Mind Control, Big Pharma, FDA...

[Dustin]

Hey Aedes, today I felt like I was getting a cold, so I took some vitamin C and I'm feeling better.

Were you just saying that it only works for colds and not the flu? You'd think if it boosted the immune system, it would also work for the flu, no?

Here's an article I found today on WebMD:

Vitamin C May Fight Colds After All
Vitamin C Boosts Immune System in as Little as 5 hours, Study Shows

By Emma Hitt, PhD
WebMD Medical News

March 12, 2003 (Denver) -- The popular belief that vitamin C can ward off the common cold may have some validity to it, say researchers who have studied changes in immune cells' response to vitamin C.

According to Susan Ritter, a graduate student at the University of Texas Health Sciences Center , several studies have looked at people taking vitamin C and the number of colds that they develop, but no research has looked at the immune system cells' response to vitamin C.

Presenting at the 60th Anniversary Meeting of the American Academy of Allergy, Asthma, and Immunology (AAAAI) on Tuesday, Ritter and colleagues reported that 12 healthy subjects who took one gram of vitamin C a day for two weeks showed a boosted immune system response during that time.

What's more, when they looked at responses in four of the patients, they found that in two of them, the response to vitamin C took place within five hours. According to Ritter, this might mean that taking a vitamin C tablet at the first sign of a cold could achieve an effect quickly enough to ward off that cold. "You may not have to take it every day," she says.

Ritter and colleagues drew blood from the subjects before and after they had taken one gram of vitamin C a day for two weeks. They isolated the immune system cells from the blood of the subjects and measured the levels of immunity boosting substances called cytokines.

Certain virus-fighting cytokines were increased after two weeks of taking the vitamin; however, when they measured the levels two weeks later, they found that the levels had returned to normal, suggesting that the effect is short-lived.

Ritter pointed out that previous studies of vitamin C have recommended several grams a day of vitamin C, which could potentially be toxic. But in their study, the patients took a much lower amount.

"We did not see any toxic side effects in the subjects," she tells WebMD.

Stephen Tilles, MD, with the Northwest Asthma & Allergy Center in Seattle, called the study "impressive" because it measures what's going on at the level of the cell.

"This study legitimizes some of the popular assumptions about vitamin C and helps validate the effect of vitamin C on the immune system," he tells WebMD.

He says that larger studies are needed to test these findings further. But he said, "this is the equivalent of about five glasses of orange juice a day, so it's way more practical and safer than the many grams per day that had been proposed earlier."

SOURCES: 60th anniversary Meeting of the American Academy of Allergy, Asthma, and Immunology, Denver, March 7-12, 2003. Susan Ritter, University of Texas Health Sciences Center, Houston. Stephen Tilles, MD, Northwest Asthma & Allergy Center, Seattle.

These statements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure or prevent any disease.

[Aedes]

Originally Posted by Dustin

Hey Aedes, today I felt like I was getting a cold, so I took some vitamin C and I'm feeling better.

I don't mean to be a jerk about this, but honestly you have NO idea if 1) you were actually getting a cold, 2) what kind of virus you had (of the MANY different viruses that cause colds), 3) what it would have been like if you had not taken vitamin C, and 4) if you might actually have gotten better faster without it. Zero idea. Furthermore, you're reporting a subjective diagnosis and a subjective response, and you're already biased towards the result you're reporting. So you'll have to understand that your anecdote is completely meaningless.

There is a reason we do clinical trials that have tens of thousands of patients, in which there are control groups and in which the investigators are blinded to which group was treated.

Were you just saying that it only works for colds and not the flu? You'd think if it boosted the immune system, it would also work for the flu, no?

Absolutely not. You may think that this assumption has logical merit, but if you had a better notion of what the phrase "immune system" actually meant you'd realize that it's a nonsensical conclusion.

There is no such thing as "boosting the immune system".

The immune system isn't just one thing.

It is probably the most complex part of the entire human body, there are myriad different cell types and functions, and there are different aspects of it that respond to different viruses. The immune system responds differently to influenza, which is a nonenveloped RNA orthomyxovirus than it does to, for example, adenovirus which is an enveloped double stranded DNA virus that causes very similar illness. And considering the other cold viruses out there (rhinovirus, coronavirus, parainfluenza virus, respiratory syncitial virus, enterovirus, human metapneumovirus, human bocavirus), as well as non-viruses that cause colds (like Mycoplasma pneumoniae and Chlamydia pneumoniae), you CAN'T generalize about a single immune mechanism that controls all these vastly disparate germs.

Here's an article I found today on WebMD...

