Month: June 2010

Is there any significant evidence that any of the following herbal remedies actually work in treating the conditions with which they’re associated?

Aloe vera for treating minor burns, including sunburn – 2009 review concludes: “some promising results with the use of aloe vera for diverse dermatologic conditions, clinical effectiveness of oral and topical aloe vera is not sufficiently and meticulously explored as yet.”

Black cohosh for reducing menopause symptoms – UK NHS clinical knowledge database states: “There is no good evidence that phytoestrogens, black cohosh, evening primrose oil, dong quai, ginkgo biloba, or ginseng are effective for treating menopausal symptoms.”

Boswellia (frankincense) for coping with arthritis and joint pain: NHS Choices says about the study of this substance: “One trial is rarely conclusive; more data are needed.”

Cranberry for cystitis and urinary-tract infections: Science-based Pharmacy has this to say after reviewing the literature: “When it comes to alternative medicine for urinary tract infections, there’s not much use in cranberry juice.”

Echinacea for influenza and cold prevention: The British Medical Journal reports that evidence of moderate quality obtained so far would suggest that, “Compared with placebo We don’t know whether echinacea is more effective at reducing the duration of symptoms of the common cold.”

Evening primrose oil for reducing cholesterol levels: Attract Wales (a UK NHS site that answers health questions) states: “We found very few studies in humans examining the effects of evening primrose oil on lipids. Those that were found were small and contained possible confounding factors.”

Feverfew for preventing migraines: A Cochrane Review says, “There is insufficient evidence from randomised, double-blind trials to suggest an effect of feverfew over and above placebo for preventing migraine.”

Flaxseed for treating the bone condition osteoporosis:

Ginkgo for Alzheimer’s and improving mental acuity: NHS Choices reports that a recent study suggests that, “Ginkgo biloba does not improve cognitive function in people with mild—to-moderate dementia.”

Papaya for herniated spinal disks: An enzyme extracted from papaya fruit can be injected into herniated disks to dissolve the gelatinous tissue and so reduce protruberant swelling (Time magazine report), this does not imply that eating papaya will be of benefit as enzymes are proteins and are broken down by the digestive system.

UPDATE: 8th July 2010

This item has come in for some criticism from “MyQute” regarding my “attack” on “natural” “foods”. I’ve used inverted commas around those words because I disagree vehemently with their use in this discussion. Anyway, here are my responses to the attack:

First, they’re not “foods”, foods are eaten for nutritional purposes, these are meant to have medicinal effects.

Secondly, the majority are not “natural” they’re produced in manufacturing plants and sold in stores, there’s nothing natural about the processes involved.

Third, I did not simply use NHS references, check each link you’ll see.

Fourth, everything on the NHS website is vetted by medical professionals with no vested interest in the issues other than in the sense that they would rather not see people waste their money on products that may have a detrimental effect.

Fifth, the references I cite round up data from various sources, such as Cochrane Reviews and are not to single studies, they each generally weigh up all the available evidence and that points to most of these products as having little or no benefit in the claimed conditions.

A few more science stories that caught my eye this week

• FieldView – Cresset Group – Free download release of FieldView, a new molecular viewer/editor that is designed to show molecules with their associated field patterns and physicochemical properties.
• Watery no-man’s land – Physical chemists know water to exist in 15 distinct phases, now research by Valeria Molinero and co-workers, University of Utah, USA, shows that at 180 K ice and liquid can coexist after water crystallizes.
• The Living Matrix: a movie promoting energy medicine beliefs – Classic bit of BS shredding. Apparently, "The heart is a functional brain. It may be the master organ for imprinting information into the holographic body field." Yeah, right
• Two suns – Will Aderoid approach the earth to within a few dozen million miles? Of course not…
• Over exposed calendar girl – X-rayed and X-rated, hot pin-up calendar girl is a serious case of over exposure. Eizo's calendar leaves no body part covered…
• Novel air-conditioner cuts cost and carbon – By eradicating the mechanics common in today's air-conditioning units, the NREL believes we could cut summertime electricity bills significantly on those parts of the world where A/C is considered an essential luxury. 90% savings suggestedq

