Mannatech is a scam - here is a summary of the "evidence" their science website provides

Mannatech is a pyramid scheme.  Ahem. Sorry - multi-level marketing scheme.

For more information and excellent research on Mannatech and their tactics - here you go:

http://mannatechscams.com/

A while back, an old friend from high school phoned me and asked whether I would like to make some money.

Tip: If any conversation starts like this, you are either going to end up broke and/or in jail.

He was selling Mannatech.  But I was not sure he knew what he was selling. So I offered to read up, in detail, about the product (which I knew to be a scam) - and get back to him.

We never did get to discuss the issue, but I did spend quite a few hours reading Mannatech's literature and writing a report on their "proof".

http://mannatechscience.org/home/publications

So now I have this piece, and no-one to share it with.  Except for the internet.

Maybe he reads my blog.

Maybe no-one in their right mind reads this.

So, well done for making it this far, you.

*playful shoulder punch*

Titled as "Love Punch 3". Wow. Such flirtation.

So here is a short (and perhaps not so sweet) shot at a company that can afford to pay 7 million dollars in fines and still be, well...fine.



First: Levels of evidence:

This diagram represents with how much confidence we can make claims about certain topics.  Not everything in medicine will ever be meta-analysis supported and this is partly due to ethics and practicality.  Anything that wants to make it into medicine has to, first of all, be based on a high level of evidence.

The evidence pyramid  is one of the great scientific wonders of the world.

The role of expert opinion, anecdotes and testimonials:

Firstly – when measured against the above – Mannatech's marketing, based on many testimonials is inappropriate, no matter how tempting it is.

Secondly, anecdotes are easily selected through cherry-picking and are subject to a confirmation bias.

Dr Darryl See, is/was Mannatech's science man.

He has had to surrender his medical license after a deluge of many, many accusations.

So...yeah.

Lastly, even if the internet is flooded with people making claims about Mannatech (or penis enlargement or weight-loss products) we must look beyond testimonials and look for evidence.

Sample sizes, p-values and confidence intervals

So say a study is a randomized controlled trial which has been double blinded.  Great.  But what is the P-value (measure of how likely this outcome was the result of chance), confidence interval (of the P-value), and overall quality of the research? 

Many studies, through their design, introduce biases which make positive results inevitable.  This is why it is very important that investigators share this information in great detail.

Large sample sizes which are representative of the population you want to apply the evidence to must be present in order to ensure that the findings are meaningful.

Patents are not evidence

A patent on any substance does not prove efficacy.  There are hundreds of thousands of patents on things which don’t work.

Trademarks and Registration are not evidence

The fact that Smarties™ is a trademarked, does not allow Nestle™ to make the claim that eating Smarties™ will make you smarter.

Citing inappropriate research

Research must directly support the claim that is being made, preferably in as similar a setting as possible.  If a claim is made about something for a certain condition – I must have the best available evidence at hand, done in as similar a population as possible for the same indication.

For example – if I want to prescribe a drug to reduce post-operative nausea and vomiting in children after anaesthesia for tonsillectomies, I need evidence gathered in as similar a setting as possible.

So if I want to claim that a drug works for people with MS, SLE, ischaemic heart disease, etc, I need to have evidence (high up on the diagram above), with a large sample size (determined statistically), and done in a population similar to the one I want to apply my results to.

With that in mind, let’s discuss the articles cited as proof for Mannatech.  The same articles were listed multiple times.  All of them were inappropriate.  

Virtually all of them are either completely unrelated for the claims being made, suffer from major methodological flaws, such as small sample sizes or lack of controls, or do not support the notion that supplementation offers a significant benefit:

BounceBack™ capsules for reduction of DOMS after eccentric exercise: a randomized, double-blind, placebo-controlled, crossover pilot study

·    The fact that it is randomized, double-blind and placebo controlled sounds impressive, but it is unimportant.

·    Study only contained 10 participants.  The confidence intervals (which were not given) would most likely make the P-values meaningless

Brain-Specific Effects of Ambrotose® Products: A Preliminary Animal Study to Investigate Cognitive Benefits Found in Humans

·    Looks like a Meta-analysis, but is a collection of studies on healthy people, (each with its own major limitations (small sample sizes, lack of third-party involvement) and, most importantly, the use of healthy subjects precludes any possibility of generalizing to a diseased population.

·    The study itself is done on mice.  No health claims can be made from this.

Human Colonic Bacteria Can Utilize Stabilized Aloe Vera Gel Polysaccharides and a Mixed Saccharide-Based Glyconutritional Dietary Supplement, Advanced Ambrotose

·    This study doesn’t show anything.

·    It shows that a bacteria can metabolize a polysaccharide.  Anyone could show the same with a petri dish, their own stool, and some agar gel.

Effect of a combination dietary supplement product (BounceBack^TM) on the signs and symptoms of delayed onset

muscle soreness after eccentric exercise: a randomized, double-blind, placebo-controlled, crossover pilot study

·    This study is the same one as the first one.

·    Only ten people participated.

·    The results (which would only be applicable to post exercise muscle soreness) are meaningless.

Effects of a Glyconutritional Supplement on Brain Potentials Associated with Language Processing

·    This study’s results are reported as “not statistically significant”. 

·    If you were to make generalizations from its findings, (which you shouldn’t), it would only be useful in refuting claims that Ambrotose works at all.

·    The most concerning is that this poster is happily cited as proof in the second article.

Immunomodulatory dietary polysaccharides: a systematic review of the literature

·     Nothing to do with Mannatech

·    Literally every English study ever  conducted on polysaccharides and the immune system.

