Saturday, October 8, 2016

"Facing a Silent Liver Disease Epidemic" or Willful Blindness?

This article, from Chemical & Engineering News via Scientific American, is a rather perfect example of much of what's wrong with what passes for science and journalism, and scientific journalism.

They're discussing non-alcoholic fatty liver disease (NAFLD), and they mention diet as a fix, but only in the following fashion:

"Right now, a doctor can only recommend lifestyle changes—better diet, more exercise, less alcohol—to stop or reverse damage to the liver, which has an amazing ability to regenerate healthy cells. Unfortunately, studies have shown again and again that people are unable to stick to a healthier regime, and liver specialists would like to be able to offer treatments."


"Some involved are convinced that—barring a significant change in diet and exercise to prevent fat from continuing to accumulate in the liver—people will need to be treated chronically, much like with a diabetes drug. Intercept’s Pruzanski says the treatment approach will likely come down to how effective drugs are at sustainably reversing the course of the disease."

That's it, those are the two mentions of "diet".

My first problem with this article is that there is no mention of this study:

"Metabolites of arachidonic acid and linoleic acid in early stages of non-alcoholic fatty liver disease--A pilot study."

Building on work done by the US National Institute of Health, this Polish team found this result:

"Following the six-month dietary intervention, hepatic steatosis resolved completely in all patients."
That came out a year before the current news article.  

So here's the problem: we have an article about an incurable, widespread disease, with a bunch of purported experts in the field interviewed, and the only study to show a 100% cure rate of this condition isn't even mentioned.  100% cure rates in any field are virtually unheard of, and never in pharmacology.  

If "science" was working the way we all think it should, this paper and work inspired by it would be the entire basis of the article.  But no, all we get is crickets, and the dismissal of dietary therapy because people are "unable to stick" to it.

Well, so this gets down to a simple analysis of odds.  Let's assume the Polish study is a valid result.

On the other hand, we have a pharmaceutical industry that has a success rate of pretty close to zero for targeting a disease and developing a therapy with a 100% cure rate, as this post makes clear.  

And that near-zero chance of curing a disease comes after years of research, by which point everyone currently suffering from the disease is likely to be dead.

I know where I'd bet, given those two options.  The Polish study doesn't require perfect adherence to that diet, as I follow their approach a whole lot more diligently than the people in that study did, and yet they all benefited.

So your odds of treating this disease are almost infinitely higher on the dietary therapy, than the near-zero chance of a pharmaceutical treatment with the same level of efficacy.

We do know that despite the gloomy assessment of the efficacy of diet in the news story that people will, in fact, change their actions based on health claims.  We all switched to the diet that induces fatty liver disease because of the health claims, now recognized as erroneous.  

Most people stopped smoking after the health implications became clear.  Education was far more successful than any anti-smoking drug.

So this article is being written in complete ignorance, apparently, of the only approach that one should logically advocate: the one with a 100% cure rate and immediate availability.

That's a pretty damning indictment of the whole enterprise, in my opinion.

What's even more damning is that what's also not mentioned is that there is a pharmaceutical candidate that has shown benefits for NAFLD, using the same approach as the dietary one above, albeit with a far lower efficacy:

"Pentoxifylline decreases oxidized lipid products in nonalcoholic steatohepatitis: New evidence on the potential therapeutic mechanism"

But you wouldn't know about this from that piece, which has the unique characteristic of entirely missing all the useful information going on in this field of study.

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