/306868/

                (Note: you’ll need to scroll past lots of ads to finish the article, which runs to about 40 paragraphs.)

                One interesting quote: ” But a recently published study of online research habits, conducted by scholars from University College London, suggests that we may well be in the midst of a sea change in the way we read and think. As part of the five-year research program, the scholars examined computer logs documenting the behavior of visitors to two popular research sites, one operated by the British Library and one by a U.K. educational consortium, that provide access to journal articles, e-books, and other sources of written information. They found that people using the sites exhibited “a form of skimming activity,” hopping from one source to another and rarely returning to any source they’d already visited. They typically read no more than one or two pages of an article or book before they would “bounce” out to another site. Sometimes they’d save a long article, but there’s no evidence that they ever went back and actually read it. “




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                1. Alef1,

                  Nice find and yes it’s the 8 second attention time now pervasively infecting even researchers. It’s difficult to dive deep given the time necessary to truly evaluate studies.

                  This article is indeed a real call to those who do take the time to read the “rest of the story” and get the whole picture.

                  Thanks for the reference.

                  Dr. Alan Kadish moderator for Dr. Greger http://www.CenterofHealth.com




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  7. I am going to ask this here, because I have posted it a few times, and haven’t got any answer. I can’t seem to get any clarity on the research behind this question.

    I have been seeing a naturopath for several years who subscribes to finding hidden food allergies by way of blood testing – he uses Rocky Mountain Analytical labs which test for food allergies and immunology – which tests for IGG, IGA and IGE. http://rmalab.com/sites/default/files/tests/instructions/20140424_CI_Food_Reactions-web.pdf

    I have struggled with dairy and yeast – cause gastro-intestinal and sinus congestion or inflammation (nighttime) for years. Cutting these foods has given me some relief, but hasn’t completely solved the problem. However, the testing also says I have IGA response to blueberry, cranberry, pineapple, sesame, mushroom. My naturopath says these are great foods but suggests they may not be good for me – and that I should eliminate them…

    I am wondering what Doctor Gregor and the research has to say about the role in such plant-based iga antibody response to plant-based foods – should I be cutting them out? This video indicates mushroom for example might cause an increase in antibodies, but REDUCE inflammation.

    My question: Are there long-term risks to me consuming these foods? Is it possible that they are causing inflammation of the mucous membranes and affecting my bodies immune system, adrenal and thyroid function, making me more susceptible to disease? Or might they act in a similar way that mushrooms do?




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    1. Have you tried a food elimination diet? Tests are great for some things, but I don’t think food sensitivity is one of them. Many of the foods we eat have dozens of ingredients that are hard to track down, so you may have thought you were (for example) sensitive to gluten, but you find that there is a preservative in many of the store bought brands that give you problems, which (still an example) is why you have the same symptoms when you eat peanut butter or this one salad dressing your brother gave you.

      A more lasting solution is to create a food diary that enables you to ‘type and cross’ the actual food you eat with your tolerance for it. If you have a lot of sensitivities it can take some time to figure it all out, but once you do it will be very empowering.




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      1. Hi and Happy Thanksgiving to you. This is Dr. Daniela Sozanski, PhD in Natural Medicine, Functional practitioner in Atlanta GA and Moderator for Nutritionfacts. My approach is that if you indeed have an allergic reaction to these foods you should eliminate them. Period. There are many, many, other antiinflammatories and antioxidants in the world of plants that would make up for them. Body is telling you that at some point in the past, for whatever reason, it has identified components of these particular foods as antigens and learned to develop antibodies to help annihilate them. Continuing the consumption of allergens, may not only exacerbate your digestive distress, but it may start affecting joints or other tissues in the long term. It’s a risk not worth taking. I hope this helps, Daniela




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      2. Hi and Happy Thanksgiving to you. This is Dr. Daniela Sozanski, PhD in Natural Medicine, Functional practitioner in Atlanta GA and Moderator for Nutritionfacts. Elimination diet is a great way to go and has been used for a long time. Attention though to the hidden allergies, where you don’t get apparent symptoms but the effect is longer term and more hidden. This is where the allergy tests come in useful. Cheers, Daniela




