Seth’s blog

When Paulo Zamboni’s wife came down with MS (multiple sclerosis), he was in an unusual position: He was a professor of medicine. Not only did he have technical expertise, he was going to care far more than than most MS researchers about finding a cure. (Likewise, when I suffered from early awakening, I had both technical expertise and cared more about finding a solution than any sleep researcher.)

Using ultrasound to examine the vessels leading in and out of the brain, Dr. Zamboni made a startling find: In more than 90 per cent of people with multiple sclerosis, including his spouse, the veins draining blood from the brain were malformed or blocked. In people without MS, they were not. [emphasis added] . . . More striking still was that, when Dr. Zamboni performed a simple operation to unclog veins and get blood flowing normally again, many of the symptoms of MS disappeared. . . . His wife, who had the surgery three years ago, has not had an attack since. . .
The initial studies done in Italy were small but the outcomes were dramatic. In a group of 65 patients with relapsing-remitting MS (the most common form) who underwent surgery, the number of active lesions in the brain fell sharply, to 12 per cent from 50 per cent; in the two years after surgery, 73 per cent of patients had no symptoms.

Clearly Dr. Zamboni has discovered something very important. Perhaps no true health breakthrough would be complete without appalling responses from powerful people within the biomedical establishment. The American MS society issued a comment on these findings that the rest of us can marvel at. According to them, people with MS should not get tested for malformed or blocked veins!

Q: I have MS. Should I be tested for signs of CCSVI?
A: No, unless you are involved in a research study exploring this phenomenon, since at this time there is no proven therapy to resolve any abnormalities that might be observed, and it is still not clear whether relieving venous obstructions would be beneficial.

Persons with MS cannot be trusted with the dangerous knowledge of whether or not their veins are malformed or blocked! The Chairman of the Board of the National MS society is Thomas R. Kuhn. The President is Joyce M. Nelson. I would love to know how they justify this position. I wrote to the National MS society asking how Kuhn justifies this. The Canadian MS society is far less negative, perhaps due to public pressure.

Over at This Is MS, the National MS position is derided. Someone has made the shrewd observation that if there is something to Zamboni’s idea, persons with MS should get a red head after exercise more often than persons without MS and is collecting data to see if this is true. There seems to be something to it.

Not only is this a wonderful discovery but it is wonderful how the National MS Society can simply be ignored. There are now much better sources of information.

Thanks to Anne Weiss, Charles Richardson, and James Andwartha.

In an earlier post I called a certain JAMA editorial “the most self-righteous editorial I have ever read.” Perhaps the authors reluctantly agreed; the editorial, which used to be here, is gone. Since I quoted from it, you can still see what I was talking about. The BMJ has an article about the disappearance, which includes this:

The BMJ sent emails to JAMA’s editor, Catherine DeAngelis, and the journal’s media relations office asking about the disappearance of the March editorial. The BMJ also asked whether Dr DeAngelis could explain why the new July editorial had toned down the policy outlined in the March editorial.

The response from a JAMA spokeswoman was “no comment.”

Correct: It is indefensible. What I said earlier still holds: The whole incident — self-righteous editorial, trash-talking by DeAngelis to a WSJ blogger, deletion of the editorial, failure to explain the deletion — “sheds a hugely unflattering light on the very powerful doctors who run JAMA — and thus an hugely unflattering light on a culture in which such people, like Nemeroff, gain great power.”

From Joyce Cohen’s The Hunt column:

For reasons unknown, Florida didn’t agree with little Noah Tovar. Since his toddler years, Noah, now 7, had suffered terribly from asthma. His parents, Jari and Selene Tovar, moved their family several times, trying to escape the mold or pollen or whatever it was that caused his breathing problems. Nothing helped much.

Noah’s parents didn’t know, I can tell, about a 1992 study of childhood asthma and allergies in Germany. Maybe childhood asthma is caused by air pollution, the researchers thought. Let’s test that idea by comparing a clean West German city (Munich) with a dirty East German one (Leipzig). Here’s one of the results:

The lifetime prevalence of asthma diagnosed by a doctor was 7.3% (72) in Leipzig and 9.3% (435) in Munich.

Less asthma in the dirty city! It wasn’t a significant difference but similar differences, such as hay fever and rhinitis (runny nose), were in the same direction and significant. Hay fever was much rarer in Leipzig.

Noah’s asthma cleared up, to his parents’ surprise, on a trip to New York. So the family moved to New York.

Even though “everyone was under the impression that New York would cause him more distress, it was just the opposite,” Mrs. Tovar said. “Not one doctor nor myself can explain what it is.”

