User:Postpostmod/Sandbox2

Jonathan Edlow, Professor of Medicine at Harvard Medical School, quotes the late Ed Masters (discoverer of STARI or Masters' disease, a Lyme-like illness) in his book Bull's-Eye, on the history of Lyme disease. Edlow writes: "Masters points out that the 'track record' of the 'conventional wisdom' regarding Lyme disease is not very good: 'First off, they said it was a new disease, which it wasn't. Then it was thought to be viral, but it isn't. Then it was thought that sero-negativity didn't exist, which it does. They thought it was easily treated by short courses of antibiotics, which sometimes it isn't. Then it was only the Ixodes dammini tick, which we now know is not even a separate valid tick species. If you look throughout the history, almost every time a major dogmatic statement has been made about what we 'know' about this disease, it was subsequently proven wrong or underwent major modifications.'"

posted 6/8/11

Posted 2011 July 12:

I think the "negative ELISA, positive Western blot" issue is a little too detailed to include in the article, in its present state of disarray. We're still on the early rungs of Wittgenstein's ladder. If it were politically possible to edit the article to reflect the controversial status of the two-tier-test as a diagnostic requirement, a source that should be acceptable to WP:MED would be the IDSA guidelines hearings report. The review panel (seven IDSA doctors and one veterinarian) voted 4-4, half for and half against, retaining the Executive Statement at the beginning of the IDSA guidelines in its present form. This is the section of the guidelines which calls for a positive result on standardized serological testing (i.e. the two-tier test) as a requirement for diagnosing LD in the absence of EM.

When I reported this |diff split vote, in response to a WP:MED member's |diff post on the outcome of the hearings, it was ignored. Later on, the same WP:MED member added to the LD article a summary of the hearings results based on the IDSA’s press release, calling the panel “independent” and not mentioning the split vote regarding the guideline’s Executive Summary |diff diff. I didn’t bother disputing it, as the editor who inserted it has always had the full support of WP:MED. It’s not what you know, it’s who you know. ;-) I think you’ll find that the same dynamic is still functioning. But who knows? Try adding it and see what happens.

Here’s a URL directly to that portion of the report, Review of Executive Summary, for the convenience of talk page readers. In the article, it would probably be better to cite the full report with page numbers of the relevant portion, thusly: |diff IDSA Lyme Disease Final Report p. 26-7. If such an edit looks like it’s going to stick, I’ll be glad to format the ref so it’s not a bare URL.

Best regards to all,

Posted 2011 July 13:

Hi MastCell; I’m not proposing to add anything. It’s politically untenable, as your comment confirms. I believe the split vote revolved around the wording of the statement in the guidelines, italicized for emphasis, that positive serology (presumably by the two-tier test) is “required” for diagnosis. In our previous discussion of the guidelines here, both you and another editor made the point that “guidelines are just guidelines”, that it’s not appropriate to say that guidelines “require” anything, because physicians have autonomy in how they treat patients. There seems to be a misunderstanding of this point, on the part of the IDSA Lyme guidelines’ authors.

The real-world problem with the statement is that it adversely affects both research and appropriate clinical diagnosis.

When seriously inaccurate tests are promoted as if they are almost perfect, you get significant numbers of patients with treatable Lyme disease being told they definitely don't have Lyme disease, but rather have diseases of unknown origin that can only be treated symptomatically, like fibromyalgia and chronic fatigue syndrome. See, for example, the influential paper I asked you to read several weeks ago,, and the published comments on it. I’d still be interested to hear your take on this paper, from a scientific, rather than political, standpoint.

I guess a certain amount of undiagnosed, untreated late Lyme disease is considered to be a form of negligible collateral damage, subsidiary to the higher goal of asserting the correctness of whatever paradigm is dominant in the field. (Sorry if that sounds harsh – I do get it that most doctors are true believers in the idea that top authorities can be implicitly trusted to provide the best that science has to offer, so they don’t think their stance can be harmful to patients. And I think most medical authorities mean well; they just haven't been adequately trained in what good scientific thinking requires, beyond a plausible story and a knack for politics. That's just my opinion, of course ;-) The idea promoted by Wormser et al. that late Lyme disease is now rare, due to most of the cases being caught in the early stages, must be soothing, especially to a conscious or unconscious Bayesian who hasn’t noticed the GIGO problem. You can’t check the science on every disease, or cure every patient. It’s all about the perceived odds.

Thank you for your continued willingness to engage in dialogue on this. One of the most mystifying aspects of the situation for patients and their caregivers is understanding “how doctors think”. (By the way, did you ever read Groopman’s book?). Your responses in discussions like these are illuminating. Best regards, Postpostmod (talk) 16:26, 13 July 2011 (UTC)

Hi Anythingyouwant; There’s no way of establishing what that number might be, from the current literature, in a way that would be acceptable here. One can only point out that the chain of evidence in the literature, cited to support current recommendation, is fatally flawed. And that doesn’t matter to WP:MEDRS. Basically, if the top authorities on a subject says the ELISA is very sensitive, and the Western blot should only be performed after a positive ELISA, then no amount of published data showing the contrary could change the WP:MED take on the subject. This is explicitly laid out in WP:MEDRS; secondary sources (review articles) and tertiary sources (textbooks) are privileged over primary sources (the ones with the actual data). The ELISA issue has been discussed before on the LD talk, for example, here. Take a look at how that argument came out. That’s why I didn’t spend time collecting the sources Weintraub used. They would be disallowed, first, because a recognized medical authority like one of the guideline authors, will always trump a dissenting journalist as a “reliable source”, regardless of the biological facts. And second, because if we cite the primary sources Weintraub used, they’ll be considered invalid by WP:MEDRS, since they disagree with the currently dominant paradigm.