·    Applicability:

o    “Taken as a whole, the oral polysaccharide literature is highly heterogenous and is not sufficient to support broad produce structure/function generalizations.”

Chemical characterization of polysaccharide-rich ingredients from Aloe vera, Larix laricina, Larix occidentalis, and Undaria pinnatifid

·    Nothing to do with Mannatech

·          Just a description of polysaccharides in terms of molecular weights and sugar contents.

Immunomodulatory activity of polysaccharides isolated from Clerodendrum splendens: Beneficial effects in experimental autoimmune encephalomyelitis

·    This study was conducted on a special type of mutant mice.

·     No generalizations can be made unless you are treating these mutant mice.

Intestinal microbiota’s naturally occurring enzymes and their  effects on plant polysaccharide digestion

·     This poster only showed that certain bacteria can digest polysaccharides.

A sensitive in vitro method for evaluation of immunostimulatory properties of natural products

·     This poster does not provide any proof for Mannatech at all and merely describes chemical analysis method and the effects of these chemicals when added to petri dishes of cells.

The Effect of Dietary Supplements on the Quality of Life of Retired Professional Football Players

·          Sample size was fifteen

·          Many, many different substances were used.

·          Self-reporting was the measurement.

·          No evidence for Mannatech’s efficacy.

An open-label dosing study to evaluate the safety and effects of a dietary plant-derived polysaccharide supplement on the N-glycosylation status of serum glycoproteins in healthy subjects

·          Sample size was 18

·          No confidence intervals given.

·          Limited information on samples.

·          Not clear how this relates to Mannatech products.

Effect of Ambrotose AO^® on resting and exercise-induced antioxidant capacity and oxidative stress in healthy adults

·     Sample size is 25.

·     “No statistically detected difference is observed in resting or exercise-induced oxidative stress biomarkers, in quality of life, or in GXT time to exhaustion.”

·     Study shows no statistically significant change.

Best, T. Bryan J, Burns N. An investigation of saccharide effects on memory performance. Abstracts of the 12th Annual Australian Psychiatry Conference, 2005.

·     “There were no statistically significant effects of the treatments on  the performance on any of the outcome measures”

The influence of a pre-exercise sports drink (PRX) on factors related to maximal aerobic performance

·     Sample size is 29

·     No confidence intervals given

·     Not generalizable

The Effectiveness of a Pre-Exercise Performance  Drink (PRX) on Indices of Maximal  Cardiorespiratory Fitness

·    Sample of 24

      Water might not be an appropriate placebo in this case.

·          The finding of increased cardiorespiratory fitness measurements after ingesting an energy drink is bizarre.

The effects of whey protein on cardiometabolic risk factors

·    This is an actual study on whey protein.  Which appears to be scientific.

·    It has nothing to do with Mannatech and was conducted by an independent research group.

Conclusion

Mannatech’s own website offers no evidence for their own products or any claims regarding their products’ efficacy.  

They just think that you are too stupid to read that which they have given you.

Essentials for Battling Bad Science

So, in scouring the web, one must sometimes take a break from fighting bad science (in your own, humble, insignificant way) and reflect upon your motives.

I have been doing a LOT of reflecting lately. A course in philosophy (along with a bit more free time than usual) can do that to a man.

Here are two videos (one to inspire and one to delight - both can do either, and both can do both, but neither can do neither):

The first is by the greatest philosopher of science, Karl Popper:
It is as relevant today as when it was written.


The second is by the British comedian, musician and science-defender, Tim Minchin:
His exchange might sound familiar if you have been living on principal, as many cannot help but do.



There.  Now you are all fired up.
Go fight argue with a homeopath.

Circumcision craziness

This is really the saddest article I have read in a long time.

http://mg.co.za/article/2013-08-16-00-the-boys-who-lost-their-manhood

Read it and weep.

All of the cost, but probably none of the benefits

Elexoma: CES is almost as trendy as an iPod, even larger, more expensive and potentially useless (with a sliver of questionable evidence)..
You are right.  Your anecdotes are so comprehensively convincing, unique and unlike any other claims made by alternative medicine products, that  I want to buy your device for R4999, now!

Why is it that drugs and therapies which have been shown to work in clinical trials do not rely on anecdotes and testimonials to sell their products?

Why do products which have never been shown to work in a clinical trial and have no or unconvincing evidence, rely on testimonials and anecdotes and shy away from using numbers to convince us?

I think the first group is sure of their claims - because well-designed clinical trials and meta-analyses support them.

The second group is merely afraid of saying that a bottle of sugar pills works just as well.  I can understand that this is not a very good marketing strategy for your banaba leaf extract drug.  Obvious this is an oversimplification and many drugs whose efficacy we currently accept as dogma will fall between these two points on the spectrum.

But what about this:

http://www.elexoma.co.za/

Elexoma is a company which sells a cranial electrotherapy stimulation device (CES).  It is interesting.  They don't seem to fall into either category completely.  Certainly their claims with regards to their product seem suspiciously comprehensive.  But I think we should start digging.

They list tons of literature on their website, but as we have seen with antagolin, this doesn't mean diddly-squat unless it is relevant.  So the question is:

"Is there any evidence that Elexoma works for any of the conditions which the proprietors claim?  If so, which ones and what is the level of evidence?

The Wikipedia article should put us off to a good start.
http://en.wikipedia.org/wiki/Cranial_electrotherapy_stimulation


Ready?
Set?
Go!

Dr. Quack (MD)

An interesting phenomenon in healthcare today is this:
Qualified professionals, using their degrees to make a quick buck.  A quack buck.

