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Letters to the Editor Issue 250

by Letters(more info)

listed in letters to the editor, originally published in issue 250 - November 2018

Tribute Obituary Leon Chaitow ND DO 7 December 1937 – 20 September 2018

 

Leon Chaito

Facebook Tribute posted by  Complementary Health Professionals

 

Leon Chaitow was a greatly respected, even revered Osteopath, Bodywork Practitioner and Editor of Journal of Bodywork and Movement Therapy (JBMT). For many years he was an author and expert columnist with Positive Health magazine PH Online. His articles and columns may be read from his Author Profile Page.

Tribute from Sasha Chaitow

It is with great sadness that I must announce that after a long and uneven battle fought with courage, strength, and the humour that those who knew him were privileged to enjoy, as of September 20th 2018, Dr Leon Chaitow is no longer with us. Since early 2018 he found himself in failing health. Nevertheless, in that time, he was able to complete his last book, Fascial Dysfunction 2e, soon to be released by Handspring Publishers, and made arrangements for editorial succession of JBMT.  For those who knew him well; in the words of Dylan Thomas, Leon raged like few against the dying of the light and did not ‘go gentle into that good night.’ He died at home, in the arms of his beloved wife Alkmini and daughter Sasha, and now lies in the British cemetery in Corfu.  In truth Leon is not gone. His legacy lives on in his many books and articles, in the students he taught, in the patients he treated, and in the family to whom he was a most beloved husband and father whose loss will never fade. The greatest way to honour him is to continue to carry that torch and pass on the spirit and essence of his work. It is with great honour and pride that I, for one, shall do so. Arrangements are being made for a memorial service in London in coming months.

Sasha Chaitow PhD 21 September 2018

 

Leon Chaitow ND DO  graduated from the British College of Osteopathic Medicine in 1960. Since 1983 he has been a visiting lecturer at numerous chiropractic, physiotherapy, osteopathic, naturopathic and massage schools in Europe, USA, Canada, Australia.  He was the first naturopath/osteopath appointed as a consultant by the UK government to a medical practice. For 11 years he was a Senior Lecturer at the University of Westminster. He is author/editor of over 70 books and founding Editor-in-Chief of peer-reviewed & Medline indexed Journal of Bodywork & Movement Therapies (Elsevier).  He was awarded an Honorary Fellowship by the University in November 2005 for “services to Complementary and Osteopathic medicine”. Until the end of 2017 he continued to teach and practice part-time in London, when not in Corfu, Greece where he focused on his writing and enjoyed his garden with his adored wife of 47 years, Alkmini. Leon passed away at home after several months of failing health on 20 September 2018.

http://leonchaitow.com/

 

 

A moral governance crisis: the growing lack of democratic collaboration and scientific pluralism in Cochrane  

Resignation Letter from Peter C Gøtzsche ,  Professor, Director, MD, DrMedSci, MSc - 14 September 2018

I regret to inform you that I have been expelled from membership in the Cochrane Collaboration by the favourable vote of 6 of the 13 members of the Governing Board.  No clear reasoned justification has been given for my expulsion aside from accusing me of causing “disrepute” for the organization. 

This is the first time in 25 years that a member has been excluded from membership of Cochrane. This unprecedented action taken by a minority of the Governing Board is disproportionate and damaging to Cochrane, as well as to public health interests.  

As a result of this decision, and a number of broader issues concerning the inadequate governance of Cochrane, in accordance with its principles and objectives, four other members of the Board have resigned.  As a result, the Cochrane Collaboration has entered an unchartered territory of crisis and lack of strategic direction.  A recovery from this dire situation would call for the dissolution of the present board, new elections and a broad-based participatory debate about the future strategy and governance of the organization.  In just 24 hours the Cochrane Governing Board of thirteen members has lost five of its members, four of which are centre directors and key members of the organization in different countries.  

Recently the central executive team of Cochrane has failed to activate adequate safeguards, not only technical ones (which are usually very good) to assure sufficient policies in the fields of epistemology, ethics and morality. Transparency, open debate, criticism and expanded participation are tools that guarantee the reduction of uncertainty of reviews and improve the public perception of the democratic scientific process. These are conditions and tools that cannot be eliminated, as has happened recently, without placing into serious doubt the rigorous scientific undertaking of Cochrane and eroding public confidence in Cochrane´s work.  My expulsion should be seen in this context. 