That paradigm tells the story that the two-tier test is 95 to 100% sensitive in disease of greater than a few weeks' duration. The data seeming to support this assertion is obtained by using a circular definition that a positive two-tier test is “required” for a disease to be diagnosed as Lyme disease, in the absence of an EM rash. MastCell understands that, as you can see here. But as long as IDSA sticks to their story, that wraps it up as far as the larger medical community and WP:MED is concerned. I know it seems strange. I’ve come to understand it as a byproduct of medical culture and training. Doctors are trained not to examine the official story – their training is to learn the story, and then to repeat it, defend it, and follow it in practice. You can see how this system evolved – if all the doctors say the same thing, then anyone who conforms isn’t accountable for bad results. As for the authorities, there's no law against mistakes in science, so they're not accountable either.

It’s generous of MastCell to educate us by showing us in detail how it’s customarily done. Expecting anything more is unrealistic – though you never know, occasionally an individual rises to meet a challenge. Best wishes for you and yours, Postpostmod (talk) 16:26, 13 July 2011 (UTC)

2011 jul 14 draft
Hi MastCell. I’m afraid your comments substantiate my point. As you know, I’ve been waiting several weeks for you to rejoin our discussion about the two-tier test and possible superior alternatives. You asked me to share my thoughts about it, and I said I’d be glad to, and suggested you read two rather short and simple papers, plus comments and, to get up to speed on the subject, as you’ve already told me you don’t have anything to do with LD professionally. You haven’t responded yet, but we’ve had breaks in our conversations before, and I’m still patiently waiting. My offer still stands to help you and your colleagues understand why it's not unreasonable to think that another diagnostic heuristic might be a better choice, based on current mainstream science. The politics is the result of scientific problems, not vice versa.

If, as you say, your concern is all about the best science currently available, why are you ignoring the science? it’s a bit absurd for you to accuse others of “vilification” and “politicization”, merely for looking carefully at the published research and pointing out its flaws. That’s done all the time in real science, and that’s how it progresses. You seem to have me and other dissenting scientists confused with the unnamed “stalkers” and “harrassers” in David Grann’s human interest story in NYT Magazine, which you inserted into the article and recommended to other WP:MED members in your recruiting effort, here.

I don't see how looking at the science can damage the article, Wikipedia, or the reputation of your profession. The dominant view will still be dominant, and will be presented as such in the article. The minority’s specific critiques of it should be summarized without prejudice as a notable minority view. A description of the skirmishes that have characterized the debate should be summarized in a cool and impartial tone. As for the political action, if the reader thinks it’s a terrible thing, or a good thing, or simply an interesting phenomenon, for people to demonstrate or take political action to ensure access to tests and treatment that are scientifically reasonable but not condoned by the dominant view, that’s his call. Just say what has happened. It's not helpful to use the article to vent your, or the medical community's, irritation about it.

Instead, perhaps you might use your excellent professional expertise and communication skills to help understand and describe the substantive scientific issues in a way people can understand. If the article ever meets WP:NPOV, in both substance and tone, I’ll be glad to help patrol it to keep it that way, including WP:WEIGHT. Of course, then I'll be the one trying to explain Wikipedia policy to new editors - that might be your best revenge. ;-0

No hard feelings, I'm looking forward to continuing our discussion of the science. I'll be offline for about a week - going to visit family. Maybe I'll see some new birds. I've been watching a cedar waxwing incubating her eggs. Come to think of it, they'll probably hatch while I'm away - wah. But I can see the babies when I get back, no hurry. Best regards, Postpostmod (talk) 22:20, 14 July 2011 (UTC)

2011 jul 24 draft
Hi MastCell, I’m back, after a nice visit with my family and childhood friends.

There are better approaches to testing, and I’ll be glad to walk you through them, but right now I’m puzzling over how to respond to your assertion that an inaccurate test is better than no test. A test that is perceived to be more accurate than it really is, misleads the treating physician as to what might be wrong with the patient. This causes misdiagnosis and mistreatment. I’m not sure why that is so hard to understand. Could you explain to me the logic behind your position? Perhaps it would be helpful to explain physicians’ needs first, and then to consider how these might differ in some ways from the needs of the patients, and what might be done to reconcile them. Best regards, Postpostmod (talk) 17:09, 24 July 2011 (UTC)

2011 aug 2 draft

 * When you’re ready to engage with the matter, please rejoin our discussion on your user talk page. It’s been a couple of months now, and I’ve reminded you politely several times. If you can’t find the time to read the two rather simple papers I recommended as background, and, please answer anyway to let me know you’re ready, and I’ll summarize the most relevant points for you. I’d rather you gathered them yourself directly from the source, since you don’t trust me. But if you won’t do that, I’d still rather have the discussion than not.
 * While you're at it, you might want to pick up the Chinese CDC's paper and see how they formulated their much less restrictive Western blot criteria - it's an eminently sensible approach.
 * Note to bystanders: we’re having the detailed discussion about LD testing on MastCell’s user talk page, rather than on the article talk page, because, somewhat counterintuitively, one of WP’s guidelines is not to discuss the article’s subject on the talk page:
 * “Stay on topic: Talk pages are for discussing the article, not for general conversation about the article's subject…” quoted from WP:talk
 * Best regards, Postpostmod (talk) 16:59, 2 August 2011 (UTC)