This study you cite has not actually been published. It was presented at a meeting, but it does not appear in the medical literature. I'll let you know what I think of the study and its applicability to this discussion if it actually gets accepted to a peer-reviewed journal.

But even so, you cannot draw any conclusion about colds based on their reported methodology and outcomes. Measuring cytokine production is clearly not an adequate proxy measure for clinical protection against cold viruses.

REAL trials about cold viruses actually take human volunteers and infect them with a standard inoculum of a cold virus. You would need to demonstrate that the subjects did not have measurable IgG, IgA, IgM, or cytotoxic T-cell responses against the virus in question (so that their clinical response would not be modified by pre-existing immunity), you would need to demonstrate that they were functionally immunocompetent (i.e. normal responses to vaccine antigens), and you would need to demonstrate that they were not deficient in vitamin C. And then you would give them all the same inoculum of the same virus, give half vitamin C and half a placebo.

You primary outcome measure would be OBJECTIVE things, like duration of fever, duration of nasal congestion, etc. A secondary outcome would be serum cytokine levels. A tertiary outcome would be subjective symptoms.

Oh, by the way, do not forget that many symptoms of infections are actually produced by the body's inflammatory response to the infection and not by the infectious organism itself. That's why we actually need to give adjunctive immunosuppressants (steroids) for some life-threatening infections like bacterial meningitis and pneumocystis pneumonia (along with antibiotics).

The point is that a higher cytokine level may actually result in a worse clinical outcome.

Finally, the thing about science is that there is always more to learn. A high quality trial MAY come along that believably demonstrates that vitamin C is beneficial and not harmful. As of yet such a trial does not exist. And the trials that DO exist are contradicted by other trials, such that a benefit to vitamin C cannot be concluded based on the existing evidence (and there is a LOT of research into this).

This was all pooled together by the Cochrane Database, which takes big topics and reviews the medical evidence. I have full text access through the medical school library. Here is the abstract and summary of the article, which looked at multiple placebo-controlled trials involving something like 11,000 patients. The only group in which vitamin C was beneficial were people exposed to extreme physical stress, but these people may be physiologically and nutritionally different from the normal population, so a result like that cannot be generalized.

Vitamin C for preventing and treating the common cold

RM Douglas, H Hemilä, E Chalker, B Treacy


Cochrane Database of Systematic Reviews 2008 Issue 1 (Status: Commented)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DOI: 10.1002/14651858.CD000980.pub3 This version first published online: 18 July 2007 in Issue 3, 2007
Date of Most Recent Substantive Amendment: 14 May 2007

This record should be cited as: Douglas RM, Hemilä H, Chalker E, Treacy B. Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD000980. DOI: 10.1002/14651858.CD000980.pub3.
Abstract

Background
The role of vitamin C (ascorbic acid) in the prevention and treatment of the common cold has been a subject of controversy for 60 years, but is widely sold and used as both a preventive and therapeutic agent.

Objectives
To discover whether oral doses of 0.2 g or more daily of vitamin C reduces the incidence, duration or severity of the common cold when used either as continuous prophylaxis or after the onset of symptoms.

Search strategy
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2006); MEDLINE (1966 to December 2006); and EMBASE (1990 to December 2006).

Selection criteria
Papers were excluded if a dose less than 0.2 g per day of vitamin C was used, or if there was no placebo comparison.

Data collection and analysis
Two review authors independently extracted data and assessed trial quality. 'Incidence' of colds during prophylaxis was assessed as the proportion of participants experiencing one or more colds during the study period. 'Duration' was the mean days of illness of cold episodes.

Main results
Thirty trial comparisons involving 11,350 study participants contributed to the meta-analysis on the relative risk (RR) of developing a cold whilst taking prophylactic vitamin C. The pooled RR was 0.96 (95% confidence intervals (CI) 0.92 to 1.00). A subgroup of six trials involving a total of 642 marathon runners, skiers, and soldiers on sub-arctic exercises reported a pooled RR of 0.50 (95% CI 0.38 to 0.66).

Thirty comparisons involving 9676 respiratory episodes contributed to a meta-analysis on common cold duration during prophylaxis. A consistent benefit was observed, representing a reduction in cold duration of 8% (95% CI 3% to 13%) for adults and 13.6% (95% CI 5% to 22%) for children.

Seven trial comparisons involving 3294 respiratory episodes contributed to the meta-analysis of cold duration during therapy with vitamin C initiated after the onset of symptoms. No significant differences from placebo were seen. Four trial comparisons involving 2753 respiratory episodes contributed to the meta-analysis of cold severity during therapy and no significant differences from placebo were seen.