Take Antagolin, for example (please see my previous post):
1. Its head of research is a qualified medical doctor.  According to their website, Dr. Conrad Smith is also a screenwriter, whose scripts are wanted in Hollywood.  Lucky for you, the overweight, desperate and easily impressed public, Dr. Smith has decided to use his experiences in the USA to exploit the untapped weight-loss and diet-fad market in South Africa, by systematically corrupting the public understanding of science.  Coincidentally, no further information is given on Dr. Smith's record.  (Other than his stellar script-writing capabilities.  I wonder if his position as a supplement salesperson helps his script applications?)

This will probably have to be a different post, but the only trial ever done with Antagolin, according to their "package insert" (if one could call that referenced piece of propaganda a PI), was done in the USA (to get a patent granted, not FDA approval), and is "on record" and "helped overweight individuals lose weight".  No sample size, control group, concurrent weight loss strategies or other drugs taken are listed, because real science gets in the way of making money.

So what about the claims that it "may reduce insulin resistance"?
Oh, I see.  Is it the experimental data on Bernebine, but not your actual formulation?
Interesting.  So you didn't think that the claims you make about your formulation need to be backed up by evidence about your formulation?

Dr. Quack.  Once again: Well done, Internet!
"The doctor will see you now.  So, take off your clothes, get in the tub and lather up."

2. The CEO of the Medical Nutritional Institute is a pharmacist named Mariaan Du Plessis.
They say that "due to her strong entrepeneurial drive, she soon left corprate employment to start her own business", (and to rip people off by making unsubstantiated claims about her products).

We will need to systematically analyse the data available on MNI's products.  This is just the beginning.  It is overwhelming.  We will start with Antagolin.


I have been in contact with their staff about evidence for their products.  They keep referring me to pubmed.  Pubmed has nothing on Antagolin (but several inconclusive studies on their ingredients).  Their evidence is missing.  I suspect it does not exist.

Reading list for the struggle against mad science

Okay

So the previous posts are bit content-heavy on my side.
Maybe I should give bit more information to explain where I depart from:

I have always been uneasy with bad science.  Ever since my child-like mind got stuck in the rut of asking "Why?"

I am currently studying medicine, which is profession that struggles to ask that question enough, but does it just enough to keep me excited.

Bad science and bogus claims are everywhere - targeting those whose education moulded them into unquestioning disciples of whatever-the-powers-that-be-say.  These people struggle in life once they leave school, always looking for a new father- or mother-figure to occupy the vacuum created post-school, post-tertiary education and/or post-family.

No-one is overtly telling them what to believe and how to think - and everyone in their life has been afraid of teaching them to think for themselves, as that would question the very authority doing the teaching.

"I expect you all to be independent, innovative, critical thinkers

who will do exactly as I say!"

They are all too happy when a supposedly benevolent tabloid, television channel or Depak Chopra fills that void with the air of calm, self-assured knowledge that permeates those who are trying to sell you something.

But they are in great danger.

And we need to ask people questions and engage them in order to get those dusty cogs in their minds clunking about again, so that they may one day do that for each other.  And close the gaps in society left by education philosophies which fear critical thinking like a monarch fears a Bolshevik.

"Don't think for yourselves, people. Then you won't want to wear your school uniform, attend sports days and  keep quiet whilst I indoctrinate you in assemblies anymore.  The school down the road is full of  free thinkers and they all do drugs and have syphilis."

For your viewing and educational pleasure, I have included two TEDtalks by Ben Goldacre.

Don't take my word for it.  Borrow or buy his books, Bad Science and Bad Pharma and decide what your think for yourself.:

And what's more:

Mad medicine, bad advice, bad reporting - Part 6: Detox

In the final post in my series on Viva Mayr and the tangents one must embark on when discussing this ridiculousness is on that word which is thrown around by every teen magazine and diet guru as if it had meaning:

Your guess is as good as mine:  I don't know what this diagram aims to show.  But it does make a good point: "detox" claims have little regard for even the most well-established science - in this case, basic anatomy.

Detox

I would just like call into question the liberal use of the word detox.  If anyone who wishes to broaden their minds and rid themselves of the yoke of ignorance,  would type the word “detoxification” into Wikipedia, go to the disambiguation page and select the “alternative medicine” option, you would be faced with the following definition:

Detoxification is an alternative medicine approach that proponents claim rids the body of "toxins", accumulated harmful substances that are alleged to exert undesirable effects on individual health. Detoxification usually includes one or more of: dieting, fasting, consuming exclusively or avoiding specific foods (such as fats, carbohydrates, fruits, vegetables, juices, herbs, or water), colon cleansing, chelation therapy, or the removal of dental fillings. (9) (10)  Body cleansing is not supported by science, with no medical benefits demonstrated, and is based on questionable or disproved scientific claims.(11) (12) (13) (14)

Those wishing to defend the embattled term “detoxification”,  will immediately jump to shout that Wikipedia is an undependable resource.  A claim to which I respond in two parts:

1.       All of the references from the article have been added to the table of references available here.  Should anyone wish to scrutinize any of the claims, all of the information which has been used to create the above definition can easily be accessed from any computer with an internet connection.  I am sure that the respective authors would welcome any questions or criticisms on the methodologies or conclusions.

2.       A claim accusing another of unreliability coming from people who depend on word-of-mouth, anecdotes and dubious “professionals” to convince them about efficacy of treatments for which there is, consistently, a lack of evidence could easily reach cataclysmic levels of irony.  I would advise individuals making such accusations to turn that same critical eye upon to the world to which you normally look to guide you with regards to healthcare decisions.