2011 aug 6 draft 1

 * Thanks. Maybe reports of the death of the the attention span are greatly exaggerated. Postpostmod (talk) 20:25, 6 August 2011 (UTC)

2011 aug 6 draft 2
Hi Tm,

Thanks for the interesting and intelligent observations. I dug out the German serology papers, and I see you’re right, they are helpful with regard to the testing problem. Haven’t gotten to the Swedish or Brazilian ones yet.

I’m glad to discuss the other issues, but I’ve been debating whether it’s better to do it here or by email. When I write anything for the public, which would include anything on any part of Wikipedia, I tend to be so meticulous that it takes a long time to write and edit. Explaining the unpopular side of a controversial medical subject for an unreceptive audience is more demanding than my professional writing. Also, it could be argued that Wikipedia isn’t really a place for discussion of subjects; discussions should be about what to say about subjects. My discussions with MastCell are motivated toward demonstrating that the criticisms which have been made of the US mainstream guidelines on Lyme disease are well founded, rather than crank “fringe views”. My point is that, because the criticisms are well founded, they deserve respectful minoritarian treatment, rather than the disrespect they’re accorded in the present version of the article. So although it may superficially look like I’m digressing into non-article-related scientific discussion, it’s actually aimed toward bringing the article up to Wikipedia’s standards.

You can see that my influential correspondents haven’t been enthusiastic about my observations, to date. However, it’s impossible to make any lasting improvements to the article without their cooperation. I don’t want to annoy them unnecessarily, by indulging in detailed scientific conversation that is not immediately directed toward improving an article, even on my talk page.

On the other hand, I don’t want to be like those doctors who refuse to talk about LD’s difficult issues simply because it’s politically inexpedient for them. So go ahead and activate the email feature of your account, and I’ll write to you that way. It will be faster for me than if I have to bring it up to “publication standard”. I just hope it doesn’t reinforce the weird but widely repeated notion that objections to the mainstream view of LD are artifacts of some conspiratorial “belief system”, rather than a well-reasoned response to the available evidence.

MastCell, if you read this and think it would be better if I addressed all these issues in public on my talk page, please let me know, and I’ll gladly defer to your more experienced judgment of appropriate Wikipedia behavior.

Best regards, Postpostmod (talk) 20:46, 6 August 2011 (UTC)

2011-8-9 draft

 * Hi Nescio, nice to meet you.


 * It’s notable because it's in Nature/News, and because the authors are influential in the field. But the paper itself is a primary source that is new, and has not been confirmed. Overall, I don't think it meets MEDRS for inclusion in the article, and it's too detailed a point to be appropriate in such a general overview.


 * If it has gotten you interested in post-Lyme disease syndrome (PLDS) and chronic Lyme disease (CLD), feel free to drop me a note on my talk page, or ask me to do it here, and I'll summarize the definitions and issues. There are some subtleties about how each term has been used in the past, and how they're being used now by different authorities. Without that background, it's hard to talk about it in a sensible manner.


 * Maybe I should clarify my view of primary references, with regard to what is helpful for improving Wikipedia medical articles. I think that older, influential primary references that form the basis of current recommended practice should be examined carefully, when there’s controversy as to their accuracy. But new primary research papers usually aren’t relevant to improving an article, although I think it's fair to mention them in a talk page discussion, when countering someone’s charge that “there isn’t any evidence to support” a certain view.

editing for fun


 * A new primary reference could be discussed on the article talk page, if WP:MED editors are willing to discuss it. If they aren't, then it violates the talk page guideline that the subject of the article should not be discussed on the article talk page. (No offense meant to WP:MED: I understand that the rules of Wikipedia don't require reading of primary papers.) Please read the threads immediately above this one. I’ve had limited success in my attempts to get past editor(s) of the article to read research papers critically and in detail, including those papers fundamental to mainstream medical practice. Given that history, I think initiating a conversation about a new primary paper, without everyone being up to speed on the background, might distract editors from dealing with the more urgent issues affecting the article and its readers.


 * Best regards, Postpostmod (talk) 18:29, 9 August 2011 (UTC)

What the mainstream has to offer
Speaking of caricaturing one's opponents, take a look at this screed:

These authors have been instrumental in crafting and propagating the current mainstream approach to Lyme disease. They seem to feel they can count on their audience to act based on unquestioning faith in the status quo, rather than on their obligation to check the actual science. Further, they believe their audience won't take intellectual offense at the questionable rhetorical devices used. Lumping the Lyme disease controversy together with HIV denialism and the vaccine controversy as equivalent examples of "antiscience" activity is absurd, and should a discredit to anyone who suggests it. Is there really that much free-floating hostility toward patients in the medical community, that such intellectually weak and emotionally ugly accusations can be expected to succeed? One would think that such tactics would alert the reader to consider whether this publication is a device to divert attention from the real issue. Which is, of course, whether or not the "activists" are correct in saying that much unnecessary sickness and suffering is caused by the scientific shortcomings of the LD mainstream's approach, which has led to a systematic failure to diagnosis and treat Lyme disease in a timely manner.