There has also been a serious democratic deficit. The role of the Governing Board has been radically diminished under the intense guidance of the current central executive team and the Board has increasingly become a testimonial body that rubber-stamps highly finalized proposals with practically no ongoing in-put and exchange of views to formulate new policies.  On dozens of issues the Board can only vote yes or no with very little opportunity to amend or modify the executive team´s proposals. 

This growing top-down authoritarian culture and an increasingly commercial business model that has been manifested within the Cochrane leadership over the past few years threaten the scientific, moral and social objectives of the organization. Many Cochrane centres have sustained negative pressure and a lack of productive dialogue with the CEO of the central office. Upon alerting the Cochrane leadership of these worrisome tendencies that negatively affect the operability and social perception of our scientific work, the Nordic Cochrane Centre has received a number of threats to its existence and financing. Many of the directors or other key staff of the oldest Cochrane centres in the world have conveyed their dissatisfaction with the senior central staff’s interactions with them. While the declared aims of interactions with the central office are to improve the quality of our work, the heavy-handed approach of some of the central staff has sometimes created a negative environment for new scientific initiatives, open collaboration and academic freedom.  There has also been criticism in Cochrane concerning the over-promotion of favourable reviews and conflicts of interest and the biased nature of some scientific expert commentary used by the knowledge translation department of Cochrane.  

At the same time, Cochrane has been giving less and less priority and importance to its civic and political commitment to promoting open access, open data, scientific transparency, avoiding conflicts of interest and, in general, not promoting a public interest innovation model. I feel that these issues are intricately related to providing “better evidence” as the Cochrane motto professes.  Recently the Cochrane executive leadership has even refused to comment publicly on new health technology policies, open access policies and other key advocacy opportunities despite the fact that an auditing of Cochrane fulfilment of objectives has shown a total failure to comply with Cochrane advocacy objectives. There is stronger and stronger resistance to say anything that could bother pharmaceutical industry interests.  The excuse of lack of time and staff (around 50) is not credible. 

There has also been great resistance and stalling on the part of the central executive team to improving Cochrane´s conflict of interest policy. A year ago, I proposed that there should be no authors of Cochrane reviews to have financial conflicts of interests with companies related to the products considered in the reviews. This proposal was supported by other members of the Board, but the proposal has not progressed at all. 

The Cochrane executive leadership almost always uses the commercial terms of “brand”,  “products” and “business” but almost never describes what is really a collaborative network with the values of sharing, independence and openness. To the chagrin of many senior leaders in Cochrane, the word “Collaboration”, which is part of our registered charity name, was deleted from communications about Cochrane. Nevertheless, it is precisely “collaboration” that is the key to what distinguished Cochrane from other scientific organisations where competition is at the forefront. The collaborative aspect, social commitment, our independence from commercial interests and our mutual generosity are what people in Cochrane have always appreciated the most and have been our most cherished added-value. 

Often it is forgotten that we are a scientific, grass-roots organisation whose survival depends entirely on unpaid contributions from tens of thousands of volunteers and substantial governmental support throughout the world. We make a substantial contribution to people’s understanding and interpretation of scientific evidence on the benefits and harms of medical interventions, devices and procedures that impact the population.  

Our work informs government legislation globally, it influences medical guidelines and drug approval agencies. Therefore, the integrity of the Cochrane Collaboration is paramount. We pride ourselves on being global providers of “trusted evidence” on a foundation of values such as openness, transparency and collaboration.

However, in recent years Cochrane has significantly shifted more to a business - a profit-driven approach. Even though it is a not-for-profit charity, our “brand” and “product” strategies are taking priority over getting out independent, ethical and socially responsible scientific results. Despite our clear policies to the contrary, my centre, and others, have been confronted with attempts at scientific censorship, rather than the promotion of pluralistic, open scientific debate about the merits of concrete Cochrane reviews of the benefits and harms of health care interventions.

Because of this moral governance crisis of the Cochrane Collaboration, I decided to run for a seat on the Governing Board and was elected in early 2017, with the most votes of all 11 candidates. It was considered an achievement, especially since I was the only one who had questioned aspects of our leadership. Regrettably today, I have been expelled because of my “behaviour”, while the hidden agenda of my expulsion is a clear strategy for a Cochrane that moves it further and further away from its original objectives and principles. This is not a personal question. It is a highly political, scientific and moral issue about the future of

Cochrane. As most people know, much of my work is not very favourable to the financial interests of the pharmaceutical industry. Because of this Cochrane has faced pressure, criticism and complaints. My expulsion is one of the results of these campaigns. 