Authors' conclusions
The failure of vitamin C supplementation to reduce the incidence of colds in the normal population indicates that routine mega-dose prophylaxis is not rationally justified for community use. But evidence suggests that it could be justified in people exposed to brief periods of severe physical exercise or cold environments.


Plain language summary
Vitamin C for preventing and treating the common cold

The term 'the common cold' does not denote a precisely defined disease, yet the characteristics of this illness are familiar to most people. It is a major cause of visits to a doctor in Western countries and of absenteeism from work and school. It is usually caused by respiratory viruses for which antibiotics are useless. Other potential treatment options are of substantial public health interest.

Since vitamin C was isolated in the 1930s it has been proposed for respiratory infections, and became particularly popular in the 1970s for the common cold when (Nobel Prize winner) Linus Pauling drew conclusions from earlier placebo-controlled trials of large dose vitamin C on the incidence of colds. New trials were undertaken.

This review is restricted to placebo-controlled trials testing at least 0.2 g per day of vitamin C. Thirty trials involving 11,350 participants suggest that regular ingestion of vitamin C has no effect on common cold incidence in the ordinary population. It reduced the duration and severity of common cold symptoms slightly, although the magnitude of the effect was so small its clinical usefulness is doubtful. Nevertheless, in six trials with participants exposed to short periods of extreme physical or cold stress or both (including marathon runners and skiers) vitamin C reduced the common cold risk by half.

Trials of high doses of vitamin C administered therapeutically (starting after the onset of symptoms), showed no consistent effect on either duration or severity of symptoms. However, there were only a few therapeutic trials and their quality was variable. One large trial reported equivocal benefit from an 8 g therapeutic dose at the onset of symptoms, and two trials using five-day supplementation reported benefit. More therapeutic trials are necessary to settle the question, especially in children who have not entered these trials.

[Dustin]

Aedes, I wasn't trying to offend or discredit you. I only know what has worked for me, and when you say that I have no idea, I believe you're mistaken.

I have tested it on myself, while waiting for different periods and seeing what effect it has, or if I would have gotten better quickly on my own. It definitely works per my experience. Have you ever tried it?

P.S. I actually think garlic works much better, it just smells kind of bad. However, there's a company that produced a stabilized form of the effective ingredient in garlic, and it doesn't smell. I've tried it and it works really well. It's called Allimax. Some people have successfully used it to completely rid MRSA when antibiotics weren't working.

These statements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure or prevent any disease.

[Aedes]

Dustin, I'm not interested in taking this too much farther, but I'll leave it with this. We do NOT generate knowledge in medicine because "it worked for that guy" except when there is no other source of knowledge. Individual anecdotes are MEANINGLESS in the face of quality evidence, and for something like that there IS quality evidence. What you consider to be tests on yourself are not actually tests. They may be enough to convince you, but that's not a standard that's going to alter anyone's medical practice or even their medical understanding. What's your anecdote worth in the face of 30 clinical trials with 11,000 patients? Would you have had the same effect if you unknowingly took a placebo?

Why would I try it on myself when a) you're recommending what the FDA and toxicologists regard as a potentially toxic dose, and b) the common cold is brief, mild, and self-limiting anyway? Even if there is a statistically significant improvement, is it worth exposing myself to toxicity when that improvement might be a matter of hours for what are only mild symptoms anyway?

Finally, I am going to sign off of this discussion at this point. I'm a board certified infectious disease specialist (actually I hold three medical board certifications), I spent the last three years as a postdoctoral clinical fellow in infectious diseases at Harvard Medical School and the Harvard School of Public Health, and my mentors included some of the world's most renowned virologists and bacteriologists. I have treated THOUSANDS of patients with MRSA in my career, probably 20 in the last month alone, and I know my specialty extremely well, so don't get me started on that one.

If you want to have a respectful discussion in which anecdotes and ideas are interpreted in light of the standard of care and evidence in medicine, then I'm all for that. But if you're going to take this tact of INSISTING that your folk remedies and personal anecdotes are sufficient justification for physicians to alter their care and for the laypeople on this site to go treat themselves differently, then I am not going to be party to it.

Why not?

Because I'm going to let you hang by yourself in the medicolegal nightmare you've put yourself in by doing so. Because I don't want to be part of it when someone reads your words, treats themselves, and has an adverse outcome as a result. And believe me, you CAN be successfully sued even as a layperson for medical advice you give anonymously on the internet -- so you'd best be SURE that your personal experiences are harmless and generalizable to everyone who might be reading this before you assume medical responsibility for them.