Let's hope no one feels compelled to insert this reference into the WP article as if what it says is factual. Keep in mind that it is labeled as a "Personal View" (although it seems like a rather large group to be considered personal), not a scientific paper. And that all of its authors have been intimately involved in the crafting of the mainstream approach, and stand to lose both face and more tangible assets if their creation falls into disrepute.

Best regards to all diligent and capable researchers and editors, Postpostmod (talk) 18:51, 26 August 2011 (UTC)

Guatemala
However, his work against syphilis is tainted by the Tuskegee Syphilis Study (1932–1972) and the Guatemala syphilis experiments (1946–1948) which were conducted by the PHS's Division of Venereal Diseases, partially during his tenure as Surgeon General.

Verifiability, not truth: diffs from Wales' talk page
Wales:

I find your response baffling. You seem to concede that what we actually do, what our actual system is, is not "verifiability, not truth". We do care about truth. A longstanding tradition of how policy is written in Wikipedia is for it to document what we actually do. Second, there is plenty of reason to think that telling lies to people that are bound to upset and outrage them does not "work". It is absolutely false to say "We don't care about the truth" and it is not at all likely to dampen the enthusiasm of fringe theory advocates. If you can find me a single example of a fringe theory advocate who responded to a direct statement that "We don't care about the truth" in a good way, I'd be delighted to study it.

In fact, a good way to deal with fringe theory advocates is to tell the truth. "We do care about the truth, deeply. All of our policies are designed to help guide Wikipedia towards ever increasing accuracy in the sense of containing true statements about the world. If we accepted statements based on the mere say-so of everyone who shows up, or if we accepted sources blindly, we wouldn't be aiming at the truth."

I simply cannot accept as a valid position that we should lie to people and pretend not to care about the truth! Surely you can hear how bonkers that sounds. (It sounds like something a fringe theory advocate might say, honestly.)--Jimbo Wales (talk) 10:21 pm, 4 November 2011

MastCell:

"Verifiability, not truth" means that we're relying on the fact-checking of reliable sources, rather than doing our own fact-checking. That approach only works if editors are committed to using sources that actually perform decent fact-checking. Personally, I'd rather see the language disappear, because it's surplanted "ignore all rules" as the most frequently misunderstood and most harmfully misapplied policy snippet on the site. "Verifiability, not truth" has the appeal of a pithy soundbite, but also the dangers - it grossly oversimplifies a complex issue, and provides ammunition for careless editing. MastCell Talk 12:48 pm, 31 October 2011, Monday (8 days ago) (UTC−4)

Sham science
Returning to the topic of "correcting misinformation" - I'm with you 100% on the Fox news issue. It's extremely irritating, and dangerous to us all. I just downloaded Testing Treatments to my ipad. I'll get back to you all after I've read it.

I guess it's not surprising that, as a scientist in biomedical research, I think the problematic bias in medicine, is in favoring arguments from authority, rather than from data. I'm relieved to see that Mr. Wales is opposed to the idea that Wikipedia cares more about "verifiability" than about truth (see this thread, for example). So maybe it's not inappropriate to suggest that demonstrably incorrect interpretations, that have become part of the mainstream, might be of legitimate interest to Wikipedians who have the appropriate training.

I've been thinking about how people can progress beyond arguments from authority, in their individual and group thinking. There isn't any substitute for impartial observation and checking of data. But few people have that skill. To have the motivation to develop that skill, one has to have the sense that it's not all that unusual for systematic errors to be perpetuated, even for decades, in spite of a lack of objective evidence that they're correct. And then one has to be willing to buck the mainstream. In science, that's an honorable pursuit, almost a requirement, while in medicine...not so much. But pseudonymous Wikipedian doctors could pursue this avenue without risking professional consequences, though the social consequences might be uncomfortable. Maybe that's reason enough not to go there. On the other hand, one doesn't want to become an accessory to betrayers of the truth.

Irreverent histories of science are good for grasping the professional politics and ego issues that often distort science. Bill Bryson's A Short History of Nearly Everything details some of the well-documented mistakes, and feuds, that attended many scientific controversies in the past. In addition, it's highly entertaining.

I just finished readingThe Alarming History of Medicine by Richard Gordon (1993, but written in a style more suggestive of the early 20th century, presumably to be funny). It's witty, and a fast read. There's a section lampooning some "alternative medicine" beliefs, after many historic mainstream medical errors have been described.

Finally, Jerome Groopman's and Atul Gawande's books describe the more common ways that current mainstream medicine goes wrong, and what might be done to improve it. Gawande is a surgeon, while Groopman is in medicine, and I think you can see that distinction in the errors they've chosen as examples. They're both good writers, enjoyable and speedy to read.

I borrowed Bad Science (Goldacre) from the library about a year ago but was disappointed - the only examples of bad science he uses are minority beliefs universally disavowed by the mainstream. I don't recall that he made any attempt to trace any mainstream view back to its origin, to determine if it might be wrong. This book might be useful to the uneducated, but for us professionals it's kind of like shooting fish in a barrel - so easy and obvious that it's arguably a waste of our talents. We can leave that to popular journalists like Golda...oops, I just found that Goldacre is a doctor. Good thing I checked the data. ;-) Clearly this is one area where the priorities of medicine and those of science are...different.

