What You Should Know about Prebiotics and Probiotics

There is a lot of interest in prebiotic and probiotics generated mainly by companies producing infant milk formula on the beneficial effects of these two agents. Probiotics are the 'good' bacteria that is found in the intestines. Prebiotics are food nutritients for probiotics or the 'good' bacteria. The idea of giving a baby prebiotics is to provide nutrition to the good bacteria so that it will grow in the intestine. It is postulated that the presence of good bacteria (probiotics) helps the newborn's intestine to develop their immune response to infection and maybe allegy. Human milk contains prebiotics.

The newborn intestine is sterile. Colonisation of the intetsine begins almost immediately with different bacterias, differing by whether the baby is exclusively breast fed or formula fed. Nevertheless by six weeks, the organisms in the intestines of these two groups are the same. Does this warrant the addition of prebiotic and probiotic to infant formula? Apparently these companies think so because they are marketing the addition to infant formula of prebiotics and probiotics as directly responsible to improve the child's immune response and to reduce allergy.

What are the facts?

• while probiotics is useful in the treatment of infective and antibiotics diarrhea, there is no evidence available that prebiotics and probiotics improve or strengthened a child's immunity.
• a Cochrane review in 2007 conclude that there is insufficient evidence to warrant routine supplement of probiotics to either pregnant women or infants for prevention of allerguc disorders in infant. The Cockrane review is a database for evidence-based medicine.
• The American Academy of Pediatrics (AAP) recently issued an extensive Clinical Report: Probiotics and Prebiotics in Pediatrics authored by Dan W. Thomas, MD, Frank R. Greer, MD, and the Committee on Nutrition and the Section on Gastroenterology, Hepatology, and Nutrition.

Medscape conducted an interview with Dr Thomas concerning this report,
 

Medscape: While the report makes clear that human milk is the preferred food for infants, what would you suggest primary care providers advise parents who choose to bottle-feed? Should infant formula supplemented with probiotics be recommended?

Dr. Thomas: No one can answer this question at this time. The health benefits of feeding infant formula containing probiotics and/or prebiotics are unproven. In essence, this report challenges industry and healthcare researchers to conduct high-quality, evidence-based studies to answer these questions.

 
The addition of prebiotics and probiotics to infant formulas is another example of industrial driven marketing based on doubtful or unproven scientific data. The inclusion of prebiotics and probiotics follow a trend of additional of supplements to infant formulas. As with prebiotics and probiotics, all these supplements have no or doubtful evidence that they are of actual value. With each inclusion, the price of the infant formula increase. This is a burden to mothers who are unable to breast feed because they could not produce milk or they have to work. In the meantime, these infant formula companies which are usually multinationals make millions.

Questionable Marketing to Doctors (2)

In response to my post on Questionable Marketing to Doctors, especially to Merck publishing a 'fake journal', I received this email in response.

Dear Dr. Tang:

Thank you for your recent e-mail letter to Merck. Merck has always been committed to the highest standards of scientific integrity, patient safety and ethics. Our voluntary withdrawal of VIOXX in September 2004 is a good example of that commitment.

Since the voluntary withdrawal there have been significant misstatements of fact in the press and elsewhere about VIOXX and it appears some of these misperceptions have found their way into your letter. The facts concerning the Australasian Journal of Bone and Joint Medicine Journal are disclosed in our company statement which is attached and posted on Merck.com (http://www.merck.com/newsroom/vioxx/pdf/statement_20090430.pdf).

The pdf file is a Merck Company statement dated 30 April 2009 which started with

Merck Responds to Questions about the
Australasian Journal of Bone and Joint Medicine Journal

Questions about a 2001 Circulation Article also Addressed

WHITEHOUSE STATION, N.J., April 30, 2009 – Merck & Co., Inc. today provided the following statement regarding questions stemming from the courtroom testimony of professor George Jelinek in Australia.

The Australasian Journal of Bone and Joint Medicine to which professor Jelinek referred was published by the medical publishing company Elsevier. Merck Sharp & Dohme Australia understood that Elsevier envisaged the complimentary publication would draw on the vast resources of Elsevier, publishers of many leading peer-reviewed journals including Lancet, Bone, Joint Bone Spine and others, to deliver novel and timely full-text articles and abstracts to physicians.

read the rest of the statement (http://www.merck.com/newsroom/vioxx/pdf/statement_20090430.pdf).and decide for yourself.

