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Letters to the Editor Issue 249

by Letters(more info)

listed in letters to the editor, originally published in issue 249 - October 2018

Tribute Obituary Dr Peter Fisher MBBChir FRCP FFHom  - 2 Sept 1950-15 Aug 2018

We are genuinely saddened and shocked to report the untimely death of Dr Peter Fisher MBBChir FRCP FFHom, aged 67, from a bicycle traffic accident in High Holborn, London on 15 Aug 2018. Dr Fisher, who was perhaps but approaching the peak of a stellar and accomplished academic, research and clinical career, was Director of Research and Consultant Physician at the Royal London Hospital for Integrated Medicine (RLHIM) - accredited (Board Certified) in homeopathy and rheumatology, President of the Faculty of Homeopathy London, Homeopathic Physician to HRH The Queen, a member of the World Health Organization’s Expert Advisory Panel on Traditional, Complementary and Integrative Medicine, who helped to draft its Traditional Medicine Strategy 2014-2023, and Editor-in-Chief of the international medical journal Homeopathy.

Peter Fisher Conference and Dr Bellare, Dr Fisher, David Tredinnick, Dr Manchanda

  1. Upper Photo: Dr Peter Fisher Presenting for the last time at the Royal Society of Medicine at New Horizons in Water Science’ - Evidence for Homeopathy? 14 July 2018.
  2. Group Photo:
  3. Dr Jayesh Bellare1, Dr Peter Fisher2, David Tredinnick MP3, Dr Raj Kumar Manchanda4
  4. Dr Jayesh Bellare, Institute Chair Professor Chemical Engineering Indian Institute of Technology, Bombay
  5. Dr Peter Fisher MBBChir FRCP FFHom, Director of Research and Consultant Physician, President of the Faculty of Homeopathy London
  6. David Tredinnick MP, Parliamentary Group for Integrated Healthcare (PGIH)
  7. Dr Raj Kumar Manchanda MD(Hom) MBA, Director General Central Council for Research in Homoeopathy, Ministry of AYUSH

Peter Fisher was an active clinician, specializing in integrating homeopathy and other forms of complementary medicine with other forms of health care. He led numerous research projects in integrated medicine. His interest in the area was triggered by a visit to China during the Cultural Revolution while still a medical student at Cambridge University. His research work centred on responding to the problems of health care, including ‘effectiveness gaps’, multimorbidity, antimicrobial resistance and polypharmacy, by integrating the best of conventional and complementary medicine.

Dr Fisher’s conscientious and stalwart battle to present and defend the evidence of homeopathic research has featured in Positive Health PH Online over the decades:

At the Houses of Parliament before the House of Lords Dinner Party on 13 Feb, I encountered Peter Fisher; we chatted and caught up on events in Homeopathy and Positive Health since our last meeting in the early 2000s. He gave me his card; I was meant to email him with our future plans. But just one month later, he was dead, struck down while cycling to work.

Dr Peter Fisher married Nina Oxenham in 1997. They were divorced last year. He is survived by their two daughters, Lily and Evie

 

 

Omega 3 Fatty Acids and Cardiovascular Disease

Commentary by Damien Downing MBBS MSB and Robert G Smith PhD

Reprinted from orthomolecular.activehosted.com

http://orthomolecular.activehosted.com/index.php?action=social&chash=f4b9ec30ad9f68f89b29639786cb62ef.98&s=c7ae1002d2f579a22c16a1b89c854212

 

The Cochrane Database of Systematic Reviews has just updated its own review: Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease.[1] Here's our take on it.

Michael Pollan, the brilliant food writer, reckoned you could sum up what to do about nutrition and diets in 7 words; "Eat food, not too much, mostly plants." That sums up both what's best for humans and what's best for the planet.

We reckon you can sum up what's wrong with evidence-based medicine (EBM) in 10 words; "Evidence is a waste of data; systematic reviews are palimpsests." You can use that as a knife to quickly dissect this study.

There are many things wrong with this review. Somebody's PR department has spun the review's "no clear evidence of benefit" into "evidence of no benefit" - absence of evidence becoming evidence of absence. And clearly the media were entirely happy to take that one and run with it.