It has been delightful to write this.  It has also been deeply depressing.  The fact that such things exist and are so commonplace makes one feel overpowered, overwhelmed and outnumbered.

If you are reading this blog in agreement, you must realize that it is your task as scientifically minded person to fight bad science and baseless claims.  We must engage with the world around us and question and foil those whose aim is to exploit and prey upon the uninformed and the desperate.

Although it is not always easy (and the varying tone of these post are testimony) to do so with all the kindness and compassion the task requires, this should always be a priority.  Antagonism and ridicule (although great fun to write) is unlikely to convince anyone face-to-face.

Mad medicine, bad advice, bad reporting - Part 5: Proof

No, for real: The original article "Take time" actually lists "bloodletting" as one of the Mayr therapies.
I know there are actual indications for this, but being gullible and having too much money is not one of them.

Proof

This is where the crux lies.  If you can prove that it works, then you can advertise as you wish and make all the claims in the world (as long as they’re true) and no-one can do anything about it.  

But then you need valid proof.  This is where it often where things like “haematogenous oxidation therapy” (or HOT, as alternative therapy experts refer to it) fall down.  Scouring Pubmed (an online database of most of published medical literature) one cannot find a single reference to it (probably because the term itself is unscientific, see below).  

In fact, the only results one get when searching for HOT, are a few websites advertising the services of alternative therapy clinics, such as Biomaxx, a website which offers a delightful and entertaining read is ever there was one (this, too will require a separate analysis).  

The fact of the matter is that not a single reference to a peer-reviewed journal article is made.  We just have to believe that these “therapies” and “drugs” work, just because a man called Dr. Michael Trogisch says so.  (Note that this is an old trick.  There is no proof anywhere that this man has a valid MD or PhD.  Read Bad Science for a detailed analysis of such claims of learnedness.  Even if he did, it does not magically validate any claim he makes, just because he wears a white coat and carries a stethoscope.) 

Coincidentally (and once again Dr. Goldacre has pointed out a similar error made by a nutritionist), the term is a rather confusing one.  Oxidation is the process by which a molecule, atom or ion gives up electrons (ie by which rust forms).  Oxygenation is the process by which the oxygen content of tissue or blood is increased.  An easy error for the uninitiated, but as I would point out in my mind-battle with medical doctors and scientists dabbling in alternative therapy:   “We are all initiates in the league of science!” (Admittedly a Batman quote, but I do think that misleading the public with regards to science is a bit more nefarious than threatening to blow up Gotham City with a neutron bomb – at least that attempts to utilize actual, albeit theoretical, science. (7))

Don't worry, by rusting the iron in your body, you will accumulate a cool endoskeleton, much like Hugh Jackman's Wolverine.  Only without the claws, healing factor and the being alive part.  But very much similar in its fictitiousness.

With regards to Mayr Clinic, I would challenge anyone to come forward with valid, peer-reviewed, scientifically scrutinized evidence for the effectiveness of the “Mayr Cure®”, as I have been unable to find any.

Anecdotes

“But what about the testimonials?” you may hysterically ask, as if this would be a sort of muting trump card destined to make me shut my know-it-all mouth.

What indeed?  A favourite quote of mine, by Roger Brinner, is this:  “The plural of anecdote is not data.”  Data is gathered by research, where there is a clear hypothesis about the change in a measurable outcome according to a well-described methodology.  

Raving reviews about some fad-diets and therapies by people who have invested time and money into it, does not count.  Healthcare has the dubious honour of having to live up to certain standards when claims are made about treatments.

We have all bought a book which had phrases like “incredibly eloquent” or “the read of your life” (often attributed to the ambiguous Independent) printed boldly below some creative and enticing cover art and title, only to find that it was not so much a book, but rather cliché plots and characters randomly arranged into some semblance of what a rhesus monkey might have produced if strapped to a stool in front of a typewriter for long enough.  

“Where did these reviews come from?” we may bewilderedly ask ourselves as we wantonly toss the pages into a bonfire made specifically for that purpose.  Where indeed?  It has been suggested (8) that  fake reviews of books are extremely common, often created by authors and publishers, under many different titles and names, in order to boost sales.  But we are smarter than that, so we look try not to be fooled by these shady one-liners on the backs of pulp fiction

.

Why then, if so many people are hesitant to believe that a mere book is worth reading on the grounds of a few unreliable anecdotes, should we believe that someone putting a pipe up your bum for a colonic irrigation is going to make you fantastic, merely on the authority of a few rave reviews from some gullible “down-to-earth middle-aged women enjoying a week of TLC”?  

Then again, if you enjoy that kind of thing for TLC, I am not going to judge. 

Just to reiterate: Don’t simply take as evidence, the words of Drs. Stossier because they are (presumably medical) doctors, who have a few dozen (presumably real) people writing positive reviews about their spa on its own website, in tabloids across the UK and (now unfortunately) in the Mail & Guardian’s Health section.  

Don’t believe that their diet works because there are five people who have given the book five star reviews.  This is not evidence.  This is anecdote and it is delightfully easy to manipulate and manufacture.

Mad medicine, bad advice, bad reporting - Part 4: Origins, Registered Trademark Cures and Advice

In the fourth post in this series on Viva Mayr and related subject matters, we will delve into the heart of the Mayr cult, and also into the core of the diet industry.

Origins:

When visiting the biographies section of the website mayrtherapy.com (6), (just to check whether Franz Mayr was conveniently invented because of his Mayo-esque name), one cannot help but notice that it is never specifically stated where Franz Mayr attained his medical degree.  

It is discomforting to see that the only evidence the good doctor’s effectiveness is in the statement that 

“thousands of prominent people came there to regain good health and good looks.” 