Questionable Marketing to Doctors

It is a sad day for me to learn of this action of the pharmaceutical giant Merck. Of all the pharmaceutical companies I have dealt with, I have always respected Merck for their integrity and responsibility. Over the years, as I watch the merging and buying over of various other pharmaceutic companies, I have noticed a declining standards of ethics and morality especially in their marketing departments. Over the last couple of years I noticed a declining standard in Merck. This report from The Scientist reveals the extent of the rot.

Merck published fake journal

Posted by Bob Grant

[Entry posted at 30th April 2009 04:27 PM GMT] in The Scientist.com website

Merck paid an undisclosed sum to Elsevier to produce several volumes of a publication that had the look of a peer-reviewed medical journal, but contained only reprinted or summarized articles--most of which presented data favorable to Merck products--that appeared to act solely as marketing tools with no disclosure of company sponsorship. Image: flicker/meviola "I've seen no shortage of creativity emanating from the marketing departments of drug companies," Peter Lurie, deputy director of the public health research group at the consumer advocacy nonprofit Public Citizen, said, after reviewing two issues of the publication obtained by The Scientist. "But even for someone as jaded as me, this is a new wrinkle." The Australasian Journal of Bone and Joint Medicine, which was published by Exerpta Medica, a division of scientific publishing juggernaut Elsevier, is not indexed in the MEDLINE database, and has no website (not even a defunct one). The Scientist obtained two issues of the journal: Volume 2, Issues 1 and 2, both dated 2003. The issues contained little in the way of advertisements apart from ads for Fosamax, a Merck drug for osteoporosis, and Vioxx. (Click here and here to view PDFs of the two issues.) read more

Dr Summer Johnson writing in blog.bioethics.net comments

What's wrong with this is so obvious it doesn't have to be argued for. What's sad is that I'm sure many a primary care physician was given literature from Merck that said, "As published in Australasian Journal of Bone and Joint Medicine, Fosamax outperforms all other medications...." Said doctor, or even the average researcher wouldn't know that the journal is bogus. In fact, knowing that the journal is published by Elsevier gives it credibility! Read more

This is one of the danger of pharmaceutical companies becoming bigger and bigger. Somehow the growth is not proportional to the growth of ethics in these companies and not consistent with the sense of morality of their original founders.


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Reality Check on Guy Kawasaki

Guy Kawasaki is an interesting guy and I have been following his writings for some time.

This brief biodata is from wiki;

Guy Kawasaki (Born August 30, 1954) one of the original Apple employees responsible for marketing the Macintosh in 1984, is a Silicon Valley venture capitalist. He is noted for bringing the concept of evangelism to the high-tech business, focusing on creating passionate user-advocates for the Apple brand. Kawasaki was a former Apple Fellow, and after leaving the company, became CEO of a pseudo-spin-off of Apple called ACIUS, which produced the 4th Dimension database program. He also started the company Fog City Software. Recently, he has been involved in the rumor reporting site, Truemors, and an RSS aggregator, Alltop. As of August 2008 his blog "How to Change the World" is ranked 88 in the world.

Kawasaki has a B.A. in psychology from Stanford University and an MBA from University of California, Los Angeles. He is Japanese American and a native of Honolulu, Hawaii where he attended the Iolani School.

He is currently a Managing Director of Garage Technology Ventures, a venture capital firm which specializes in high-technology start-up firms located in Silicon Valley, California as well as co-founder of Nononina, the company that created the Truemors and Alltop websites.

This book, Reality Check (2008) is his latest. He writes in the introduction, "...I grew frustrated with the shortcoming of blogging, which I started to do in earnest in 2006 with my blog "How to Change the World." I quickly learned that people rarely scroll past the home page of a blog or search for previous material. However I wanted my blog to serve as a constant reference source for a wide range of topics of entrepreneurial interest. The reality is that blogs and online sources don't do this very well for everyone.

...inspired me to publish Reality Check.That is, I wanted to provide hardcopy information to hardcore people who want to kick ass, and I wanted this information in something you can hold you your hands-aka, a book. Why a book? Because a book boots up faster than a blog and a book has better copyediting and fact-checking than a blog. Also a book is not dependent on Internet connectivity, battery life, or of the ineptness of HTML printing. And best of all, because you can write in a book, stick stickies in a book, and dogear its corners."

Here is it folks, the guru of Silicon Valley prefers a book to a blog!

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