What is the “sick user” effect and why does it screw up science?

It’s all very well Mike Adams (The Health Ranger) getting up in arms about conspiracies and supposed scientific fraud. I admire his enthusiasm and there is certainly plenty of the things he gets angry about going on in the world.

But science is nowhere near as cut and dried as untrained people think. Mike is not a doctor and has never been in a clinical situation or had to figure out fact from fiction in a patient setting.

Not all doctors and scientists who come up with odd answers are crooks, Mike!

As an example, let’s take a published study that investigates the taking of vitamins: it follows a bunch of people who take supplements and concludes that vitamins actually shorten your life. On average, the supplement takers died sooner… That’s obviously a fraudulent study; we know that vitamins help you live longer, right?

Well, no! That’s not necessarily true.

It may be that naughty patients themselves are screwing up the investigation, not the doctors. How so?

It’s a common enough observation among doctors in general that most patients do want to bother getting involved in living a healthy lifestyle. They are too lazy and expect doctors to fix them, after decades of self abuse, when they finally get sick and have to report in.

But when he or she is diagnosed with cancer, the patient suddenly gets very interested in health issues; maybe starts exercising; and taking supplements. It may be too late! In any case, he or she doesn’t do much else; no vigorous lifestyle changes; no heartfelt emotional cleansing. He or she dies on schedule and gets listed as someone on supplements who died prematurely.

It’s called “sick user syndrome” and is often a problem for researchers. People who are already in trouble suddenly jump on the bandwagon and profoundly distort the resulting statistics. It may even look like a therapy causes trouble: but it doesn’t at all, it’s just that “sick users” tend to influence the results.

OK, Mike?

This was noted by a great 11-year EPIC study published recently (EPIC doesn’t mean epic, it stands for European Prospective Investigation into Cancer and Nutrition, a GREAT initiative). They showed overall the powerful benefits of antioxidant vitamin supplement use at the start of the study was associated with a 48 percent reduction in the risk of cancer mortality over 11 years of study. The findings were published in the European Journal of Nutrition.

In addition, the risk of all-cause mortality was reduced by 42 percent in people who were supplement users at the start of the study. That’s the cruncher: if the person was genuinely interested in health and ALREADY taking supplements as part of a lifestyle regime, he or she did exceptionally well (I know of no drug that can achieve that kind of mortality reduction).

So where did the “sick user” result come in?

The EPIC researchers noted that people who started taking supplements AFTER the start of the study were at a higher risk of cancer mortality and so-called all-cause mortality. These were the naught minority who didn’t take any sensible health measures, till diagnosed, and then jumped onto the vitamin game, in the vain hope it would save them…

Nah. Life is cruel like that.

Controversial

Of course there are those who are not happy with any finding that taking nutrients is good for us. In 2007 an infamous meta-analysis was published by Goran Bjelakovic et al. and from the Copenhagen Trial Unit at the Copenhagen University Hospital in Denmark in the Journal of the American Medical Association (Vol. 297, pp. 842-857).

The meta-analysis “proved” that vitamins A and E, and beta-carotene may increase mortality risk by up to 16 per cent. But in fact the trial was totally bent (as Mike Adams would readily argue): the excluded quality 400 trials, because no deaths occurred!

This was kind of crazy as a study protocol. Many people were not comfortable with it. And in fact, recently, a team of internationally renowned antioxidant scientists, including Prof Blumberg, re-analysed the SAME DATA used by Bjelakovic et al., and arrived at completely the opposite conclusion.

Blumberg et al. found that 36 percent of the trials showed a positive outcome or that the antioxidant supplements were beneficial, 60 percent had a null outcome, while only 4 percent found negative outcome.

The EPIC scientists based their findings on analysis of intakes of 23,943 people, all free of cancer and heart disease at the start of the study.

Compliance

Most interesting in this study was the definition of “regular use”. The bar was set pretty low (25% of what they were supposed to take) and might easily have missed the resulting benefits: In other words, for 5 doses or one week of use per month when the label states ‘take daily’.

Maybe that was a deliberate attempt to invalidate the results, Mike? If it was, the ruse misfired. Because even with such poor compliance and mediocre levels of vitamin supplementation, the benefits were still dramatically measurable.

As Prof Blumberg added, “If this was a study of a drug and adherence was this poor, a null outcome would be dismissed as meaningless due to non-compliance.”