Mrs. Tovar’s doctors are badly out of date. The hygiene hypothesis has been around since the 1990s, supported by plenty of data that, like the German study, shows that childhood allergies are better in dirtier environments. Noah is better in New York because New York air is dirtier than Florida air — that’s the obvious explanation.

In The Probiotic Revolution (2007) by Gary Huffnagle with Sarah Wernick, which I’ve mentioned earlier, Dr. Huffnagle, a professor of immunology at the University of Michigan, describes a self-experiment he did:

Could probiotics relieve something as tenacious as my lifelong allergies and asthma? I decided to take a probiotic supplement and make a few simple changes to my diet to my diet, just to see what happened. Yogurt became my new breakfast and my new bedtime snack. I also upped my intake of fruits and vegetables. Whenever possible, I substituted whole grains for processed ones. And I tried to cut back on sugar. [Why he made the non-probiotic changes is not explained. In another part of the book he says he also increased his spice intake.] No big deal.

Because I doubted this little experiment would work, I didn’t mention it to anyone, not even my wife. And I didn’t bother to record my allergy symptoms. . . My “aha” moment came after about a month: I’d spent the evening writing a grant proposal, a box of tissues at my side. After all these years, I knew to be prepared for the inevitable sneezing and runny nose caused by my mold allergies, which kicked up at night. But when I finished working and cleared the table, I realized I hadn’t touched the tissues. And as I looked back on the previous month, I could see other changes. This wasn’t my first sneeze-free evening; I hadn’t needed my asthma inhaler for several months. To my astonishment, the experiment had been a great success.

This is a great and helpful story. Only after I read it did I realize I’d had a similar experience. I’ve never had serious allergies but I used to sneeze now and then in my apartment and my nose would run a lot; I went through more than one box of Kleenex in a month. Maybe 4 in one morning. In January, I made just one change: I started to eat lots more fermented foods (yogurt, kimchi, kefir, etc.). My sneezing and Kleenex use are now almost zero.

The Tovars can live wherever they want, I’m sure, if they feed their son plenty of fermented food.

Previous post about childhood allergies and fermented food.

More After the column appeared, someone wrote to the Tovars:

Funny, same thing happened to me.  I moved from England where I had chronic asthma, to New York City where I had none.  Stayed in NY for twenty years asthma free, then moved back to England with my wife for the last ten years and my asthma has returned all the time I’ve been back.

At a store today I saw two containers of Siggis “Icelandic style” yogurt I wanted. One said “best by 4/27/09″; the other said “best by 5/18/09″. To my shock I realized the older one was better. It had more bacteria.

The opposite of what we’re supposed to think.

Expired food — don’t throw it out, give it to me.

Emory University professor Charles “Disgraced” Nemeroff was, you should remember, a respected psychiatric researcher. One of the most respected. What this says about academic psychiatry — and perhaps all academic medicine — is scary to think about.

Now comes a second episode along these lines: JAMA editors attack Jonathan Leo, a professor at Lincoln Memorial University, for daring to publish an article pointing out an undisclosed conflict of interest — exactly Nemeroff’s problem. In the most self-righteous editorial I have ever read, Catherine DeAngelis, JAMA’s Editor in Chief, and Phil Fontanarosa, the Deputy Executive Editor,

• say that Leo should not have contacted the New York Times
• “A telephone conversation intended to inform Leo that his actions were inappropriate transformed into an argumentative discussion as Leo continued to refuse to acknowledge any problem with his actions.”
• tell Leo to never submit anything to JAMA due to “his apparent lack of confidence in and regard for” the publication
• “We felt an obligation to notify the dean of Leo’s institution . . . We sought the dean’s assistance in resolving the issue . . . “
• “Our tone in these interactions was strong and emphatic . . . seriously . . . responsibility . . . fair process . . . integrity of science . . . We regret . . . “
• make it more difficult to report future conflicts of interest

To make sure everyone understood this wasn’t temporary insanity, Catherine DeAngelis made similar comments to the Wall Street Journal:

“This guy is a nobody and a nothing” she said of Leo. “He is trying to make a name for himself. Please call me about something important.” She added that Leo “should be spending time with his students instead of doing this.”

Yes, nothing is less important than an unreported conflict of interest in JAMA.

The JAMA editorial, published a week after the WSJ article, claims that DeAngelis didn’t call Leo “a nobody and a nothing” but since the WSJ has not fixed the supposed error I conclude that the editorial claim of quote fabrication is wrong — not to mention highly implausible.

In their editorial, the JAMA editors write that “a rush to judgment [that is, Leo pointing out the conflict of interest himself rather than deferring to them] . . . rarely sheds light or advances medical discourse.” Au contraire. This “rush to judgment” has shed a hugely unflattering light on the very powerful doctors who run JAMA — and thus an hugely unflattering light on a culture in which such people, like Nemeroff, gain great power.