[Dustin]

Aedes, if you can find one instance where I've recommended that people try what I've tried, then please point it out. I haven't done any such thing, so please don't assume to change what I've said.

I do however understand your perspective in keeping yourself out of trouble. And for the record, anyone reading this, please DO NOT try anything I've mentioned! How about that? However, I would recommend that people do research on alternative medicine.

I've enjoyed our discussions on this forum and appreciate your input.

[Aedes]

You don't have to make specific personal recommendations to be sued for it. If you present it as unqualified fact without any individualization or any acknowledgement of its limitations (i.e. that it's a personal anecdote that might not be generalizable to anyone else, and that you're not trained in medicine and you have not reviewed the contradictory evidence), then you CAN be held responsible for simple misunderstandings that result in harm.

I've enjoyed our discussions as well. But unlike philosophy, which is just a hobby of mine, here you're going head to head with me in an arena in which I have professional expertise and a lot of experience -- and there are REAL consequences of being wrong in medicine, so quality of evidence is something we CONSTANTLY need to evaluate. Even expert opinion is regarded as the weakest type of medical evidence in the face of controlled trials.

Oh, regarding MRSA and garlic, there is no evidence of any kind that taking garlic or garlic extract by mouth can treat MRSA infections or reduce MRSA colonization in humans, and there is only preliminary research in animals. There are investigational compounds called diallyl sulphides (the best known is called allicin) that are found in garlic, and in their chemically pure form are inhibitory to MRSA in culture. The only clinical trial has been in immunocompromised mice.

The strains of MRSA in the community are becoming very common, and it is a VERY serious thing. There are lots of options for treatment of MRSA with effective drugs, and there are options for MRSA decontamination as well (though it's not really permanent). I don't see a role for garlic or garlic extract for this purpose, because the serum levels of the active compounds are going to be negligible compared to the extracts that are being studied. I'd be happy to recommend it if we learn that its effectiveness can be demonstrated by a trial. Otherwise I'll wait to see if one of the investigational garlic compounds ends up purified and becomes a novel antibiotic that is safe and effective. But then it's not garlic any more so than penicillin is bread mold or any more so than aspirin is a leaf from a willow tree.

This abstract is the BEST of only 5 articles in the medical literature about garlic and MRSA. As you can see it's a bit removed from any clinical importance quite yet. It's a study from Taiwan that was published about 10 months ago in the Journal of Medical Microbiology:

Two diallyl sulphides derived from garlic inhibit methicillin-resistant Staphylococcus aureus infection in diabetic mice.

The inhibitory effect of diallyl sulphide (DAS) and diallyl disulphide (DADS) against meticillin-resistant Staphylococcus aureus (MRSA) infection in diabetic mice was studied. The influence of these agents on the plasma levels of fibronectin, C-reactive protein (CRP), fibrinogen, interleukin (IL)-6 and tumour necrosis factor-alpha (TNF-alpha), and on the activity of plasminogen activator inhibitor-1 (PAI-1), antithrombin III (AT-III) and protein C, in MRSA-infected diabetic mice was examined. To induce diabetes, mice were treated intraperitoneally with streptozotocin for 5 consecutive days. Ten clinical MRSA isolates obtained from infected patients were used in this study. Diabetic mice were infected by injecting 200 microl MRSA/PBS suspension containing 10(7) c.f.u. via the tail vein. At day 4 post-infection, 200 microl DAS or DADS was administrated twice orally with an interval of 12 h. Eight hours after each administration, the blood and organs of mice were collected. Results showed that DAS and DADS significantly decreased MRSA viability in the kidney (P<0.05), with administration of each agent twice showing a greater inhibitory effect than when given once (P<0.05). MRSA infection in diabetic mice significantly elevated the plasma levels of IL-6 and TNF-alpha (P<0.05). DAS or DADS given once did not affect the plasma levels of IL-6 and TNF-alpha (P>0.05); however, DAS or DADS given twice significantly decreased the plasma levels of both IL-6 and TNF-alpha (P<0.05). DAS and DADS treatments also significantly reduced the plasma levels of CRP, fibronectin and fibrinogen (P<0.05). DAS or DADS treatment did not affect PAI-1 activity (P>0.05), but DAS or DADS given twice significantly increased AT-III activity (P<0.05). DADS given twice elevated protein C activity (P<0.05). MRSA infection significantly increased malondialdehyde levels in the kidney and spleen (P<0.05), and these levels were significantly decreased by treatment with DAS or DADS (P<0.05). These data suggest that DAS and DADS could provide multiple protective functions against MRSA infection in diabetic mice.