What is at stake is the ability of producing credible and trustworthy medical evidence that our society values and needs. 

Peter C Gøtzsche ,  Professor, Director, MD, DrMedSci, MSc

Nordic Cochrane Centre, Rigshospitalet, Dept 7811

Tel: +45 35 45 71 12   general@cochrane.dk    www.nordic.cochrane.org

 

 

Top Official at Memorial Sloan Kettering Resigns After… - ProPublica

Charles Ornstein, Katie Thomas

 

Re-published from propublica.org

https://www.propublica.org/article/memorial-sloan-kettering-official-jose-baselga-resigns-after-failing-to-disclose-industry-ties

 

This story was co-published with The New York Times.

Update, September 13, 2018: This story has been updated throughout.

Update, September 14, 2018: On Friday afternoon, Dr José Baselga resigned from the board of drugmaker Bristol-Myers Squibb, which he served on since March.

Dr José Baselga, the chief medical officer of Memorial Sloan Kettering Cancer Center, resigned on Thursday amid reports that he had failed to disclose millions of dollars in payments from health care companies in dozens of research articles.

The revelations about Baselga’s disclosure lapses, reported by The New York Times and ProPublica last weekend, have rocked Memorial Sloan Kettering, one of the nation’s leading cancer centers, in recent days. Its top executives scrambled to contain the fallout, including urgent meetings of physician leaders and the executive committee of its board of directors.

In his resignation letter released Thursday, Baselga, who also served as the physician-in-chief, said he feared that the matter would be a distraction from his role overseeing clinical care and that he had been “extremely proud” to work at Memorial Sloan Kettering.

“It is my hope that this situation will inspire a doubling down on transparency in our field,” he said, adding that he hoped the medical community would work together to develop a more standardized system for reporting industry ties.

In an email sent to the staff Thursday evening, Dr Craig B Thompson, the hospital’s chief executive, said that Baselga had made “numerous” contributions to Memorial Sloan Kettering, patients and cancer treatment. Dr Lisa DeAngelis, the chairwoman of neurology, will take over as acting physician-in-chief until Baselga’s successor is hired.

The resignation was effective immediately, and he will have no continuing role at the cancer center, although he will stay for two weeks to ease the transition, said Christine Hickey, a spokeswoman for the cancer center.

Thompson echoed comments he made to the hospital staff on Sunday, saying that the cancer center had “robust programs” in place to manage employees’ relationships to outside companies, but that “we will remain diligent.” He added, “There will be continued discussion and review of these matters in the coming weeks.”

Baselga, a prominent figure in the world of cancer research, omitted his financial ties to companies like the Swiss drug maker Roche and several small biotech start-ups in prestigious medical publications like the New England Journal of Medicine and the Lancet. He also failed to disclose any company affiliations in articles he published in the journal Cancer Discovery, for which he serves as one of two editors in chief.

All told, ProPublica and The Times found that Baselga had failed to report any industry ties in 60 percent of the nearly 180 papers he had published since 2013. That figure increased each year - he did not disclose any relationships in 87 percent of the journal articles that he co-wrote last year.

In an interview and later statement, Baselga said he planned to correct his conflict-of-interest disclosures in 17 journal articles, including in the New England Journal and the Lancet. But he contended that in dozens of other cases, no disclosure was required because the topics of the articles had little financial implication. He also said his failed disclosures were unintentional and should not reflect on the value of the research he conducted.

Baselga and Memorial Sloan Kettering said that he had disclosed his industry relationships to the cancer center.

The New England Journal and the Lancet, as well as professional societies like the American Society of Clinical Oncology and the American Association for Cancer Research (AACR), said they were conducting reviews of Baselga’s disclosure practices after inquiries from The Times and ProPublica. Baselga was president of the AACR in 2015 and 2016 and appears to have violated disclosure rules for reporting conflicts of interest during that period.

In his statement Thursday, Baselga said that he took full responsibility for his disclosures and that he had already submitted updates to medical journals “and will continue to do so until the record is complete.”