• Low-temperature fraud detection – A low-temperature plasma probe can identify art fraud without damaging the artwork, which is important should the work turn out to be genuine.
• Flat-packed particles – Graphene is a material comprising sheets of carbon just one atom thick; graphene is like a single layer of graphite. However, it was the discovery that it has some peculiar electronic properties because of the existence of massless quasiparticles that has led to an explosion of interest in this material. Some researchers suggest that ultimately it will become the material that gives us a post-silicon world in computing.
• Yet another supernova – Just when you’d given up hope of another starburst, a third type comes along unannounced! This third class of previously unidentified supernova could help explain some anomalous observations in the night sky and even how our bodies come to contain so much calcium.
• Skin cancer – Burning questions about malignant melanoma are more than skin deep
• Water calculator – How much water does your household use each year, how big is the carbon footprint for that usage, what savings could you make?
• Natural Health, Placebos and Gibberish – Great bit of skeptical vandalism in the name of science and rationalism from Dr Dean Burnett. Spot the difference!

Diseases can be classified as Type I (those that are incident in both rich and poor countries); Type II (those that are incident in both rich and poor countries but with a substantial proportion in poor countries, for example tuberculosis [and malaria]) and Type III (those that are overwhelmingly or exclusively incident in poor countries, for example, African trypanosomiasis [and leishmaniasis and Chagas’ diseases]). Type II diseases are often termed as neglected diseases and Type III as very neglected diseases.

It is these demarcation lines drawn between the three “types” of diseases that has, in many ways, led to disease in what we used to call the Third World to be all-but ignored except in terms of media lamentation. One might suggest that the phrase “developing world” paints too rosy politically correct a picture despite serious poverty, malnutrition, and disease. Indeed, it’s almost as if labelling diseases in this way resurrects the old First, Second, and Third World ethos, although some observers point out that people in the pharma industry don’t actually use the terms Type I, II, and III.

Despite the introduction of stronger patent protection in India in the wake of the World Trade Organization’s TRIPS (Trade Related Aspect of Intellectual Property Rights) agreement, the pharma multinationals are not addressing Type III diseases. Even so-called compulsory licensing (a euphemism that gives “authorisation to a government or company to make and sell a pharmaceutical drug without the permission of the patent holder”, has not seen disease in India, China, Brazil and elsewhere challenged in any serious way.

Writing in IJTG, Sudip Chaudhuri of the Indian Institute of Management Calcutta, in Kolkata, West Bengal, India, suggests that a policy shift that more openly encourages partnerships between public and private sector is now needed, and the same approach might be adopted in Brazil and China, too.

In general, multinational corporations do not find diseases in poor nations attractive enough for research and development (R&D) investment. The markets are enormous, but there is not enough hard cash circulating to provide a big enough return on investment to keep shareholders happy. Some companies, AstraZeneca and GlaxoSmithKline, among them, have realised that drugs must be developed for neglected diseases regardless, while there has definitely been a perceptible increase in R&D driven by not-for-profit organisations and foundations such as the Drugs for Neglected Diseases Initiative, Medicines for Malaria Venture (MMV). Regarding India in particular, GSK’s donation program for lymphatic filariasis is having a great impact. And also in India, Merck announced a new partnership (The MSD Wellcome Trust Hilleman Laboratories) that is not only based in India, but will address developing world needs from there.

Nevertheless, it’s a never-ending battle and more needs to be done. The G-FINDER survey, funded by the Bill and Melinda Gates Foundation, highlights how much various people and organisations are investing in neglected tropical diseases.

The motives for pharmaceutical R&D can be twofold: Push incentives include public support (underpinned by direct public spending on R&D grants or tax credits). According to Chaudhuri, an National Institute for Health Care Management (NIHCM) foundation study revealed that 48 of the 50 of the best-selling drugs approved by the US Food & Drug Administration (FDA) during the 1990s were developed with some government funding during the product cycle. The major pull incentive is the likelihood of profit guaranteed by the patent system.

Unfortunately, in India, and presumably the other Type III countries, much of the pull incentive is irrelevant. “Pull mechanisms offer a better return for the output of R&D,” explains Chaudhuri, “It presupposes that the companies have the capacity and capability to undertake R&D. If they do not have this, if they cannot generate an output in the first place, obviously the question of benefiting from the higher value of the output promised does not arise.”