(Whether they had good looks to regain is not known to me, likewise is whether they actually regained anything.  They did lose money, however, as is still the case with clients of Mayr’s acolytes.)  I could also not help but note the banner which read, “Spa medicine utilizing the MAYR®cure”.

Cures and Registered Trademarks

Years of scepticism has taught me to distrust any health advice with a little superscript “R” next to any part of its wording.  

Goldacre writes at length on the subject, but to paraphrase and to add a bit of my own fizz, I will say this:  Good health advice is not hard to find.  Eat balanced meals with lots of fruit and vegetables, exercise regularly and avoid a sedentary lifestyle.  

There.  Simple as that.  And its not going to cost you a thing because it is common knowledge.  (Okay, perhaps it is not as simple, but until compelling evidence emerges to suggest otherwise, I suggest we stick to these guns).

But that’s exactly the problem for an industry which aims to make money out of people’s desires to live longer, feel better and, most importantly, get all of this as part of a quick fix.  In order to make people believe that they need to pay you for such advice or buy your diet book, you must overcomplicate things and sciencey-fy everything, using vague and ill-defined terms like “haematogenous oxidation” and “nasal reflex therapy” and a favourite of many crusaders of bad science, “detox” – but more on that later.  

Most importantly, you need to patent, register and copyright this advice in order to maximize profits.

Viva Mayr is by no means special.  Nor is the fact that it is run by doctors (Harald and Christine Strossier).  People are easily impressed by what they perceive to be relevant qualifications.  

Just because an engineer is running a hot dog stand, does not mean that his wors will be mathematically perfect.  

Well done internet! When I searched for "Engineer hot dog", this is what came up.  This coincidentally also proves the point I was trying to make.

Similarly, just because someone happens to have a “Dr” in front of their name, does not make them an authority on anything health related (or even an MD or PhD, as you will find by reading any of Goldacre’s other work).  And even if they are an MD, they may still stray from the straight and narrow of evidence-based medicine into the shadow of the valley of homeopathy and the like.

The medical profession is, contrary to popular belief, not a very efficient way of making money, especially with the average person becoming more educated and gaining access to virtually unlimited information at their fingertips (information which, say, might encourage people to exercise and eat their greens to stay healthy - for free).  

This has led many in the healing profession to seek greener pastures by dabbling in alternative medicine.  It is a lucrative pastime, filled with the mystery of vague terms and unsubstantiated theories that science and medicine have attempted to dispel for the better part of five centuries.  In a way, alternative medicine has become a safe haven for arts and remedies which don’t stand up to well against the rigors and demands of actual science.

What do you call alternative medicine which has been proven to work?  Medicine.

Mad medicine, bad advice, bad reporting - Part 3: Pictures, Praise and Pronunciation

This is an actual picture featured in Vogue  magazine's article on Viva Mayr in 2013.  It appears that this woman has been connected to a Galvanic cell which is currently using magic to extract the toxins from her.  They could also be using her as a battery.  Either way - that swimming cap is probably to keep her brain safe from radiowaves.
Source: http://loveisspeed.blogspot.com/2013/07/destination-detox-austrias-viva-mayr.html

Viva Mayr

When googled, Viva Mayr seems more like a hotel than any form of health centre.  Indeed, when you visit their website, a small banner to the right invitingly reads, “Hotel awards 2013.  Enter now”.  It is a confusing labelling issue. Is this a “clinic” offering “spa medicine” (whatever that might be) or a hotel and spa offering expensive fancy-sounding treatments for which there is no evidence, but which clients are nonetheless encouraged to purchase at risk of dereliction of their own health.  (The author proposed a budget version of this, encouraging readers and thus would-be Mayr clients to opt only for a third of the prescribed treatments.  Alas, if only real medical prescriptions could be optimized similarly for financial reasons.)

A quick search may yield the following result: (Not safe for work)

http://loveisspeed.blogspot.com/2013/07/destination-detox-austrias-viva-mayr.html

An article, full of unquestioning child-like praise for the center can be found here:

http://www.vogue.com/magazine/article/destination-detox-austrias-viva-mayr-clinic/#1

If these are actual photographs of the Mayr clinic then things are a bit worse that I could have possibly imagined.  It looks reminiscent of the "The House of Wax" or some sort of Sci-fi horror I have always been to scared to watch - Ayn Rand-ian ideas of what women should look like, suspended in trance-like hazes, undergoing who-knows-what-kind-of pseudomedical procedures and having their ordeals retold in Vogue magazine.  The stuff of nightmares, really.

A matter of pronounciation

My german is not what it could be, but even the slightest attempt to pronounce the name of the “Viva Mayr Clinic” could easily leave the individuals sipping their coffee across from me at the breakfast table, to believe that I am referring to the presitigious Mayo Clinic, a tertiary health centre which was ranked as the 3^rd best hospital in the US in 2011 (5).  This convenient almost-homophone no doubt adds weight to the air of established authority which pervades the article and online references to the institutions and individuals concerned.

In the next post, I will discuss a small matter of mysterious origins.

Mad medicine, bad advice, bad reporting - Part 2: Taking the time to chew on the bull****

"Come and enjoy the view" they said, "Enjoy our colonic irrigation" said no-one ever.
This man, seated at the Viva Mayr clinic is probably still recovering from his morning of blood-letting and laxative induced-diarrhoea. (Okay, I have no idea what he is doing or recovering from, but I could be spot on.)

In my previous post, I introduced my topic for discussion.