A spokeswoman for the New England Journal, Jennifer Zeis, said in an email Thursday that Baselga had submitted changes to his disclosures but that editors had questions for him before the articles could be corrected. A spokeswoman for the AACR said that organization was continuing to review Baselga’s disclosures.

Baselga, 59, is an expert in breast cancer research and played a key role in the development of Herceptin, which was developed by Genentech, a subsidiary of Roche. He came to Memorial Sloan Kettering in 2013 after serving as chief of haematology and oncology at Massachusetts General Hospital in Boston. Before that he was a leader at the Vall d’Hebron Institute of Oncology in Barcelona, Spain.

Medical journals and professional societies have imposed stricter rules about reporting relationships to industry after a series of scandals a decade ago in which prominent physicians failed to disclose payments from drug companies. But medical journals have said they don’t routinely fact-check authors’ disclosures, and much is left to the honour system.

Ethicists say that outside relationships with companies can shape the way studies are designed and medications are prescribed to patients, allowing bias to influence medical practice. Reporting those ties allows the public, other scientists and doctors to evaluate the research and weigh potential conflicts.

Jeffrey S Flier, who was dean of the Harvard Medical School from 2007 to 2016, said medical leaders should be held to a higher standard.

“The higher you are in the organizational structure, the more important it is that you fulfil those obligations,” he said. “You’re not just another faculty, you’re also a faculty to whom other people look up and your reputation is tied to the institution’s reputation.”

That said, he added, relationships between academic faculty members and the health care industry are essential to developing new drugs.

Baselga has extensive ties to a range of companies, including sitting on the board of the large pharmaceutical company Bristol-Myers Squibb and serving as a director of Varian Medical Systems, which sells radiation equipment and for whom Memorial Sloan Kettering is a client.

Baselga has served on the boards of at least four other companies since 2013, and the positions required him to assume a fiduciary responsibility to protect the interests of those companies, even as he oversaw the cancer centre’s medical operations. Baselga and Memorial Sloan Kettering have said the cancer center has put firewalls in place to prevent any conflicts.

Baselga received nearly $3.5 million in payments from drug, medical equipment and diagnostic companies from August 2013 through 2017, according to Open Payments, a federal database that tracks payments to physicians from health care companies. Most of that amount, about $3 million, involved a payment from Genentech for Baselga’s ownership interest in a company it acquired, Seragon Pharmaceuticals, in 2014.

But the $3.5 million in the Open Payments database does not include payments from companies that don’t have products approved by the Food and Drug Administration. Such companies are not required to report their payments under federal law.

For instance, Infinity Pharmaceuticals, a start-up with no approved drug, paid Baselga nearly $250,000 in cash and stock options for serving on its board from 2015 to 2017. He declined to disclose how much he received from such companies.

Baselga was one of the highest-paid staff members at Memorial Sloan Kettering, earning more than $1.5 million in 2016, the most recent year for which the nonprofit’s financial filings are available.

About the Author

Katie Thomas covers the pharmaceutical industry for The New York Times.

Source and Acknowledgement Citation

Re-published from propublica.org

https://www.propublica.org/article/memorial-sloan-kettering-official-jose-baselga-resigns-after-failing-to-disclose-industry-ties

 

 

Gene Therapy Breakthrough in Treating Rare Form of Blindness

The positive results of the world’s first gene therapy trial for a genetic cause of blindness known as choroideremia have been reported in this week’s edition of Nature Medicine. [1]

The trial involved 14 patients receiving a single injection into the back of the eye of a virus containing the missing gene and began in 2011 at the Oxford Eye Hospital - part of the Oxford University Hospitals NHS Foundation Trust. By the end of the study there was a significant gain in vision across the group of patients as a whole.

Furthermore, of the 12 patients who received the treatment without any complications, 100% either gained or maintained vision in their treated eyes, which was sustained for up to 5 years at the last follow up. During this time only 25% of the untreated eyes which acted as controls maintained vision. The gene therapy treatment was generally well tolerated and there were no significant safety concerns.

Professor Robert MacLaren the ophthalmologist who led the trial said: “The early results of vision improvement we saw have been sustained for as long as we have been following up these patients and in several the gene therapy injection was over 5 years ago. The trial has made a big difference to their lives.”

