Seeking ‘evidence-based’ guidelines

Published in Jama Network a new investigation questions the quality of evidence supporting recommendations in major cardiovascular guidelines. The authors asked, “What proportion of recommendations in current American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) guidelines are supported by evidence from multiple randomized controlled trials (RCTs), and how has this changed over the past 10 years.” The answer – a paltry 8.5% of recommendations from the ACC/AHA and 14% from the ESC were based on level A evidence (RCTs), whilst a huge 41% and 54% came from the lowest level, level C (expert opinion only). When compared to prior guidelines the quality of evidence had not improved, and if anything may have reduced. These revelations are troubling, not least because these organisations are supposed to be promoting the highest quality recommendations available to doctors and patients. It also makes a mockery of those who claim natural health alternatives are not ‘evidence-based’. The nature and scope of evidence-based medicine today is a complete corruption of the original intention by Sackett et al because it suits big corporations like Bad Pharma. By choosing to rely on RCTs alone, completely ignoring clinical observation and patient experience the hierarchy of evidence is excessively narrowed which benefits profits and penalises patients. Surely the gold standard should be evidence of what does (and doesn’t) work in real world terms? True science involves proving a hypothesis, not manipulating data to support foregone conclusions.

Move over statins there's a new kid in town!

You’ve heard that the drug companies often claim that side effects of statins are nothing to worry about? Well you might be surprised that there’s a new kid on the block, that claims to be a successor to statins which doesn’t cause side effects. So, having escalated the statin wars in a desperate attempt to prove benefit and deny harm, this new class of cholesterol-lowering drug from manufacturer, Esperion, acknowledges the harm by claiming that bempedoic acid doesn’t cause the side-effects (i.e. harms) experienced by statin takers. Apparently, it’s processed in the liver and therefore doesn’t reach the muscles, but we have yet to see what effect this processing might have on the liver. Despite the hype, data regarding safety and efficacy of the new treatment are currently limited to short-term studies and the cost of the drug is slated to be significantly higher. Bad Pharma appears a long way from giving up on a very profitable line of drugs for the number one killer disease.  But let's not forget that personalised diet and lifestyle modification, done the right way, can make lifesaving changes in a matter of days.

Eggs – demon food or essential nutrient?

Eggs are a nutrient dense, important food source for many. Over the years they have been unfairly demonised, mainly due to their naturally-occurring cholesterol content. Despite the fact that dietary cholesterol only has a small effect on blood cholesterol and a lack of good evidence connecting dietary intake of cholesterol with heart disease, eggs have failed to lose their tag as an unhealthy food. Adding to the confusion and controversy is a new study in JAMA Network.  It shows only a modest association (not a causal relationship), with up to 30 years follow up, that eating more than an egg  is bad for your health. However, despite what appears to be an impressive-looking study, there are serious flaws and significant conflicts of interest. Of utmost concern is that “ingredients in mixed dishes were considered” by the researchers to warrant inclusion rather than the consumption of eggs on their own. We all know you can’t compare apples with oranges and expect to come up with robust science on only apples. One wonders if those mixed dishes also included refined carbs, sugars and vegetable fats all of which impact one’s fat handling and management in the body. Once again it would seem the magic pen of the spin doctors has been at work again to support Bad Pharma and its continued push for global statin domination.

UK NHS to trial Ayurvedic remedy

Having recently blacklisted a range of natural medicines, the UK’s NHS is to trial the use of an Ayurvedic remedy, Andrographis paniculata, to treat acute respiratory infections. Based on research conducted by Pukka Herbs, this trial is extremely timely given the major threat from the rise of antibiotic resistance and reinforces previous studies showing that CAM trained GPs prescribe significantly fewer antibiotics. Although a step in the right direction, there is still a long-way to go until natural therapies are embraced as an effective strategy for health creation and promotion to reduce the burden on an already overstretched service.

CBD confusion continues

Following the recent classification of cannabinoids as novel foods, industry groups challenging the classification have triggered authorities to rethink their decision. The European Industrial Hemp Association (EIHA) presented evidence at the Standing Committee on Plants, Animals, Food and Feed (PAFF Committee) showing hemp and hemp extracts have been extensively used before May 1997, suggesting CBD products are not novel and should remain available. In the UK, the government has responded to an online petition calling for CBD to be kept on the market as a food supplement. The response states that, “The Food Standards Agency (FSA) is working with industry and key stakeholders to develop guidance for enforcement officers for a proportionate response”. It goes on to say evidence has not been provided in the UK or other Member States that shows evidence of prior use and that despite hemp’s significant history of consumption, CBD is a “highly purified extract” resulting in its classification. In a statement the Cannabis Trades Association (CTA), following meetings with the Food Standards Association, said there is a misunderstanding over how CBD oil is produced. Meanwhile the threat to consumer access to supplies of CBD products remains, whilst Pharma gains more time to ready itself to step into an extremely lucrative market.

Monsanto found guilty – again!

Jurors in the latest Roundup cancer trial have found the plaintiff's use of Roundup in his garden was a substantial factor in the development of his cancer. This comes following reports calling the impartiality of the judge in the case into question. The jury now need to decide whether Bayer/Monsanto should be held liable, a decision that could bring yet more punitive financial damages against the company that is already reeling from the damages handed down in the first roundup trial held last year.