Comment...1. The Quackbuster has no idea what LEAP is nor clearly ever looked at it after posting his uninformed comments over 18 months ago.Another viewpoint... ________________________________What's eating Stephen Barrett?by Burton GoldbergJuly 1998Alternative Medicine DigestHe says he's using science to protect the public from expensive fad diagnoses, but if this "quackbuster" has his way, the public will have no recourse but conventional medicine for their health problems. RECENTLY, I set myself the exercise of trying to understand what motivates a self proclaimed "quackbuster" to write a book debunking an entire field of medicine. A "quackbuster," as we've come to know over the years, is someone who is dedicated to casting aspersions on alternative medicine, regardless of whether there is any factual basis. As alternative medicine continues to grow more popular - an estimated 42% of Americans now use it - the "quackbusters" are growing more clamorous in their denunciations of our field. They have to be - they're almost a minority view.Highly visible among these self appointed "quackbusters" is Stephen Barrett, M.D., a retired psychiatrist, author of numerous books, and spokesman for the "Quackwatch" community. In his latest book, Chemical Sensitivity: The Truth About Environmental Illness, coauthored with Ronald E. Gots, M.D., Ph.D (Prometheus Books, 1998), Barrett goes after all the illness categories for which diet and chemical exposure are "falsely blamed."Multiple chemical sensitivity, sick building syndrome, food related hyperactivity, mercury amalgam toxicity, candidiasis hyperactivity, Gulf War syndrome - these are all costly misbeliefs and fad diagnoses, says Barrett. "Many Americans believe that exposure to common foods and chemicals makes them ill," he says. "This book is about people who hold such beliefs but are wrong."Not only are patients wrong, Barrett says, they are "financially exploited as well as mistreated." They are duped by "farfetched" notions and "dubious claims," by headline-crazed media and "toxic television," and by "physicians who use questionable diagnostic and treatment methods."Patients presume they are being made allergic or toxic or even being poisoned by the mass of modern chemicals, cosmetics, cleaning agents, drugs, and other human-made substances. They are mistaken, says Barrett. Their misbeliefs are especially hard to understand, Barrett says, "at a time when our food supply is the world's safest and our antipollution program is the best we've ever had."Patients' symptoms are mental (psychosomatic) in origin - "they react to stress by developing multiple symptoms." Their symptoms are not caused by chemicals or dietary factors, he says. In fact, Barrett suggests that some patients are "hysterical," others are "paranoid," and the rest have "certain psychological factors" that "predispose" them to "develop symptoms" and to seek out "questionable" doctors (meaning alternative medicine practitioners) who will attach a ("not scientifically recognized") disease label to them.Regarding Gulf War syndrome, for example, Barrett declares: "It provides a feeding trough for serious scientists, since funding is abundant, and for every charlatan with a newsworthy theory." On the matter of the dangers of mercury fillings, he states: "The false diagnosis of mercury amalgam toxicity is potentially very harmful and reflects extremely poor judgment."For the most part, of the illnesses listed above, nearly all are mere "labels" rather than legitimate illness conditions, asserts Barrett; they're not caused by foods or chemicals; there are no "scientific"" studies conclusively proving the association of diet, chemicals, and illness; and we are best advised to dismiss them out of hand, he says.In most cases and for most of the illnesses commonly associated with chemical sensitivity, Barrett says the mass of mistaken patients would be better off seeking "mental help" from a psychiatrist or other "mental health practitioner." Alternative medicine physicians and especially "clinical ecologists" (the old name for practitioners of environmental medicine, which links exposures to toxic substances with health conditions) should be chastised, investigated, put on notice, and if possible, put out of business, says Barrett.Most of what Barrett claims can be refuted, easily and decisively. That's not my intention here. I'm more interested in looking at the bigger picture - what is Barrett really saying amidst his quackbusting bluster, and why?Barrett appears to be saying that the typical American patient is stupid, hysterical or paranoid, easily duped, and generally incapable of making a rational, correct medical decision on their own. The patient is mistaken and wrong in thinking their multiple symptoms have any connection to the foods they eat or the environmental chemicals to which they are exposed. The media is irresponsible and not to be trusted as an information source about medicine, especially about alternatives. Doctors who practice alternative medicine are unscientific, opportunistic frauds or quacks, peddling flawed or junk science So who can you turn to - who is not on Barrett's hit list? Conventional doctors. Barrett doesn't say this outright, but it's the only logical conclusion. His message is the old and familiar one from the l950s: the (conventional) doctor knows best.I next pondered what could be the purpose of this book. What could be the result of debunking the connection between foods, chemicals, cosmetics, and drugs with the varieties of environmental illness (mentioned above) now afflicting millions of patients. Why does Barrett (and his colleagues) so dislike alternative medicine? What's eating him that he must disparage the field at every opportunity?The purpose has to be this: to corral this mass of suffering "confused" patients into the treatment pen of conventional medicine. But here Barrett's rationale collapses. The patients end up with nothing.Surely no person suffering unexplained allergies or general toxicity wants to be told they're stupid, mistaken, and ought to have their head examined. And surely no patient who has abandoned conventional medicine (because the one or two dozen doctors they consulted hadn't a clue as to how to help them) would be interested in Barrett's thesis. It is genuinely hard to imagine how a suffering patient could actually be persuaded by Barrett to dismiss alternative approaches when the conventional ones were not useful, or even worse, were harmful.But let's say, despite these reservations, patients allowed themselves to be herded into Barrett's allopathic corral. There would be nothing