The success of the Oxford study has since led to a much larger international gene therapy trial involving over 100 patients across nine countries in the EU and in North America. It is now led by Nightstar Therapeutics, a gene therapy spin-out company established by the University of Oxford and Syncona to develop the treatment further. If successful the follow on trial could result in the gene therapy treatment being formally approved by the relevant regulatory bodies worldwide.

Overall gene therapy is a new treatment that is currently being developed in several trials for a variety of diseases. The concept of gene therapy is to alter or correct inherited diseases at the level of the DNA and if successful, a single treatment might have life-long effects. These early results support the notion that a single gene correction can have long-lasting beneficial effects on nerve cells of the retina to prevent blindness.

Choroideremia is one disease in a spectrum of inherited eye diseases sometimes referred to as ‘retinitis pigmentosa’ and which have now become the most common cause of untreatable blindness in young people. Last month, the European Medicines Agency formally approved its first gene therapy treatment for a different eye disease. Experts predict that other currently incurable diseases are likely to follow and will have approved gene therapy treatments in future years.

Dr Neil Ebenezer, Director of Research, Policy and Innovation at Fight for Sight, said: “All research breakthroughs are made by standing on the shoulders of others. Our mission is to fund research that will stop sight loss and we’re delighted to have been part of this breakthrough which will have huge benefits for the future. This technique could transform how we treat diseases and could have broad applicability to a range of other conditions.”

Chris Hollowood, Chief Investment Officer at Syncona, commented: “Nature Medicine’s publication of the findings of the first choroideremia gene therapy trial is a great endorsement of the work by Professor Robert Maclaren and the team and validation of the early results that encouraged Syncona to partner with Robert to found and build Nightstar. Since then, Nightstar has advanced the therapy to a pivotal Phase 3 trial. We look forward to continuing our support of Robert and Nightstar as we seek to bring transformational treatments to patients.”

Reference

1. Kanmin Xue, Jasleen K Jolly, Alun R. Barnard, Anna Rudenko, Anna P. Salvetti, Maria I. Patrício, Thomas L. Edwards, Markus Groppe, Harry O. Orlans, Tanya Tolmachova, Graeme C. Black, Andrew R. Webster, Andrew J. Lotery, Graham E. Holder, Susan M. Downes, Miguel C. Seabra & Robert E. MacLaren.  Beneficial effects on vision in patients undergoing retinal gene therapy for choroideremia,’ Nature Medicine Letters. Nature Medicine 24: 1507-17. 2018. https://www.nature.com/articles/s41591-018-0185-5

Source and Further Information

Chris McIntyre in the University of Oxford press office at christopher.mcintyre@admin.ox.ac.uk

Tel: +44 (0)1865 270 046

 

 

Malaysian Medicinal Herb has Anti-diabetic Properties

Chemical analysis of the plant Cosmos caudatus Kunth reveals that it contains substances that can lower blood sugar naturally. Researchers identify the chemical constituents in C. caudatus extract using Liquid Chromatography Mass Spectrometry (LCMS).

Copyright : Dr. Khozirah Shaari/UPM

Researchers in Malaysia have shown that the plant Cosmos caudatus Kunth contains chemicals that can lower blood glucose levels. These plant-based substances could be investigated further as potential therapeutic agents to help manage high blood sugar in diabetes, a disease that affects 422 million people worldwide.

Diabetes takes several forms, but is commonly characterized by the body’s inability to properly produce or respond to the hormone insulin, which leads to elevated glucose levels in the bloodstream. Controlling blood glucose is crucial because elevated sugar levels can damage the heart, eyes, nerves, blood vessels, and kidneys.

Cosmos caudatus, known as Ulam raja (“King’s Salad”) in Malaysia, is an important herb commonly consumed as a raw vegetable that is well-known for its health benefits. It is found in Southeast Asia, particularly Indonesia and Malaysia. Cosmos caudatus has long been used in traditional medicines to help treat high blood pressure, arthritis, fever and diabetes.

To see what might be behind these reported benefits, researchers from Universiti Putra Malaysia (UPM) and International Islamic University Malaysia characterised the chemical profile of C. caudatus leaves. They created an extract from dried, ground leaves of the plant using an organic solvent, and then analysed the chemical constituents present in the extract. They showed that C. caudatus is rich in chemicals known as flavonoid glycosides, which can reduce blood glucose levels by inhibiting α-glucosidase, an intestinal enzyme involved in glucose uptake in the gut. Further analysis is required to quantify exact amounts of flavonoid glycosides present and compare to other sources.