Systematic Reviews are Palimpsests

What's a palimpsest? Back when things got written on vellum, an animal skin, not on paper, you didn't throw it away; you recycled it and wrote over the original. It was called a palimpsest. A systematic review gives an opportunity to write over the conclusions of a whole list of papers with your new version of the truth. You do that by the way that you select and exclude them. For instance there was a meta-analysis (that's a systematic review with more numbers) in 2005 that concluded that vitamin E supplements significantly increased the risk of death.[2] The way they did that was to rule out any study with less than 10 deaths - when fewer deaths was exactly the outcome they were supposed to be looking for. The reason they gave for doing that was "because we anticipated that many small trials did not collect mortality data." We're not buying it; they used it as a trick to enable them to get the negative result they wanted - to over-write the findings of a long list of original studies.

And here we have authors doing the very same thing in this omega-3 study - and upping the ante slightly. Now the threshold is 50 deaths. Fewer than that and your study is ruled out of the final, supposedly least biased, analysis . . on the grounds that it's more biased. We don't know how they could keep a straight face while saying (our interpretation); "The studies with fewer deaths showed more benefit from omega-3s, so we excluded them."

At least that's what happened back in 2004 when the first version of this came out.[3] But this is the 8th update (we think) and they no longer bother to tell you about what they included or excluded in detail, so we can only assume that if they had changed that exclusion they would have told us.

The weird thing is that they are allowed to do it. Nutrition researcher Dr. Steve Hickey has shown that in systematic reviews there is generally control for bias in the included studies, but none for bias in the actual review and its authors.[4,5] They found not one example of adequate blinding among 100 Cochrane reviews (like this one); they could all be palimpsests. Do we know that they are fake? No, but it doesn't matter: what we do know is that we can't trust them. Nor can we trust this Cochrane review. Things haven't changed since 2004.

Evidence is a Waste of Data

Evidence is what lawyers and courts use to find someone Guilty or Not Guilty, and we all know how that can go wrong. It's a binary system: you're either one or the other. But at least if you're on trial all the evidence should be about you and whether you did the crime. In EBM the evidence is all about populations, not about individuals. When a doctor tells you "There's a 1 in 3 chance this treatment will work" he is required to base that on big studies, or even systematic reviews. You don't, and you can't, know what that means for you because very likely you don't fit the population profile. As Steve Hickey (again) said, the statistical fallacy underlying all this states that you have one testicle and one ovary - because that's the population average!

The authors of this study update started off with about 2100 papers that looked relevant. They then excluded 90 per cent of them for various reasons - some of them good reasons, some not. A smarter way to work would be to data-mine them and look for useful information about sub-groups and sub-effects in all the papers. Is there a particular reason omega-3s might work for you and not for others? Perhaps you can't stand fish, or are allergic to them, and so are deficient in omega-3s. But the review system doesn't allow it, it insists on overall conclusions (about populations), and that's a colossal waste of data.

It also confounds the overall finding of the review - it biases it in fact. Here's an example: while most subgroups that made it to the final analysis showed a small reduction in risk from taking omega-3s in one form or another (pills, food, whatever), those who got it from supplemented foods, which we understand means stuff like margarine with added omega-3, showed a 4.3-fold death risk increase! The problem here is that the effects of omega-3 fatty acids cannot be studied alone as if they were a drug. What counts are all the other components of the diet that affect a person's health. Processed foods and drinks that contain many unhealthy ingredients can't be made healthy by adding small doses of vitamins, minerals, and omega-3 fatty acids. In fact, many processed foods that contain small doses of vitamins and other essential nutrients are unhealthy because they contain large doses of sugar, salt, and harmful ingredients such as preservatives, dyes, and other non-food items.

Why Lipids are so Important

Part of the problem is that lipids are truly complicated, and not many people, patients, doctors or even scientists, understand them well. You need a good understanding of lipid metabolism to appreciate the difference in metabolism and impact between alpha-linolenic acid (ALA, in food such as oily fish) and extracted oils such as EPA and DHA that are only found at high levels in omega-3 supplements. At these levels they are effectively new to nature; nobody, indeed no mammal, was exposed to really high doses of DHA until we invented fish oil supplements.[6] Miss that fact and you miss the difference between having people eat fresh oily fish or just using omega-3 margarine!