MastCell, I see you're a fan of Betrayers of the Truth. Ironically, one of "my" Lyme disease patients appears in that book as a young scientist who followed up the data of one of the "betrayers", and helped show it to be false. I think that unpleasant experience contributed to his ability to question authority. (Although it still took him 7 years to question his doctors' confident assertions, figure out what was going on, and get testing and treatment.) Of course, it was somewhat traumatic for a scientist involved in medicine, not only to be incorrectly treated, but to have his faith in the relative integrity of medical research betrayed. (By the way, this case wasn't me, it was a close friend and colleague, whose slow decline from health, and slow recovery, I've witnessed, on a daily basis, for many years.)

I've been told to stop apologizing for the length of my contributions, so I'll abstain. ;-)

Happy reading and thinking to all, Postpostmod (talk) 18:54, 11 November 2011 (UTC)


 * PS: I recommend Richard Feynman's Surely You're Joking, Mr. Feynman, if you haven't read it recently. If you read it twice, you can ROTFL the first time through, and the second time around, ponder the lessons embedded in each chapter regarding human relations, science, common sense, and authority. (I tried to get a Unitarian science-and-religion group to read it, but those who had, nixed it, probably because of the topless dancers.;-)Postpostmod (talk) 02:15, 12 November 2011 (UTC)

b12 in food
F Watanabe    2007 http://ebm.rsmjournals.com/content/232/10/1266.long

Previous Section Next Section Assay of Vitamin B12 in Foods

sentence in article not quite right. lacto assay suggested spiru good source of B12, but measuring binding to pig IF discriminated betwe true B12 and closely rel pseudo. Current thinking is that the lacto can use pseudo, but humans (and other mammals? all other mammals? cannot. So iin these cases, although Lacto assay is usually good, get conflicting results in a few foods like spiru. I think this explains the confusion:

Historically, vitamin B12 content of foods has been determined by bioassay with certain vitamin B12–requiring microorganisms, such as Lactobacillus delbrueckii subsp. lactis ATCC7830 (formerly Lactobacillus leichmannii; Ref. 13). Radioisotope dilution assay (RIDA) method with radiolabeled vitamin B12 and hog IF (the most specific vitamin B12–binding protein) has also been used for the determination of vitamin B12 content in foods (14). Although it was reported that the values determined by the RIDA method were slightly higher in human serum than those determined by the microbiologic method (15), Casey et al. (14) demonstrated the excellent correlation between both methods in food vitamin B12 analysis.

A fully automated chemiluminescence vitamin B12 analyzer with the acridinium ester–labeled vitamin B12 derivative and IF has been commercialized. Currently, various types of similar vitamin B12 analyzers are being manufactured and clinically used for the routine assay of human serum vitamin B12 worldwide. About 10 years ago, my colleagues and I evaluated the applicability of this machine in food analysis, indicating the excellent correlation coefficient between both methods in most foods tested, although in some specific foods the values determined by the microbiologic method were about several-fold greater than the values determined by the chemiluminescence method (16). This difference may be due to the fact that L. delbrueckii used for the microbiologic assay of food vitamin B12 uses corrinoid compounds that are inactive for humans as well as vitamin B12. Ball (1) stated that about 30% of the reported vitamin B12 in foods may be microbiologically active corrinoids rather than vitamin B12. Furthermore, it is known that both deoxyribosides and deoxynucleotides (known as the alkali-resistant factor) can substitute vitamin B12 in this lactic bacterium (17). .... Edible Algae. Purple and green laver (nori) and Chlorella are currently thought to have good levels of real B12.Various types of edible algae are used for human consumption the world over. Dried green (Enteromorpha sp.) and purple (Porphyra sp.) lavers (nori) are the most widely consumed among the edible algae and contain substantial amounts of vitamin B12 (32 to 78 μg/100 g dry weight; Ref. 39). In Japanese cooking, several sheets of nori (9 × 3 cm; about 0.3 g each) are often served for breakfast. A large amount of nori (< 6 g) can be consumed from certain sushi, vinegared rice rolled in nori. However, edible algae other than these two species contain none or only traces of vitamin B12 (39). Dagnelie et al. (53) reported the effect of edible algae on the hematologic status of vitamin B12–deficient children, suggesting that algal vitamin B12 appears to be nonbioavailable. As bioavailability of the algal vitamin B12 is not clear in humans, my colleagues and I characterized corrinoid compounds to determine whether the dried purple and green lavers and eukaryotic microalgae (Chlorella sp. and Pleurochrysis carterae) used for human food supplements contain vitamin B12 or inactive corrinoids. My colleagues and I found that these edible algae contain a large amount of vitamin B12 without the presence of inactive corrinoids (54–57).

To measure the bioavailability of vitamin B12 in the lyophilized purple laver (Porphyra yezoensis), the effects of feeding the laver on various parameters of vitamin B12 were investigated in vitamin B12–deficient rats (58). Within 20 days after vitamin B12–deficient rats were fed a diet supplemented with dried purple laver (10 μg vitamin B12/kg diet), urinary methylmalonic acid excretion became undetectable and hepatic vitamin B12 (especially coenzyme vitamin B12) levels significantly increased. These results indicate that vitamin B12 from the purple lavers is bioavailable in rats.