The researchers also performed a biochemical test to assess the antioxidant potential of the flavonoid glycosides in C. caudatus. This is relevant to treating diabetes because the disease can lead to cellular damage caused by increased production of reactive oxygen species. They found that the flavonoid glycosides showed “very good” free radical scavenging activity -- one of the more potent extracts inhibited up to 84.5% of free radical activity in a test tube.

The results, published in the Pertanika Journal of Tropical Agricultural Science, indicate that C. caudatus leaves are a rich source of bioactive compounds, and could be further investigated for development into a botanical nutraceutical product for diabetes and blood sugar management. Further research will be required to determine to what extent the plant’s bioactive compounds could lower blood glucose and reduce free radicals in people with diabetes, as well as any potential side effects.

“We hope to next carry out an animal study to validate the pharmacological effect of the plant extract and further understand its mechanism of action,” says Khozirah Shaari, chemistry professor at Universiti Putra Malaysia. 

Further Information

Prof. Dr. Khozirah Shaari,  Laboratory of Natural Product, Institute of Bioscience

Universiti Putra Malaysia 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia 

khozirah@upm.edu.my   Tel: +(603) 8946 8081 

Petranka Journal

http://www.pertanika.upm.edu.my/

The paper is available from this link:

http://www.pertanika.upm.edu.my/Pertanika%20PAPERS/JTAS%20Vol.%2041%20(3)%20Aug.%202018/32%20JTAS%201327-2018.pdf

Further information about the Journal

The Chief Executive Editor (UPM Journals), Pertanika Journal

Office of the Deputy Vice Chancellor (R&I), Tower II, UPM-MDTC, Putra Science Park

Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan MALAYSIA

Phone: +(603) 8947 1622   executive_editor.pertanika@upm.my

Date of Release: 02 October 2018.

Acknowledgements

The Chief Executive Editor, UPM Journals

 

 

Probiotics Branded ‘Useless’: But What’s the Truth?

In a widely-shared news story published on 6 September, a group of Israeli scientists found no long-term benefit to probiotic consumption.[1, 2]

Researchers had studied samples surgically extracted from multiple sites in volunteers’ stomach and intestines. These samples were taken after the volunteers consumed a probiotic cocktail containing 11 strains of ‘good bacteria’.

There are two key points worth making. Number one: the response to the story has been overblown, and many outlets have failed to conceal their glee in dishonestly reporting that probiotics are – to incompletely quote the study’s lead author – ‘quite useless.’

Number two: the news itself is unsurprising and probably quite correct.

Although the results have stunned many, we were not unduly surprised given the nature of probiotic bacteria commonly found on the market. Most probiotics are wholly ineffective as far as meaningful, long-term intestinal colonisation is concerned, and we’ll explain why.

‘The Probiotics Don’t Work’: The 2018 Study

One of the main questions surrounding probiotics is: what really reaches the gut? It’s fairly simple to determine how much probiotic bacteria is in a food or supplement (at least at the time of manufacture), but how many microbes take hold in the gut and become part of the microbiome? Immunologist Eran Elinav of the Weizmann Institute of Science attempted to find this out. He did so by directly sampling volunteers’ microbiome using endoscopies and colonoscopies. As part of the study, 15 healthy volunteers were selected and chosen to receive either a commercially-available supplement or a placebo for a period of four weeks. The supplement’s 11 strains comprised the four major Gram-positive bacterial genera typically used in off-the-shelf probiotics: namely Lactobacillus, Bifidobacterium, Lactococcus and Streptococcus. The supplement contained 5 billion Colony-Forming Units.

In half of the probiotic group, the supplemental bacteria was shown to basically pass right through them: going in one end and out the other. In the remainder, the bacteria lingered before eventually being crowded out by highly competitive existing microbes. This according to colonoscopy and enteroscopy analysis conducted weeks after the introduction of probiotic consumption. As well as humans, the Israeli researchers tested the effect of probiotic supplements on the intestines of mice. Interestingly, they found that “gut probiotics colonization in supplemented GF (germ-free) mice increased by 10-fold, 5-fold, 20-fold, and 50-fold in the UGI lumen, UGI mucosa, LGI mucosa and LGI lumen.”

Valid Talking Points from the Probiotic Study

Several very important points were made by the Israeli researchers, but for the most part they were not faithfully reproduced in the clickbait articles.