We know from a variety of studies that a diet containing generous portions of green leafy and colorful vegetables and fruits, moderate portions of eggs, fish, and meat, and supplements of adequate doses of essential nutrients (vitamins and minerals) is effective at lowering the risk for cardiovascular disease. Adequate doses of both omega-3 (in flax oil, walnuts, fish) and omega-6 (in seed oils such as canola, soybean, peanut) fatty acids are essential for health. Although essential, omega-6 fatty acids are thought to contribute to inflammation throughout the body whereas omega-3 fatty acids are anti-inflammatory. Omega-3 fatty acids are essential for most body organs including the brain but are found in lower levels than omega-6 fatty acids in most vegetables. Risk for cardiovascular disease can be lowered by adequate doses of vitamins C (3,000-10,000mg/d), D (2,000-10,000 IU/d), E (400-1,200 IU/d), and magnesium (300-600 mg/d) in addition to an excellent diet that includes an adequate dose of omega-3 fatty acids.[7]

About the Commentators

Dr Damien Downing is a specialist physician practicing in London, and President of the British Society for Ecological Medicine. Robert G Smith is a physiologist and Research Associate Professor at the University of Pennsylvania Perelman School Of Medicine.

References

1. Abdelhamid, A, Brown TJ, Brainard JS, et al., (2018) Omega 3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Syst Rev. 7:CD003177. https://www.ncbi.nlm.nih.gov/pubmed/30019766
http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003177.pub3/abstract

2. Miller ER, Pastor-Barriuso R, Dalal D, et al., (2005) Review Meta-Analysis?: High-Dosage Vitamin E Supplementation May Increase. Annals of Internal Medicine, 142(1), pp.37-46. Available at: http://annals.org/article.aspx?articleid=718049.

3. Hooper L, Thompson RL, Harrison RA, et al.. (2004) Omega 3 fatty acids for prevention and treatment of cardiovascular disease. Cochrane Database Syst Rev. (4):CD003177. http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003177.pub2/abstract

4. Hickey S, Noriega LA. Implications and insights for human adaptive mechatronics from developments in algebraic probability theory, IEEE, UK Workshop on Human Adaptive Mechatronics (HAM), Staffs, 15-16 Jan 2009.

5. Hickey S, Hickey A, Noriega LA, (2013) The failure of evidence-based medicine? Eur J Pers Centered Healthcare 1: 69-79. http://ubplj.org/index.php/ejpch/article/view/636

6. Cortie CH, Else, PL, (2012) Dietary docosahexaenoic acid (22:6) incorporates into cardiolipin at the expense of linoleic acid (18:2): Analysis and potential implications. International Journal of Molecular Sciences, 13(11): 15447-15463. http://www.mdpi.com/1422-0067/13/11/15447