A nutritional analysis for the dietary food intake and serum vitamin B12 level of a group of six vegan children aged 7 to 14 who had been living on a vegan diet including brown rice for 4 to 10 years suggests that consumption of nori may keep vegans from suffering vitamin B12 deficiency (59). Rauma et al. (60) also reported that vegans consuming nori and/or chlorella had a serum vitamin B12 concentration twice as high as those not consuming these algae.

Edible Cyanobacteria. Some species of the cyanobacteria, including Spirulina, Aphanizomenon, and Nostoc, are produced at annual rates of 500–3000 tons for food and pharmaceutical industries worldwide (61). Tablets containing Spirulina sp. are sold as a health food fad, since it is known to contain a large amount of vitamin B12 (62). We found that commercially available spirulina tablets contained 127–244 μg vitamin B12 per 100 g weight (63). When two corrinoid compounds were characterized from the spirulina tablets, the major (83%) and minor (17%) compounds were identified as pseudovitamin B12 (adeninly cobamide) and vitamin B12, respectively (Fig. 2⇓). Several groups of investigators indicated that pseudovitamin B12 is hardly absorbed in mammalian intestine with a low affinity to IF (64, 65). Furthermore, researchers showed that spirulina vitamin B12 may not be bioavailable in mammals (63, 66). Herbert (67) reported that an extract of spirulina contains two vitamin B12 compounds that can block the metabolism of vitamin B12. And van den Berg et al. (68) demonstrated that a spirulina-supplemented diet does not induce severe vitamin B12 deficiency in rats, implying that the feeding of spirulina may not interfere with the vitamin B12 metabolism. Further studies are needed to clarify bioavailability of spirulina vitamin B12 in humans. end quoteS Upshot is that the Lactobacillus assay mislead people to think that Spir had plenty, while the pig IF binding assay later suggested that most of the b12 was a closely related corronoid, dubbed pseudovit b12, that can't be used by humans, but can be used by the Lactobacillus. Purple and green laver (nori) and Chlorella (eukaryotic microalgae) do have real vitamin B12. Purple nori was found to reverse effects of B12 defic in rats, and nori was found to result in higher levels of B12 in vegans. Chlorella is expensive, nori less so. Calculate ammounts needed to eat.

Vegetables. Many studies have been performed to measure vitamin B12 content in various vegetables. For decades, edible bamboo shoots have been believed to contain considerable amounts of vitamin B12. However, it turned out that they do not contain appreciable amounts of vitamin B12; however, certain compounds showing vitamin B12–like activity (known as the alkali-resistant factor) were found in them (44). Similar results were found in cabbage, spinach, celery, garland chrysanthermum, lily bulb, and taro (44). Only trace amounts of vitamin B12 (< 0.1 μg/100 g of wet weight edible portion), which was estimated by subtracting the alkali-resistant factor from total vitamin B12, were found in broccoli, asparagus, Japanese butterbur, mung bean sprouts, tassa jute, and water shield (44). These vegetables may have the ability to take up vitamin B12 found in certain organic fertilizer. ... Edible Algae. Various types of edible algae are used for human consumption the world over. Dried green (Enteromorpha sp.) and purple (Porphyra sp.) lavers (nori) are the most widely consumed among the edible algae and contain substantial amounts of vitamin B12 (32 to 78 μg/100 g dry weight; Ref. 39). In Japanese cooking, several sheets of nori (9 × 3 cm; about 0.3 g each) are often served for breakfast. A large amount of nori (< 6 g) can be consumed from certain sushi, vinegared rice rolled in nori. However, edible algae other than these two species contain none or only traces of vitamin B12 (39). Dagnelie et al. (53) reported the effect of edible algae on the hematologic status of vitamin B12–deficient children, suggesting that algal vitamin B12 appears to be nonbioavailable. As bioavailability of the algal vitamin B12 is not clear in humans, my colleagues and I characterized corrinoid compounds to determine whether the dried purple and green lavers and eukaryotic microalgae (Chlorella sp. and Pleurochrysis carterae) used for human food supplements contain vitamin B12 or inactive corrinoids. My colleagues and I found that these edible algae contain a large amount of vitamin B12 without the presence of inactive corrinoids (54–57).

To measure the bioavailability of vitamin B12 in the lyophilized purple laver (Porphyra yezoensis), the effects of feeding the laver on various parameters of vitamin B12 were investigated in vitamin B12–deficient rats (58). Within 20 days after vitamin B12–deficient rats were fed a diet supplemented with dried purple laver (10 μg vitamin B12/kg diet), urinary methylmalonic acid excretion became undetectable and hepatic vitamin B12 (especially coenzyme vitamin B12) levels significantly increased. These results indicate that vitamin B12 from the purple lavers is bioavailable in rats.

A nutritional analysis for the dietary food intake and serum vitamin B12 level of a group of six vegan children aged 7 to 14 who had been living on a vegan diet including brown rice for 4 to 10 years suggests that consumption of nori may keep vegans from suffering vitamin B12 deficiency (59). Rauma et al. (60) also reported that vegans consuming nori and/or chlorella had a serum vitamin B12 concentration twice as high as those not consuming these algae.