  • “Significant inter-individual human microbiome variability mediated by factors such as age, diet, antibiotic usage, food supplements, underlying medical conditions, and patterns of circadian activity can impact effects of probiotics.”
  • “Humans display considerable person-to-person variation in gut microbiome composition, which may be more permissive to colonisation with exogenous probiotics bacteria.”
  • “We observed a significant inverse correlation between initial levels of a given probiotics species in a given GI region and its fold change, i.e., low abundant species were more likely to expand than those already present in high loads.”
  • “Gut mucosal colonisation may be highly dependent on the capacity of probiotics to interact with locally-entrenched microbiome niches, which vary in their physiological properties along the GI tract.”
  • “When all probiotics-consumers were considered together, probiotics consumption led to transcriptional changes in the ileum, with 19 down-regulated and 194 up-regulated genes noted, many of which related to the immune system including B cells.”

Something else that wasn’t reported in the juicy ‘Probiotics Are Useless’ story was that the results weren’t quite as terrible as they seemed on first glance. To quote from the study, "some participants featured significant gut mucosal association of probiotics as compared to others.”

Probiotics were described for two participants in particular as “very significantly colonising” and four more subjects were identified as “permissive”. Permissive is a term used to describe “individuals with a significant elevation in the absolute abundance of probiotic strains in their GI mucosa.” Among permissive participants, total bacterial load remained higher than baseline even a month after the cessation of probiotics, and following supplementation “descending colons of permissive individuals became enriched for three pathways associated with humoral immune response and cytokine-mediated signalling.”

“Taken together, these findings point out that human consumption of the examined 11 probiotic strains results in universal shedding in stool but with highly individualised lower gastrointestinal mucosa colonisation patterns.”

Lastly, “it is important to note that the conclusions reached in our study are based on the use of one multi-strain probiotic preparation by healthy adults.”

The wording is important here. One multi-strain probiotic preparation. Extrapolating these results to say “all probiotics are useless” is rather ludicrous.

Why Most Probiotics Don’t Colonise the Gut

What the study seemed to show is that most forms of exogenous bacteria are unable to colonize and provide long-term benefits. We do not disagree. One of the main reasons probiotics don’t work is that our microbial community is too inhospitable, too competitive. We are home to tens of trillions of microbial cells, and this ecosystem operates much like a jungle, with fierce competition between microbes serving to maintain a degree of stability.

Believe it or not, our microbial cells outnumber our human cells. As outlined in a 2016 review of four decades’ research into the human microbiome, the average man (weighing 70kg and aged 20-30) harbours 39 trillion bacterial cells compared to 30 trillion human cells.

It is foolish to think that consuming 5 billion microbes will have a meaningful long-term effect. 5 billion is a drop in the ocean when you consider how much resistance those microbes are going to meet from entrenched resident bacteria.

For every microbe introduced via supplement in the Israeli study, there would have been approximately 7,800 resident microbes waiting to crowd it out.

Most probiotics on the market contain one, five or ten billion Colony-Forming Units, and therein lies the problem. Even those marketed as high-strength contain 50 or 100 billion, with just a handful boasting a CFU count upward of 100 billion. Although some will argue that strength doesn’t matter, supplements containing more viable live bacteria are clearly more likely to overcome the competition problem. This was demonstrated by a previous study which assessed the merits of using probiotics for lowering blood pressure. Researchers found that the magnitude of improvement was greater "when daily dose of probiotics exceeded 100 billion." There are other factors to consider when assessing the effectiveness of gut-health supplements. One concerns the source of the probiotics. You might wonder where manufacturers derive their microbes. The truth is that almost all of them use bacteria cultivated from the digestive tracts of animals (usually cows) or from plants/soil.

Naturally, the effectiveness of probiotic supplements can depend on the quality of this source, as well as the number of strains present. Bacteria which intuitively lives within plants or cows is not optimised for the human gut.

Important Considerations When Choosing a Probiotic

The way we see it, there are three factors to consider when contemplating whether a probiotic will work.

  • Source of probiotic bacteria
  • Probiotic potency
  • Gut environment

We discussed the first two in the previous section. But what about gut environment?

As was clear from the Israeli study, results were highly individualised from person to person. Factors such as age, diet, antibiotic usage, food supplements, underlying medical conditions and patterns of circadian activity determined the extent to which colonisation occurred.