“In the developing countries, even if drugs were to be developed for neglected diseases, the return despite market exclusivity would be very low because of the low purchasing power and virtual absence of any health insurance,” he adds. Without an incentive to innovate companies in these regions of the world will either ignore Type III diseases or else produce illicit generic versions of patented drugs.

But, is it possible through government intervention and public sector collaboration to develop the infrastructure and funding for new drug R&D? In promoting new drugs for neglected diseases, governments of developing nations could provide both the push and the pull.

Efforts towards this goal have already been made in recent years, explains Chaudhuri. Indeed, all the major national laboratories in the drugs field (including CDRI, IICT, NCL, CCMB and IICB), academic institutes (including Indian Institute of Science, Bangalore, All India Institute of Medical Sciences, New Delhi, National Institute of Pharmaceutical Education and Research, Chandigarh) and about 50 pharma companies (Dr. Reddys, Ranbaxy, Dabur, Glenmark, Lupin, Cadila Pharmaceuticals and Alembic) are working towards this goal.

Moreover, the Open Source Drug Discovery (OSDD) initiative led by the Council of Scientific and Industrial Research (CSIR) is pushing R&D for new drugs for neglected tropical diseases such as malaria, tuberculosis and leishmaniasis by providing a collaborative platform for scientists, doctors, software professionals, students and others to facilitate drug discovery. Medicines themselves are only part of the problem and various pharma company initiatives are in place: http://www.globalhealthprogress.org

Unfortunately, regulatory approval and the obligatory clinical trials carried out in developed countries are a current stumbling block for all efforts. Chaudhuri and colleagues are now campaigning to expand the public-provate partnerships to include organisations from other innovative developing countries such as Brazil and China. They are also looking to make it possible for clinical trials for drugs against Type III diseases to be considered valid in India, Brazil, and China, where they are much cheaper to run than in the developed world.

At the time of writing, The Global Network for Neglected Tropical Diseases, an initiative of the Sabin Vaccine Institute, was set to host a briefing in conjunction with the Congressional Malaria and Neglected Tropical Diseases (NTD) Caucus on current and future efforts to control and eliminate NTDs. Merck’s Ken Gustavsen told me that, “As with any problem, more can be done – pushes and pulls – to address this. And with continued attention by all partners (companies, NGOs, governments, etc.), progress will continue to be made.”

If we are to have demarcation lines on types of diseases, then surely the same lines should be applied to testing the drugs to treat them. It’s not a matter of push and pull, but give and take for pharmaceutical R&D.

Sudip Chaudhuri (2010). R&D for development of new drugs for neglected diseases in India Int. J. Technology and Globalisation, 5 (1/2), 61-75

Related articles elsewhere

• Open Source Project Looks for Better TB Treatments (ostatic.com)
• Emerging nations ‘will push drug spending above $1trn’ (independent.co.uk)
• AstraZeneca answers the great call of China (telegraph.co.uk)

How does the ongoing saga of the BP oil leak in the Gulf of Mexico following the Deepwater Horizon disaster compare with three decades of major oil spills. An infographic from the oil spill timeline page of Iglu Cruises provides a visual comparison using data apparently sourced from the BBC.

Unfortunately, the Iglu graphic somewhat distorts the relative size of the figures. Those oily blobs are scaled by diameter rather than area, so what looks like a huge difference between the recent Gulf leak and Saddam’s deliberate spillage is not quite as enormous as it appears if you assume the relationship is about area of the oily blobs. My apologies for republishing this without making this clear in the initial blog post. I’ve now add red circles that show the actual relative size of each oil spill based on the area of the circles rather than their diameter, which is the more usual way of representing such statistics.

The complete infographic also shows some aspects of the human and environmental impact as well as the variance in the flow rate of oil from the well according to BP and independent observers. I’m disinclined to critique the rest of it given the dubious oily blobs.

Cosmic Variance mentioned this.

UPDATE: Kevin Zelnio has written a critique of the state of oil spills and published a bar chart covering the last fifty years.