7. Case HS (2017) Orthomolecular Nutrition for Everyone. Turner Publication Co., Nashville, TN. ISBN-13: 978-1681626574

Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

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Editorial Review Board

Ilyès Baghli, M.D. (Algeria)     Ian Brighthope, M.D. (Australia)     Prof. Gilbert Henri Crussol (Spain)     Carolyn Dean, M.D., N.D. (USA)     Damien Downing, M.D. (United Kingdom)     Michael Ellis, M.D. (Australia)     Martin P. Gallagher, M.D., D.C. (USA)     Michael J. Gonzalez, N.M.D., D.Sc., Ph.D. (Puerto Rico)     William B. Grant, Ph.D. (USA)     Tonya S. Heyman, M.D. (USA)     Suzanne Humphries, M.D. (USA)     Ron Hunninghake, M.D. (USA)     Michael Janson, M.D. (USA)     Robert E. Jenkins, D.C. (USA)     Bo H. Jonsson, M.D., Ph.D. (Sweden)     Jeffrey J. Kotulski, D.O. (USA)     Peter H. Lauda, M.D. (Austria)     Thomas Levy, M.D., J.D. (USA)     Homer Lim, M.D. (Philippines)     Stuart Lindsey, Pharm.D. (USA)     Victor A. Marcial-Vega, M.D. (Puerto Rico)     Charles C. Mary, Jr., M.D. (USA)     Mignonne Mary, M.D. (USA)     Jun Matsuyama, M.D., Ph.D. (Japan)     Dave McCarthy, M.D. (USA)     Joseph Mercola, D.O. (USA)     Jorge R. Miranda-Massari, Pharm.D. (Puerto Rico)     Karin Munsterhjelm-Ahumada, M.D. (Finland)     Tahar Naili, M.D. (Algeria)     W. Todd Penberthy, Ph.D. (USA)     Dag Viljen Poleszynski, Ph.D. (Norway)     Jeffrey A. Ruterbusch, D.O. (USA)     Gert E. Schuitemaker, Ph.D. (Netherlands)     Thomas L. Taxman, M.D. (USA)     Jagan Nathan Vamanan, M.D. (India)     Garry Vickar, MD (USA)     Ken Walker, M.D. (Canada)     Anne Zauderer, D.C. (USA)    Andrew W. Saul, Ph.D. (USA), Editor-In-Chief

Editor, Japanese Edition: Atsuo Yanagisawa, M.D., Ph.D. (Japan)
Robert G. Smith, Ph.D. (USA), Associate Editor
Helen Saul Case, M.S. (USA), Assistant Editor
Ralph K. Campbell, M.D. (USA), Contributing Editor
Michael S. Stewart, B.Sc.C.S. (USA), Technology Editor
Jason M. Saul, JD (USA), Legal Consultant

Comments and Media Contact

drsaul@doctoryourself.com OMNS welcomes but is unable to respond to individual reader emails. Reader comments become the property of OMNS and may or may not be used for publication.

Acknowledgment Citation

Reprinted from orthomolecular.activehosted.com

http://orthomolecular.activehosted.com/index.php?action=social&chash=f4b9ec30ad9f68f89b29639786cb62ef.98&s=c7ae1002d2f579a22c16a1b89c854212

Click here to see a web copy of this news release:

 

 

Diabetics Face Higher Risk of Mouth Cancer; Women in More Danger

New research has discovered that women who suffer from diabetes face a dramatically increased chance of developing mouth cancer. The research, published in Diabetologia, discovered that women have a 13 per cent higher chance of developing oral cancer if they suffer from diabetes.[1]

Overall women faced a 27 per cent increase of developing any form of cancer if they had diabetes, while men also faced a 19 per cent increased risk according to the study.

With previous research showing close links between diabetes and the development of mouth cancer, as well as other forms of the disease, leading health charity the Oral Health Foundation, is calling on people to be aware of the close links between their oral health and their wider wellbeing.

CEO of the charity Dr Nigel Carter OBE, which campaigns tirelessly to raise awareness of mouth cancer, believes the research could help to identify individuals at risk of mouth cancer.

Dr Carter said: “This could be a very significant piece of research, and one that could help to save lives. Diabetes has previously been linked to poor oral health, but this new research shows a specific link to mouth cancer.

“This makes regular dental visits an absolute must. If your dentists know that you are diabetic, they will check your mouth accordingly. For many years we have known that diabetic patients are more likely to get gum disease and need extra dental care but this is yet another reason for regular checks.

“It is important, not just for diabetics but for everyone to be aware of what the signs and symptoms of mouth cancer are. Be alert to ulcers which do not heal within three weeks, red and white patches in the mouth and unusual lumps or swellings in the head and neck area.  If you experience any of these visit your dentist immediately.

“More people lose their lives to mouth cancer every year in Britain than from cervical and testicular cancer combined. Without early detection, the five-year survival rate for mouth cancer is only 50 per cent but if it is caught early, survival rates can dramatically improve to up to 90 per cent, as well as the quality of life for survivors being significantly increased.

“Smoking, drinking alcohol to excess, poor diet and the human papillomavirus (HPV), often transmitted via oral sex, are all lifestyle choices that will increase the risk of developing the disease. As diabetes has now been shown to be another potential risk factor, amending your lifestyle to make sure you take yourself out of harm’s way makes it more important than ever to be mouth aware."