In this post I shall begin my overly-elaborate criticism of the both Green's article and the Mayr clinic: 

“Take time to chill and chew the fat” by Harriet Green is a disturbing entry in the Health section of the Mail and Guardian. (1)  A short while back, another article (2) cited the excellent book, “Bad Science”, by Dr. Ben Goldacre.  

The tome systematically analyzes and picks apart bad science and errors of scientific interpretation made, most commonly, by journalists.  (It should be noted that Goldacre, an actual medical doctor, is an esteemed journalist himself, having been the author of a similarly titled column in the UK Guardian since 2003, as well as another book, “Bad Pharma” in 2012).  

It is woefully ironic that an article such as, “Take time” has found itself published in the same section which quoted such a work of necessary genius.

In a Health section which contains sensible stories on statins, exercise programs, cancer screening, HIV and TB, this article seems horribly out of place.  Someone else seems to agree, as “Take time” is classified under Scitech on the MG.co.za website.  This is bending the term science beyond breaking point. 

Acclaim

“The acclaimed, hardcore detox at the Viva Mayr Clinic is easier to digest than one would think” reads the subheading for the article.  

The only acclaim one seems to find for the Viva Mayr spa is that found on its own website and the unreliable reel of articles similar to “Take time”.  Not one objective scientific outlet has acclaimed this centre and it is clear why.  

We will analyze the issue of “detox” towards the end to show that it is a term born from the mouths of marketing gurus, not scientists.

The piece reads more like an advertorial testimonial rather than any form of legitimate health journalism.  “The Viva Mayr is a magnet for celebrities and the rich, but there are plenty of “ordinary” people here too.”  It is good to know that the money of the average reader will be just as welcome as a celebrity’s at this haven for ritualistic bad health advice.  

The Viva Mayr website is even given at the end “for more information”.  I think “for marketing purposes”, would be more appropriate. 

(http://www.viva-mayr.com/en.html)

It is curious that a previous Health section article entitled “Seven days, seven diets” (3) took a very humoristic tone towards fad-dieting and seemed to be pointing out how silly each of them were.  Harriet Green’s piece arrived just as I was recovering from an outrageous article “Light at night sets off alarm bells” (4) which made the incomprehensible conclusion that, as a recent study had made a link between artificial light and breast cancer, reading your children bedtime stories would increase their risk of developing breast cancer.  

These alarmist, misleading and sensationalist articles are a completely different kettle of fish and deserve to be scrutinized on their own merit (or lack thereof).

Although this may take some time, I intend to systematically analyze most of the article to show that it is not worthy of being published by the Mail & Guardian.  Many readers will have been misled, and they must be exposed to the facts and armed with the necessary tools to defend themselves against such deception.

Mad medicine, bad advice, bad reporting - Part 1: An introduction to my humble onslaught against Viva Mayr

Here is a link to an article that should make you cringe:

http://mg.co.za/article/2013-01-18-take-time-to-chill-out-and-chew-the-fat

You should be cringing for a few reasons, including:
1. That was quite terrible.
2. That was devoid of actual science.
3. That article appeared in the health section of the Mail & Guardian, an otherwise highly respectable news outlet (arguably one of the best in South Africa), earlier this year.

I read the article and wept (metaphorically - in reality I jumped up from the breakfast table and ran upstairs, but more on that shortly).  I wrote a long letter to the editor.  I hoped that they would publish it.  The letter became too long.  It mutated.  It changed into an article.  I know of no-one who would publish my rantings outside of very limited circulation leaflets.(Alas, I have yet to print my opinions on the back of penis-enlargement pamphlets - a strategy which, I am told, will undoubtedly increase my circulation.  Just perhaps not that kind of circulation.)  The piece fermented in a folder in My Documents.  It is ready.

So I give to you a series of  blogposts.  Devoid of an editor.  Full of reason.  And occasional humour.  For your convenience and my integrity, I have added a list of sources, to which the following posts will refer.

Works cited:

1. Green, Harriet. Take time to chill out and chew the fat. www.mg.co.za. [Online] January 18, 2013. [Cited: 01 20, 2013.] http://mg.co.za/article/2013-01-18-take-time-to-chill-out-and-chew-the-fat.

2. Dillner, Luisa. Exposed: Bitter pill of bad pharma. Mail & Guardian Website. [Online] Mail & Guardian, 10 26, 2012. [Cited: 01 20, 2013.] http://mg.co.za/article/2012-10-26-00-exposed-bitter-pill-of-bad-pharma.

3. Heritage, Stuart. Seven days, seven diets. Mail & Guardian Website. [Online] 01 11, 2013. [Cited: 01 20, 2013.] http://mg.co.za/article/2013-01-11-seven-days-seven-diets.

4. Illsbury, Darryl. Light at night sets off alarm bells. Mail & Guardian Website. [Online] November 09, 2012. [Cited: January 20, 2013.] http://mg.co.za/article/2012-11-09-light-at-night-sets-off-alarm-bells.

5. US News. US News Health. US News Website. [Online] 2011. [Cited: 01 20, 2013.] http://health.usnews.com/best-hospitals/area/mn/mayo-clinic-661MAYO.

6. Mayr Therapy. Mayr Therapy Biographies. Mayr Therapy. [Online] Mayr Therapy, 2009. [Cited: 01 20, 2013.] http://www.mayrtherapy.com/biographies.htm.

7. Anne Marie Helmenstine, Ph.D. About.com Chemistry. About.com. [Online] About.com, 2013. [Cited: January 20, 2013.] http://chemistry.about.com/od/chemistryfaqs/f/neutronbomb.htm.