Edible Cyanobacteria. Some species of the cyanobacteria, including Spirulina, Aphanizomenon, and Nostoc, are produced at annual rates of 500–3000 tons for food and pharmaceutical industries worldwide (61). Tablets containing Spirulina sp. are sold as a health food fad, since it is known to contain a large amount of vitamin B12 (62). We found that commercially available spirulina tablets contained 127–244 μg vitamin B12 per 100 g weight (63). When two corrinoid compounds were characterized from the spirulina tablets, the major (83%) and minor (17%) compounds were identified as pseudovitamin B12 (adeninly cobamide) and vitamin B12, respectively (Fig. 2⇓). Several groups of investigators indicated that pseudovitamin B12 is hardly absorbed in mammalian intestine with a low affinity to IF (64, 65). Furthermore, researchers showed that spirulina vitamin B12 may not be bioavailable in mammals (63, 66). Herbert (67) reported that an extract of spirulina contains two vitamin B12 compounds that can block the metabolism of vitamin B12. And van den Berg et al. (68) demonstrated that a spirulina-supplemented diet does not induce severe vitamin B12 deficiency in rats, implying that the feeding of spirulina may not interfere with the vitamin B12 metabolism. Further studies are needed to clarify bioavailability of spirulina vitamin B12 in humans.

View larger version: In this window Figure 2. Structural formula of vitamin B12 and pseudovitamin B12 (7-adeninyl cyanocobamide).

Aphanizomenon flosaquae, a fresh water cyanobacterium, grow naturally in Upper Klamath Lake, Oregon. Kay (69) described that the bacterial cells contain some corrinoid compounds that can be used as vitamin B12 in humans. In contrast, my colleagues and I found that the corrinoid compound purified from Aphanizomenon cells was identified as pseudovitamin B12, which is inactive corrinoid for humans (70). We found that the dried bacterial cells contained 616 μg vitamin B12 per 100 g weight. Escherichia coli 215-bioautography of the Aphanizomenon extract indicated that the bacterial cells contained only pseudovitamin B12 (70).

Aphanothece sacrum (Suizenjinori) is an edible cyanobacterium that is indigenous to Japan. The dried bacterial cells are used as an ordinary food item after soaking in water or a nutritional supplement. The nutrition labeling of this bacterial product shows that the dried cells contain a large amount of vitamin B12 (94 μg/100 g); however, the corrinoid compound purified from the bacterial cells was identified as pseudovitamin B12 (71). Therefore, its nutritional value is questionable. Nostoc commune (Ishikurage) contains considerable amounts (99 μg/100 g) of vitamin B12 in its dried cells as measured by the microbiologic method; however, only 12% of the vitamin may be active, since the main (88%) and minor (12%) compounds in the bacterial cells were identified as pseudovitamin B12 and vitamin B12, respectively (72). In summary, the results reviewed above indicate that edible cyanobacteria often contain a large amount of pseudovitamin B12, which is known to be biologically inactive in humans. Therefore, they are not suitable for use as a source of vitamin B12 for the prevention of vitamin B12 deficiency among the high-risk population, such as vegans and elderly subjects.

Vitamin B12
Spirulina is not considered to be a reliable source of Vitamin B12. The standard B12 assay, using Lactobacillus leichmannii, shows spirulina to be a minimal source of bioavailable vitamin B12. Spirulina supplements contain predominantly pseudovitamin B12, which is biologically inactive in humans. Companies which grow and market spirulina have claimed it to be a significant source of B12 on the basis of alternate, unpublished assays, although their claims are not accepted by independent scientific organizations. The American Dietetic Association and Dietitians of Canada in their position paper on vegetarian diets state that spirulina cannot be counted on as a reliable source of active vitamin B12. The medical literature similarly advises that spirulina is unsuitable as a source of B12.

Not quite right. Looks like the Lactobacillus assay shows good B12 levels, and that's why it used to be thought that spirulina was a good source. But an assay using Now Watanabe suggests that the Lactobacillus can use closely related corronoids (like pseudovit B12) that humans (and presumably other mammals) can't use. An assay measuring binding to xxx, which distinguishes between true and pseudo B12, showed that while Purple and green laver (nori) and Chlorella bind to the pig currently thought to have good levels of real B12.don't see any mention of rat-feeding experiments, though. Purple and green laver (nori) and Chlorella are currently thought to have good levels of real B12. (Ineed to check the details of amounts present versus amounts thought to be required by humans.

Edible Cyanobacteria. Some species of the cyanobacteria, including Spirulina, Aphanizomenon, and Nostoc, are produced at annual rates of 500–3000 tons for food and pharmaceutical industries worldwide (61). Tablets containing Spirulina sp. are sold as a health food fad, since it is known to contain a large amount of vitamin B12 (62). We found that commercially available spirulina tablets contained 127–244 μg vitamin B12 per 100 g weight (63). When two corrinoid compounds were characterized from the spirulina tablets, the major (83%) and minor (17%) compounds were identified as pseudovitamin B12 (adeninly cobamide) and vitamin B12, respectively (Fig. 2⇓). Several groups of investigators indicated that pseudovitamin B12 is hardly absorbed in mammalian intestine with a low affinity to IF (64, 65). Furthermore, researchers showed that spirulina vitamin B12 may not be bioavailable in mammals (63, 66). Herbert (67) reported that an extract of spirulina contains two vitamin B12 compounds that can block the metabolism of vitamin B12. And van den Berg et al. (68) demonstrated that a spirulina-supplemented diet does not induce severe vitamin B12 deficiency in rats, implying that the feeding of spirulina may not interfere with the vitamin B12 metabolism. Further studies are needed to clarify bioavailability of spirulina vitamin B12 in humans.