We would suggest that other factors include pH and electrolyte balance, body temperature (since gut microorganisms thrive in incubation, warm is better), circulation, nutrient flow, vitamin D levels and omega-3 status. With so many aspects to consider, it’s little wonder some volunteers responded better to probiotics than others.

What to Take Away from the 2018 Study

  • The idea that everyone can benefit from a universal probiotic bought from the supermarket or chemist is wrong. Probiotic colonisation patterns are dependent on both the individual and the supplement used;
  • Dr. Elinav did not brand probiotics useless. His exact quote was that “buying probiotics at the supermarket without any tailoring, without any adjustment to the host, at least in part of the population, is quite useless.”

In closing, let us not forget that there have been several studies which stressed the benefit of probiotics. A review of 313 randomized controlled trials published earlier this year in the British Medical Journal, for example, found that taking probiotics helped to prevent diarrhoea, bronchitis and eczema. The studies further highlighted improvements in heart disease risk and inflammation markers in the blood. As with other sensationalist news stories, it is worth digging deeper to uncover the truth.

References

1. Suez J, Zilberman-Schapira G, Halpern Z, Segal E, and Elinav E. Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT Cell 174: 1406-1423.E16, 6 Sept 2018. DOI: https://doi.org/10.1016/j.cell.2018.08.047  

2. Zmora N, Zilberman-Schapira G, Suez J, Halpern Z,Segal E, and Elinav E. Personalized Gut Mucosal Colonization Resistance to Empiric Probiotics Is Associated with Unique Host and Microbiome Features. Cell 174: 1388-1405.E21, 6 Sept 2018. DOI: https://doi.org/10.1016/j.cell.2018.08.041

Source and Acknowledgement Citation

Republished from water-for-health.co.uk

https://www.water-for-health.co.uk/our-blog/2018/09/probiotics-branded-useless-but-whats-the-truth/

 

 

Martin Walker – Plea to Fund Printing of his latest Book

Republished from Martin Walker

https://www.facebook.com/frakatime/posts/10217907827306176

 

This is a plea. I have almost finished my latest book, it has taken almost ten years. I won't say what it's about but those who know my work will know that it is, as always on behalf of others.

However I can't raise the money to get it printed, or for that matter for me and my family to live. It has become impossible for me to raise money myself and my age is gradually wearing me down and making my responsibilities impossible.

Two things, Any money will be accepted with gratitude. A 'secretary' type person who worked to raise money would be greatly appreciated.

Just for your information here is the list of my previous writing all done on behalf of the disadvantaged, all published without money and many of them without publishers:

Books

  • Poor Man, Beggar Man, Thief (1972)
  • Frightened for my life (with Geoff Coggan 1982)
  • State of Siege (with Jim Coulter and Susan Miller 1984)
  • A Turn of the Screw (1985) ·With Extreme Prejudice (1986)
  • Dirty Medicine (1993)
  • A Cat in Hell’s Chance, ed. Walker (2002
  • Catti di Hillgrove (published in Italian)
  • SKEWED (2003)
  • Brave New World of Zero Risk (2005)
  • HRT: Licensed to Kill and Maim (2006)
  • The Fate of a Good Man (2007)
  • Cultural Dwarfs and Junk Journalism (2008)
  • Silenced Witnesses, ed. Walker I (2008)
  • Silenced Witnesses, ed. Walker II (2009)
  • Autiste: depuis le Vaccin, de partents temoignent (I/II published in French (2017) Overthrowing the Temple (2011)
  • Dirty Medicine: The Handbook (2011)
  • Corporate Ties That Bind: An Examination of Corporate Manipulation and Vested Interest in Public Health. (editor) (2017)

Essays

  • Company Men
  • The Ghost Lobby
  • The Complainant
  • Vaccine Damage Denial and the UK Press
  • To Encourage The Others
  • An Interest in Conflict Uncomfortable Science and Enemies of the People
  • The Urabe Farrago
  • Science is the New Politics
  • The Great Pretender
  • Nothing for an eye: The Camelford water poisoning case
  • Lots of Law but Little Justice

Reporting

 

Further Information

For more information please contact http://www.slingshotpublications.com

Acknowledgement Citation

Martin Walker

https://www.facebook.com/frakatime/posts/10217907827306176

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