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    2. Hi and Happy Thanksgiving to you. This is Dr. Daniela Sozanski, PhD in Natural Medicine, Functional practitioner in Atlanta GA and Moderator for Nutritionfacts. My approach is that if you indeed have an allergic reaction to these foods you should eliminate them. Period. There are many, many, other antiinflammatories and antioxidants in the world of plants that would make up for them. Body is telling you that at some point in the past, for whatever reason, it has identified components of these particular foods as antigens and learned to develop antibodies to help annihilate them. Continuing the consumption of allergens, may not only exacerbate your digestive distress, but it may start affecting joints or other tissues in the long term. It’s a risk not worth taking. I hope this helps, Daniela




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      1. I think people equate “allergic reaction” with like- “I feel bad” or “tired” or “bloated”.

        I’m allergic to basil. I know that’s not a common allergy but when I first found out I got an itchy mouth and throat- and felt a little wheezy that was more than eight years ago. In the past month I’ve gone to the er twice after being exposed to basil (ingesting it accidentally and then just plain smelling fresh basil on someone’s dish in a restaurant). It’s weird to have a random food allergy but let’s make sure to differentiate “allergy” vs. “intolerance” ie “makes me feel bad”.




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  8. I understand that the conventional medical view is that these tests are largely useless and inappropriate. Nice revenue generators though.
    “The fact that IgG tests test for dozens of foods is also concerning. Even IgE panel tests—which allergists and doctors use to test for immune responses—aren’t very accurate, and return a lot of false positives. One review of 125 kids found that 80% to 100% of the foods that IgE tests flagged could be safely reintroduced into their diets. Another study looked at over 700 oral food challenges – where a person eats a small amount of a suspected allergen under medical supervision—and found that only 19% of patients reacted. “It’s important for people to appreciated that an IgE test is not synonymous with a diagnosis,” says Kirste.”
    http://healthydebate.ca/2017/01/topic/igg-tests-science

    Here are some articles which explain why
    http://onlinelibrary.wiley.com/wol1/doi/10.1111/j.1398-9995.2008.01705.x/full
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443017/
    http://www.cmaj.ca/content/early/2016/09/06/cmaj.160124




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    1. In my ignorance took the ELISA/ACT blood test. Wasted a lot of $$$ on information worth nothing. What really got me was they suggested taking the test again in 6-12 months because allergies will/can change. Didn’t research and find all the negative information until after spending the $$$. The test had my blood reacting to things I had not ingested in 10 or more years. But according to them if I left this stuff alone for 6-12 months my allergy would probably disappear. hmmmmmmmmmmm




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      1. Hi JJ, thanks for your comment. The discussion on allergy and food sensitivity made me curious to look back in my notes from 2001!!! I did a course in allergy and mechanism of allergy at Southampton University and it was fascinating.
        I wanted to mention about what they said to you about allergy would disappear if left alone. They were right as what I learnt when an allergic inflammation happens. 1) When an antigen meets an antibody and recognizes specific epitope it can be taken up by an antibody this process is called Recognition. 2)The body response by producing more and more antibodies that recognizes that particular antigen. 3) The next phase is remembering faster immune response in the next encounter. 4) Regulate by producing cytokines that up regulate and down regulate immune response.




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  9. Is it possible that casseine and gluten in parents diet triggered an epigenetic expression of autism? How about children of vegan parents….how often do they have children with autism? Check that stat among the seventh day adventist.




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  10. I have been looking up therapies for stroke for a relative and they talk about things being the placebo effect and they weren’t worried about people using things and having a placebo effect. They were much more worried about something they called the “noseebo” effect where, because you don’t believe, you don’t do anything and don’t get recovery. In Christianity, the placebo effect might be a type of faith and certainly a type of hope and the thing is, hope and faith often lead toward finding the answers and sometimes downright miracles.

    I started out back in March and found one “placebo effect” thing after another and I honestly feel so much better and the thing is, sometimes the researchers are ignoring the group that actually really did have improvements.

    I say it, because I would be someone who doubt all “gluten sensitivity” but I have three friends who genuinely got better after changing their diets, whether it was the gluten or not.

    I guess at that point, it doesn’t matter why they felt better. People who feel better are more positive, more hopeful, get more exercise, eat better, all from a placebo effect leading to hope. Maybe.




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