8. RJ Ellory: Fake book reviews are rife on the internet, authors warn. The Telegraph. [Online] 2012. [Cited: January 20, 2013.] http://www.telegraph.co.uk/culture/books/booknews/9518531/RJ-Ellory-fake-book-reviews-are-rife-on-internet-authors-warn.html.

9. Barrett, S. "Detoxification" Schemes and Scams". Quackwatch. [Online] May 2009, 8. [Cited: January 20, 2013.] http://www.quackwatch.org/01QuackeryRelatedTopics/detox_overview.html.

10. WebMD. "Detox Diets: Cleansing the Body". WebMD. [Online] June 23, 2012. [Cited: January 20, 2013.] http://www.webmd.com/diet/features/detox-diets-cleansing-body-feature.

11. Henderson, M and F, Yeoman. Detox diets are a waste of time and money, say scientists. The Times. [Online] January 3, 2006. [Cited: January 20, 2013.] http://www.webmd.com/diet/features/detox-diets-cleansing-body-feature.

12. BBC News. Scientists dismiss detox schemes. BBC News. [Online] January 3, 2006. [Cited: January 20, 2013.] http://news.bbc.co.uk/2/hi/health/4576574.stm.

13. Randerson, J. Detox remedies are a waste of money, say scientists. The Guardian. [Online] June 23, 2010. [Cited: January 20, 2013.] http://news.bbc.co.uk/2/hi/health/4576574.stm.

14. Ernst, E. Alternative detox. PubMed. [Online] August 19, 2012. [Cited: Januart 20, 2013.] http://www.ncbi.nlm.nih.gov/pubmed/22297655.

The posts will follow in short succession and will read like an engineer's road-sign:
http://xkcd.com/781/

MNI Lifestyle - Almost like Scientology, but less pushy. And less science.

So whilst I was researching Antagolin (see previous post and watch this space - these people are going down), I noticed the website on which it is marketed has a "free stress test".

Seriously? - I wondered whether I had just stumbled upon a treasure trove of ridiculousness and bad science - all rolled into one delicious morsel, ready to be torn apart by anyone with have a brain and a bit of common sense.

Alas, LRH will have to wait for another day (and I have a substantially smaller chance of legal repercussions now).

Left: L. Ron Hubbard, founder (or discoverer?) of Scientology.  Right: Phillip Seymore Hoffman in the film, The Master, which has apparently nothing to do with Scientology, apart from everything.

No, the stress test didn't ask me whether I wanted to buy Dianetics (amazing how far sciencey words will get you in the world).  Instead it asked me for my email address and made me fill out a form with a likert scale.  The questions asked about my "quality of life, emotional wellbeing and social interaction".  Normally, because of my enormous interest in positive psychology and the like, my response to these questionnaires is somewhere along these lines:

http://threewordphrase.com/depression.htm

But for science, I used the method acting techniques of Stanislavsky to fill the questionnaire in like a depressed, overweight push-over (and it took me seconds of clicking on the left column to get into that mindset).

The results I got, as previously stated, didn't ask me if I wanted to accept Lord Xenu into my heart (I know this isn't the gist of it, but it doesn't make a difference, really), but instead didn't seem too crazy, at first.  I will quote select passages for you:

"Your Stress Level.
- is very high and will require urgent attention.
Your ability to concentrate.
- is significantly impaired and will require urgent attention.
Your general mood.
- is severely compromised and requires urgent attention.
Your burnout risk.
- is very high and will require urgent attention.

Steps to manage stress:

Get the basics right
Think more strategically
Act logically
Take a supplement to enhance your mental functioning
Avoid collateral damage
Ask for advice"

Seems perfectly reasonable and I might just...wait.  Hold on one cotton-picking minute right there!

"Take a supplement to enhance your mental functioning"

What do you mean, like methylphenidate? (That is, ritalin)  I took a closer look:
They went on about rhodiola and inosotol.

"What makes Rhodiola attractive is that it is a highly effective natural substance
with an extremely low side effect profile."  They even quote a "trial" involving "56 doctors".  They give no references.

At this point I would like to make clear that neither of the above are currently used in psychiatry.  Plus - if these were in fact psycho-active drugs -  I wouldn't be too keen on taking them on the advice of an automatically generated pdf report from a site that sells Antagolin.

Also, did I mention that MNI Lifestyle just so happens to sell Rhodiola and Inosotol, but racily repackaged as "NeurovanceTM" (along with a few other fancy-named herbs with no actual clinical data to support their fantastical claims)?

For your education and enjoyment, I have included their advertisement, creatively labeled as "English - Female" to show you how well they target customers (based on gender and language).
Convenient.  What are the chances that you so happen to sell the very supplements I am told I need, MNI Lifestyle?!

Are people actually gullible enough to be fleeced by this kind of shenanigan?

Feel free to take the test yourself and post your results below.  I am almost certain they will advise "supplementation" regardless of your supposed sanity or Scientology-deficit:
http://assessment.mnilifestyle.co.za

Also, see their silly "drug-blurbs" for NeurovanceTM and other trademarked placebos:
http://www.mnilifestyle.co.za/products/neurovance/
(See below for Antagolin)

To avoid backlash from alternative medicine zealots, I will post the wikipedia pages for Rhodiola and Inosotol below (in case you have trouble working a search engine), along with a caution:
http://en.wikipedia.org/wiki/Inositol
http://en.wikipedia.org/wiki/Rhodiola_rosea

Caution:
Do not be fooled by a few initial studies showing "promising" results for any drug.  A lot of "promising" research translate into inert, useless (or far inferior) drugs or, in worst case scenarios, straight-up poisons.