Mild-mannered description of controversy, from Columbia U.
http://columbia-lyme.org/patients/controversies.html


 * The Lyme Disease Controversy


 * The CDC clinical criteria for Lyme Disease which exist for the purpose of monitoring the rate of Lyme disease nationally are quite narrowly defined in order to ensure a high degree of specificity in the diagnosis. These criteria are mainly useful for the early stages and rheumatological presentations of Lyme Disease, such as when a patient appears with an erythema migrans rash, arthritis, a Bell's palsy, or early central neurologic Lyme disease (meningitis or encephalitis). The CDC criteria are not very helpful for helping the clinician to detect late stage neurologic Lyme Disease. For example, the most common manifestation of late neurologic Lyme Disease is cognitive dysfunction (often referred to as "encephalopathy"). A patient who presents with new onset encephalopathy and a positive blood test for Lyme Disease would not be considered by the CDC to be a case of Lyme disease. Although the CDC recognizes that Lyme encephalopathy exists, encephalopathy is not part of the "surveillance case definition". Hence, physicians who rely on the narrow surveillance case criteria of the CDC for clinical diagnosis will fail to diagnose some patients who in fact do have Lyme disease; in these cases, the patient's treatment will either not occur or be delayed. Such delay in treatment may result in an acute treatable illness becoming a chronic less responsive one.


 * Other physicians who use a broader more inclusive set of clinical criteria for the diagnosis of Lyme disease will make the diagnosis of Lyme Disease and initiate treatment. The latter group of doctors, by treating some patients for "probable Lyme Disease", will make use of antibiotic responsiveness to confirm their diagnostic impression. These physicians, by erring on the side of not letting a patient with probable Lyme Disease go untreated, will help many patients who otherwise would not get treatment; undoubtedly, however, because of the inclusiveness of their diagnostic approach, these physicians will also treat some patients with antibiotics who do not have Lyme Disease. These physicians would argue that the serious consequences for physical, cognitive, and functional disability associated with chronic Lyme Disease outweigh the risks of antibiotic therapy.


 * Both sets of doctors are practicing medicine in a reasonable fashion based on the application of certain diagnostic principles, although the therapeutic approaches differ considerably stemming from the narrow vs broad criteria for diagnosis. This is the essence of the medical controversy surrounding chronic Lyme disease. Until medical doctors have a test that definitively identifies the presence or absence of infection (and such a test does not yet exist), the controversy about the diagnosis and treatment of chronic Lyme Disease will continue.


 * In July 2009, the IDSA held a hearing to review recommendations and critiques of the 2006 Lyme Disease IDSA treatment guidelines by a range of speakers from the United States. The comments of those speakers can be found at the IDSA website.

PR and the NYT
Ha, good one about the number of lawyers. I'm sure they're well-connected, expensive lawyers, too.

Regarding the reputation of the NYT, see the following about its relationship with PR agents: Pogue, reader comments. Nice that they stepped in when Pogue went overboard in exploiting the revolving door between journalism and PR, but look at what it says about the reliance of "the newspaper of record" on PR pros. I knew that the PR agent's job is to generate favorable "publicity" that appears to be objective third-party information about a client, whether it's a person or an organization. This implies that PR agents are, essentially, marketing their contacts among the people who write and publish (or broadcast) the news. Which means that the news must be (clandestinely, I had assumed) influenced by paid, um, informants. I guess they're called flacks (and the journalists are called hacks). The reader usually never knows that a PR agent was involved.

What I didn't know is that newspapers, including the NYT, are not at all embarrassed to get and publish stories from PR agents, on behalf of their clients. It's business as usual, or as Brisbane puts it, a "role they [PR professionals] play in the everyday machinations of The Times". In other words, if you can afford a well-connected PR agent, then you can greatly increase your chances of having your story published in the ultra-prestigious NYT. I'm not sure if the fee is adjusted depending on the results, as I've heard medical ghost-writing fees often are, with the highest fee for NEJM or JAMA, lower fee for specialty journals, etc.) I haven't figured out (yet) who typically pays the newswriter, if it's a freelancer rather than a staff reporter on salary. Probably not the client directly, that would look really bad. (But doesn't it look bad, no matter who pays?) Maybe the PR agent, who adds it onto their bill. Possibly the newspaper, if the story seems sufficiently entertaining to its particular readership. Maybe the prestige of a byline in the NYT is sufficient to lower the monetary fee the writer charges. Or maybe it's some combination of the above.

To me, this seems as unethical as our system of allowing wealthy individuals or corporations to donate to election campaigns, and to pay Washington insiders to lobby Congress, cabinet members, and government regulatory agencies. As Lily Tomlin said, No matter how cynical I get, I can't keep up. Postpostmod (talk) 22:24, 15 December 2011 (UTC)

2 Identifying pseudoscience

2.1 Use of vague, exaggerated or untestable claims 2.2 Over-reliance on confirmation rather than refutation 2.3 Lack of openness to testing by other experts 2.4 Lack of progress 2.5 Personalization of issues 2.6 Use of misleading language.

Sounds like Steere, Wormser, et al. ;-)