Source: European Journal of Nutrition?Published online ahead of print, doi: 10.1007/s00394-011-0224-1 ?“Vitamin/mineral supplementation and cancer, cardiovascular, and all-cause mortality in a German prospective cohort (EPIC-Heidelberg)”?Authors: K. Li, R. Kaaks, J. Linseisen, S. Rohrmann

8 COMMENTS

  1. I absolutely agree with you regarding the great distortion of accuracy that many of these so called studies reveal. From my own experiences of having a mild form of type II diabetes, metabolic syndrome, clinical gout and hypertension in my past which I was able to completely reverse a number of years ago by shifting to a mediteranian type diet consisting of lower glycemic loads, taking a large series of antioxidants that are too many to mention, fish oils, coconut oil, cod liver oil, Iodoral or lugols solution and nordic tracking 20 minutes every morning for years and I feel like I did when I was in my 20’s. I am currently in my mid to late 50’s. So I do know for sure that the supplements and type of diet and lifestyle that I shifted to had a very huge influence on my entire health state. When I read many of these health studies involving vitamins, there is so many variables that I can suggest immediately where they are screwing up in the way the researches have designed these studies. It just seems to me many times which is also quite obvious that many studies have been designed to make a political point or just make their view look correct and everyone else like you or me are just stupid fools. But I can see many of the mistakes they make in their studies whether its intentional or ignorant. Thank you for bring this topic up which is a great passion of mine as well.

  2. Obviously you don’t like Mike Adams. Only Scientists and Doctors have the right to an opinion. At least Mike Adams isn’t filling our Nation with vaccines and medication. I presume you think Mothers have no right to make decisions with regard to their children
    as they have no Scientific or medical degree. I think he like you is trying to keep us informed and I for one are intelligent enough to do some research and I certainly don’t rely on anyones so called facts. I don’t doubt that you both spend a lot of time trying to do your best and care about people. I thought you were above the I’m mightier than though attitude. But obviously not.

    • Well, you are snotty Sarcha, and no mistake.
      You have no right to tell me what I think – especially when you are very wrong.
      I admire Mike a lot. He does a great service.
      But he makes a LOT of mistakes. For example his opinion about ADHD is a DISASTER (and it is only an opinion). Doctor like me spent years back in the 70s and 80s trying to get ADHD recognized as a real condition, so these kids could be helped, instead of being abused and punished by the system. Mike Adams claims it doesn’t exist (few years ago).
      Well, he’s not a doctor. If he’d ever seen what I saw in clinical practice, he could never have come up with such a gaff.
      I remember one kid who was so wired he spent the entire one hour interview with his parents running round and round the room, jumping onto my desk as he passed and running between us every circuit. It was exhausting to watch and VERY pathological.
      For someone to publish an opinion to millions that this condition is a hoax saddens me beyond belief.
      It’s (to me) like saying there’s no such thing as malaria, it’s just something the blacks made up to get sympathy and medical attention.
      As for the rest of your comments, they are both offensive and stupid. I was a champion of alternative medicine – and mother’s opinions – for many decades before Mike Adams spotted his marketing niche. It’s because of doctors like me, out there, who took the flack, that he’s able to tell these stories at all.
      So I think you are on the wrong list Sarcha. I suggest you unsubscribe from mine. I’ve been around far too long and seen far too much to be of use to an opinionated person like yourself.

  3. I was dianosed with lung and brain cancer in jan.2011.I was taking supplments before that but not the right kind.After the bad news I started looking on the internet for some kind of magic potion.I’ve seen hundreds.Everyone has a different solution.I should have been taking these vitamins when I was a young man.I was overcome with solutions to my problems.I was overloaded with info.Too much info.I’m getting chemo and radiation treatments now and so far not many side effects except being tired.I don’t know how this is going to end(well I do)What we have to do is take care when yu’re young.we have to eat the lousy veggies card board food.The internet has too much info.for me to digest.I never seen so many miracle cures and you know what,I’m going to try them.

    • Good for you Charles,
      Science is great but in the end, it matters what happens to YOU, not what happens to the stastistical majority.
      Prof.

  4. I think that Mike was saying that the neurologic disorders affecting kids these days are caused by vaccines and food additives(not all..just most). He was not trying to say that these kids don’t have a problem. I think he feels that these names (ADHD, PDD, ect) are created in order to sell drugs to kids. At any rate, that is my two cents.

    I have been reading mike adams for years…the dude knows what he is talking about. I just found your site…we will see if you do.

    It seems that you were at little sensitive at sarcha’s comments…i didn’t think that they were snotty or attacking you in anyway…

  5. @WM: I read Sarcha’s comments as sarcastic. not sure if “snotty” is the right word, but yeah. Especially when s/he says “I presume you think Mothers have no right to make decisions with regard to their children as they have no Scientific or medical degree.” that’s just a low blow, as Keith never suggested that.

    also, gotta love it when Sarcha says “I for one are intelligent enough to[…]” — that was just LOL funny to me

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