In the UK, it is estimated that over four million live with diabetes, with many cases going undiagnosed. Type-2 diabetes, which is closely linked to lifestyle and diet, has been rapidly increasing in recent years and is now one of the world’s most common long-term health conditions.

References

1. Ohkuma, T., Peters, S. and Woodward, M. (2018). Sex differences in the association between diabetes and cancer: a systematic review and meta-analysis of 121 cohorts including 20 million individuals and one million events. Diabetologia.

Source and Further Information

Please contact: Gavin Hawes on Tel: 01788 546 365;  gavin@dentalhealth.org    www.dentalhealth.org

About the Oral Health Foundation

The Oral Health Foundation is the leading national charity working to improve oral health. Our goal is to improve people’s lives by reducing the harm caused by oral diseases - many of which are entirely preventable. Established more than 45 years ago, we continue to provide expert, independent and impartial advice on all aspects of oral health to those who need it most. We work closely with Government, dental and health professionals, manufacturers, the dental trade, national and local agencies and the public, to achieve our mission of addressing the inequalities which exist in oral health, changing people’s lives for the better. Visit www.dentalhealth.org  for more information.

 

 

Cancer Patient in South Wales Receives Life-Saving Operation

71-year-old Peter Maggs received life-saving chest surgery at Morriston Hospital, Wales, during an operation to remove a large sarcoma from his chest. As part of the procedure, Mr Maggs received a rib prosthesis which was designed by Morriston Hospital. This is the first chest prosthesis to be manufactured and implanted into a patient in Britain.

 

www.youtube.com/watch?v=9G2vGtQH77s

Source: 3dprintingindustry.com news

 

Chris Pockett, Head of Communications at Renishaw plc stated, “We are delighted to have been   the subcontractor for this complex 3D printed titanium implant designed in-house by Abertawe Bro Morgannwg University Health Board. The implant was produced on a Renishaw metal additive manufacturing (AM) machine at our Miskin facility near Cardiff, where all our AM systems are manufactured.”

To remove the sarcoma, Mr Maggs’ surgeons had to remove part of his sternum and three of his ribs. Without a prosthesis, this would have left his chest in an extremely unstable condition.

Heather Goodrum, Biomedical 3D Technician and Peter Llewelyn Evans, Manager of Maxillofacial Laboratory Services at Morriston Hospital, designed the implant using data from CT scans of Mr Maggs’ chest. Renishaw then produced the implant from titanium using its additive manufacturing technology, to the specification of the hospital.

“Additive manufacturing allowed us to produce an implant that was an excellent fit for the patient,” explained Ed Littlewood, Marketing Manager at Renishaw’s Medical and Dental Products Division. “Conventional prostheses are produced during surgery, once the affected area has been examined and the correct fit determined. Producing the implant in advance meant the surgery time was reduced, which benefitted the patient and the surgeon.”

The remaining bone in Mr Maggs’ ribcage was narrow and soft. Conventional prostheses, which are made of biocompatible cement, would not have been strong enough to support this bone.

“Traditionally, the patient would have been fitted with a Polymethyl Methacrylate (PMMA) implant, which can only be hand-fashioned during surgery,” explained Peter Llewelyn Evans, Maxillofacial Laboratory Services Manager at Morriston Hospital. “Additive manufacturing allowed us to save around two hours of surgery time, because the implant could be designed and manufactured prior to the procedure. The shorter the procedure time, the better it is for the health of the patient.

“Being able to manufacture the implant from titanium also increased its biocompatibility and closeness to the original bone structure, both leading to a better outcome for the patient.”

Due to Mr Maggs’ successful recovery, Morriston Hospital is planning to use additively manufactured implants to treat future patients of this kind.  

Renishaw’s Medical and Dental Products Division offers metal AM systems to additively manufacture a range of products for healthcare applications, including patient-specific implants (PSIs) for craniomaxillofacial surgery and dental frameworks.

Further Information

Please contact Chris Pockett on Tel: 01453 524113;     www.renishaw.com      www.renishaw.com/healthcare.

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