The reason we don't go guzzling anti-freeze the moment we find that it kills Influenza in a petri dish, is...well, painfully obvious, but my hyperbole illustrates that elaborate theories or lab-results (or even small trials, that include, for example, 56 people) don't necessarily translate well to real-life.

A prime example of this is the issue of anti-oxidants (along with a myriad of drugs that will never be known by fancy names like Losec or Tramadol, but rather linger in obscurity, known only forever only by codes, such as Cp3421).

But someone much more experienced, knowledgeable and outright better than me has written brilliantly on these topics.
I will address this briefly in a future blog post.

This is overwhelming.

More posts to follow.

Antagolin - May help propagate science resistance

I just saw an advertisement for AntagolinTM on television. It claims to treat insulin resistance.

Or it plays an interesting game of probabilities.

It states that “Antagolin may help to alleviate insulin resistance and assist you gain better control over your weight.”

I know that it does not do this, because that would make it an antidiabetic drug. Direct to consumer marketing is illegal in South Africa.

Ergo – this is not an actual drug.

And I combat unsubstantiated claims of those who prey upon the desperate and uneducated.

(Although it does contain 30mg of Insul-X2 (with
Berberine - but more on this later), 840mg of Banaba leaf extract, 40mg of Chromium and I suspect 100% bullshit.)

Antagolin.com proudly states that “Antagolin has not been clinically tested”.   This doesn't seem to bother them much.

How are we allowing marketers to make claims that this untested “drug” may help lose weight and treat insulin resistance or prediabetes?

By broadcasting this advertisement, the broadcaster implicitly endorses this trash.

Dealing with this is overwhelming.

It may take a while.

Please post your own research in the comments section. 

More posts to follow soon! http://www.mnilifestyle.co.za/products/antagolin/

Books, e-books and Ozymandias

One of the reasons, apart from "the way it feels" and "I like the concept of a book" that people give for not switching over to e-readers (which are cheaper in the long run, more convenient and environmentally friendly) is that they would no longer be able to display their library of completed books in their homes.

Come on. Many of us are guilty of this vanity.

As if one of the reasons one would read would be to stack the books on a shelf to intimidate your guests into submission:

This bookshelf is really intimidating.  It may crush you in a book-avalanche.  An e-reader with the same amount of books would do very little damage.

"Look upon my works ye mighty, and despair!"

Top achievers - achieving poorly or simply eluding your sample?

 Some research I have come across paints a dire picture for education in South Africa, with "top achievers in maths and science" performing poorly or showing little interest in maths and science. 

This is quite oxymoronical and I question whether the correct students are being asked...

 This post is probably quite disjointed.

 It is just a bit of nerdy venting. Perhaps some of it makes sense to you and perhaps you find a bit that you agree or disagree with.

 Here, I will simply devote a short section to a phenomenon which occurs often, but is seldom identified and scrutinized with the necessary enthusiasm.

Few people, save an optimist (like me), argues with a research result which seems to affirm the accepted cynicism. South Africa, like many other countries, is filled with those who pounce upon any bit of negative information and use it to propagate their particular brand of gloom.

Some consider this a prophecy or a cautionary tale.  I doubt the former and don't really take the latter to heart.

They may be right, but the point I want to make is that we need to resist the urge to select information which agrees with our preconceived notions, and rather only listen to that which has substantial proof. I recently attended a conference for Health Educationalists (people teaching health sciences), where a paper was presented, entitled, "Recruiting rural origin students to health sciences - a one year follow up of top achievers at rural high schools in South Africa".

 The presentation was great and the aim was admirable. More such research is required and, more importantly, the issue needs to be addressed.

The abstract concludes that "a minority of top achieving rural high school students are able to access tertiary institutions in South Africa, but many of those that are successful do access financial aid". 

The research also aimed to see how effective a "road show" open day might be. Apparently students more readily gather information on these issues from peers than from open days. The issue, however, is that the article claims that its sample represents the "top achieving students", whereas the only proof for this is that they arrived at the open days and agreed to participate in the study.

No correlation was attempted with the region's National senior certificate achievement levels and it was accepted that very few students from this region succeed. This may be true, but I would have liked to see researchers confirm that a bit more independently.

 It is very likely that the students that attended the open day were not, as they assumed, the top achievers in maths and science, but any students who were willing to attend. As a student, I often saw this happen - a few students are asked to attend (perhaps originally the top achievers), but if these decline, any other students willing to go are sent in their stead. This happens readily and makes the claim of "top achievers" dubious.

 I am willing to accept that these might be the elusive stars of their classes, but will require a bit more persuading. On a similar note, I recently learned of a survey in the Stellenbosch area of the Western Cape, South Africa, which also polled 40 "top achievers" in maths and science and established their career plans consisted of "having babies" after finishing school and that they would not continue with science as a subject because they "[didn't] like reading".

 These scandalous results become the highlight of dinner conversation, confirming the damning suspicions of pessimists, but no-one asks how these "top achievers" were recruited. Once again, it was left to the discretion of the region's schools to send their most promising students. One researcher admitted that she knew of a top student who had declined to attend.

 Admittedly this doesn't prove anything, but should at least force one to scrutinize your sample a bit more closely. We can accept that the situation is as bad as it seems, that top students from certain schools only want to procreate and have an aversion to reading, but only if we are sure that these are top students.

 I'm quite certain that a carelessly selected group of students from any high school might yield similar results if the correct (or incorrect) students are interviewed.

 In conclusion, I think everyone needs to be a bit more critical of the information we hear and propagate and, where possible, ask a few detailed questions to establish how robust or flimsy a claim based on research may be.