there for them. Conventional medicine has no cure or treatment for these illnesses. In fact, as Barrett repeatedly points out, for the most part, conventional medicine does not even validate the existence of these illness categories and regards a diagnosis of such illnesses as bogus medicine. Of course, Barrett does offer patients "mental help."Let's look at this setup carefully. Barrett and his "quackbusting" colleagues say they are working to protect the public against health frauds. They don't want the public to waste its money on "sham" treatments that don't work. The false labels of multiple chemical sensitivity, environmental illness, and the rest, do the public a "disservice," Barrett says, and seeking treatment for these wastes the financial resources of insurance companies, employers, and other third party reimbursers.But since conventional medicine has nothing to offer patients who "believe" they are suffering physical distress from these conditions, the patients, in effect, are left on their own to suffer some more. Barrett's plan seems to be to corral these misguided patients into the conventional medicine pen so he can dissuade them of their mistaken notions regarding their illness and make them "see" that it's all psychosomatic.Clearly the patients do not benefit at all from this scenario, so who does? The makers of drugs, petrochemicals, cosmetics, synthetic food additives, pesticides, prepared foods - in short, the massive food and chemical industry of North America benefits. They are no longer held accountable as causal factors in multiple symptom illnesses. They are let off the hook. They can proceed with business as usual. There are no poisons in their products. (See the cartoon about "quackbusters" by Harley Schwadron in "The Politics of Medicine" section, this issue, p. 106.)In the paradox of "quackbusting," the quackbusters say they're protecting public health, but in fact, they're abandoning the public to their own suffering to protect the financial interests of conventional medicine, which has no interest in or ability to produce benefits for these conditions. The "quackbusters" say they're serving the public, but the truth is they're grossly disserving patients. Thanks to Barrett's remarkable chemical insensitivity, a great many patients will be left to suffer on their own without any diagnosis or treatment, except perhaps another round of Prozac on the house.Reproduced with permissionAlternative Medicine Digest, July 1998 ALTERNATIVE MEDICINE ONLINE __________________________________"There is little evidence in general that food intolerance is a real phenomenon of major clinical signficance. That is, there may in fact be something to it, but it is probably fairly rare." ____________________________________This freqeuntly made claim is quite simply not fact, posted by those unfamiliar with the subject in toto. Documentation dates all the way from the 1980's and up through the most recent work on jejunal isolation studies in Sweden.Further disinformation: _________________________________________"Another point is that the best studies actually come from lactose intolerance, which although not the same thing as an immunological intolerance, suggest that people have difficulty in figuring out what foods bother them (if any indeed do)." ___________________________________________This is simply obfuscatory....some of the best studies deal directly with immunologic actcivation and provocation mechanisms within the bowel in response to oral challenge...and the use of immunomodulation which supresses the symptoms.LActose intolerance is well known to be symptom generating mechanism seprate and apart from the food hypersensitivity mechanisms which are involved in generating IBS symptom sets...it is a comorbidity at best....has nothing to do with the subject at hand whatsoever.If one wants to understnd food and chemical hypersensitivity and its role in symptom generation, and remission, in what is commonly called "IBS"....One can start with the Merck Manual here... _________________________________Current Merck Manual: "RECENTLY FOOD INTOLERANCE WAS FOUND TO BE RESPONSIBLE FOR SYMPTOMS OF SOME PATIENTS WITH THE IRRITABLE BOWEL SYNDROME, CONFIRMED BY DOUBLE-BLIND FOOD CHALLENGE. AN INCREASE IN RECTAL PROSTAGLANDIN LEVELS WAS NOTED WHEN A REACTION OCCURRED. PRELIMINARY INFORMATION SUGGESTS THE SAME PHENOMENON MAY TAKE PLACE IN PATIENTS WITH CHRONIC ULCERATIVE COLITIS." ___________________________________A Disease Mangment Program, such as LEAP, incorporates needs assessment tools and protocols to isolate those patients who characterize the patient which can potentially benefit, from those who are least likely to benefit, then enter those who can benefit into the Program. In this case the population which is most likely to benefit is that which is commonly identified as "diarrheic IBS" or "cyclic D&C" subpopulations. Properly diagnosed these represent better than 2/3 of that population and this is the population where the outcomes will be the best and for whom the protocol was developed by the doctors and dieticians who developed it.And as I have distributed many times before to many people who have emailed asking for it, I have put together in emailable form a collection of abstracts of some of the many papers spanning the last 25 years of study on the phenomenon of food and chemical hypersensitivity which I have emailed those who have written and asked for it. Those interested can contact me and I will send you what I have "transferred" from old fashioned hard copies to Word documents so far.A book on the subject from a renowned immunologist and allergist expert in this field can be read, and the reader can form her own conclusions:"FOOD ALLERGIES AND FOOD INTOLERANCE: THE COMPLETE GUIDE TO THEIR IDENTIFICTION AND TREATMENT", Professor Jonathan Brostoff , M.D.. Allergy, Immunology and Environmental Medicine, Kings' College, London
http://www.amazon.com/exec/obidos/ASIN/089...r=2-1/102-64875 08-3420903[/URL]The autheor, Professor Brostoff, and a staff of other physicians are in the final editing of a new medical text for physicians on the subject as well, which should be published in 2003. The first edition "food Allergy and Intolerance" has been out of print for sometime. The new edition will provide some much needed guidance to the medical profession itself on the subject matter.This book may help further with patients suffering IBS and trying to get a handle on all aspects of symptom generation inlcuidng
diet:IBS: A DOCTORS PLAN FOR CHRONIC DIGESTIVE TROUBLESBy Gerard Guillory, M.D.; Vanessa Ameen, M.D.; Paul Donovan, M.D.; Jack Martin, Ph.D.
http://www.amazon.com/exec/obidos/search-h...9085785-1742301 If you wish to read about the LEAP Disease Management Program and some peoples experiences with it, the following threads are recommendedLEAP and BLOOD TESTS
http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000285 WHAT IS LEAP?
http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000287 LEAP PT UPDATES
http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000286 "...THE LEAP THREADS BEING MOVED..."
http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000292 _______________________________________"Mike has just indicated that there is no funding available to begin addressing it." _______________________________________This is not what Mike said at all. Nor did Mike ever suggest anything realtive to this as an issue: _________________________________________"You can publish in the medical lit and not void out your patent rights." _________________________________________In fact the patented technolgy description was published directly to our peers, the laboratory professionals, three different times. One has othing to do with the other vis a vis new technology and limited publication....the real world issues must be addressed, those which are not experienced in the halls of academe.Mike said that the information published so far on this new technology consists of (3) articles in the American Clinical Laboratory Journals (reprints are available on request), an independednt study by a group of physicians in Europe, published in a european Allergy Journal, which demonstrates that the MRT test performed as claimed in their opinion, (reprints available on request), and that so far the first third party funding made available for studying MRT and LEAP Disease Mangement came from an AUTISM group, the Texas Center for Autistic Research and Treatment. The results of this study, in this application, must be positive since the Center is now using LEAP on their own private patients.I said that so far there have been no parties interested, private or public, in providing the large sum needed to implement a study protocol by a third party, even though one has been selected which is a well respected center for investigative studies. Not only does this center have extensive experience in FDA drug trials but their practive division (private patients) have used LEAP for IBS with success, in spite of the fact that the funding for the study is not forthcoming from any source. They are actually using it themselves based on the observed clinical outcomes on theor private patients with IBS-d...these investigators, WHO MAKE THEIR LIVING DOING PRECLINICAL TRIALS FOR DRUG COMPANIES INCLUDING IBS DRUGS.Mike said this kind of investigation does not yield such things as specifically a marketable drug in the end game, so the funding is exceedingly difficult to locate...not given up but sometimes you just have to find a way to do it yourself then. Therefore, if anything is to be done further as far as IBS goes, since this is a non-pharmacotherapy alternative and the private nor public sector have an interest in supporting it, the company will have to accumulate the money itself from operations. The daunting size of the number suggests it will take a bit to accumulate that amount of money. But it will be done. In the meantime anyone considering a Disease Mangement approach like LEAP should read all the available information published on the role of non IgE mediated hypersensitivity reactions in symptom generation, including an actual BOOK on the subject, consider the physician and dietician base using the method, talk with patients who have been through said protocols, consider the fact that over 270 insurance plans so far pay for it.Most of these plans have not, as has been suggested, done so solely to appease patients needs for alternative therapies. BUT many times as a result of MEDICAL NECESSITY REVIEWS of the IBS patients case, the technical papers on the test, the reports from physicians who have tried it so far and their outcomes, etc...what documentation is requested varies with the Plan Med Nec Review procedures. They have consistently deemed it approrpiate for reimbursement as the material presented was sufficient to meet their burden of proof of efficacy. It also seems to those involved that it makes sense to determine if the patients symptoms are being precipitated by non-allergic food or chemical hypersensitivity as if this can be isolated and removed, the symptoms should be reduced as will then the cost of ongoing care.Newness does not warant effectiveness, nor conversely does it imply a lack of efficicy. It simply means that the rules of "new" apply as they do to all new technologies, modalities, and protocols. The longer they are on the market the more information amasses. So each person has to decide on their own at what point sufficient info has amassed to satisfy them.Many physicians, dieticians and third party payers who have assessed the PROGRAM so far have decided that the existing information meets their burden of proof sufficient to allow their patients to access it and benefit from it. Also, much of the information available on IBS must be considered in the context of both the source and the fact that no one physician or group knows all that there is to know about IBS disease managment and physiology. All the info from many sources needs to be integrated by the medical community itself, and so far this has not occurred.Eat well. Think well. be well.MNL