Dispatches from Probiotic Summit

EFSA is right to dismiss “overrated” peer-reviewed probiotic science: Consultant

By Shane Starling in Brussels

- Last updated on GMT

EFSA is right to dismiss “overrated” peer-reviewed probiotic science: Consultant

Related tags Peer review

The European Food Safety Authority (EFSA) should discount probiotic studies that have passed peer-review and been published in even the most prestigious nutrition science journals, because the peer-review process itself “is overrated”, says a leading consultant.

Lina Paulionis, senior scientific and regulatory consultant at Intertek Cantox’s Canada bureau, made the controversial assertion at the Probiotic Summit in Brussels yesterday in response to an exasperated presentation from veteran probiotic academic, Professor Ger Rijkers.

The Dutch researcher compared EFSA’s dismissive treatment of probiotic science – no probiotic has yet won a positive opinion from the agency - to a roulette game where there were no winners because every number was ‘0’, prompting Paulionis to question the peer-review publishing process.

Paulionis acknowledged the EU system was tough in a presentation that compared it with US and Canadian regimes, but said EFSA’s hard line was also shining a light on failures in peer-review mechanisms.

“I think EFSA has uncovered a big flaw in the peer-review process and really uncovering limitations in peer-reviewed publications,” ​she said, adding, “I think it is overrated in the sense that peer reviewers are not given any guidance on what exactly to critically appraise a manuscript for…”

That said, Paulionis said good science did exist and was capable of winning health claims under the EU nutrition and health claims regulation (NHCR), if dossiers are compiled in the right way.

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Good Science, you know it makes sense

Posted by Bill LaChenal,

So, thinking as someone with a sceptical scientific turn of mind, with an interest in politics & economics, have I got this right?

Politicians, being good people, care for the economy & the population's health by insisting on Evidence Based Medicine.

EBM proponents insist on Good Science.

..Good Science may rule out all long-standing common experience, all clinical outcome studies, any "Un-Scientific" observations, as unreliable, as "unacceptable evidence".
..Good Science accepts only the one plank of EBM, the RCT. Obviously the very best plank, and you need no more than one plank to build a bridge.
..Good Science that accepts only the DBPCRCT, with narrowly defined hypotheses, published & peer-reviewed in major journals.
...This is the Placebo Controlled Trial, depending on the Placebo, a substance that has No Effect. Except for the Placebo Effect, that is. Which is not fully understood by Good Science.
....(The Placebo Effect that is, which, since only recently, we find it would be unethical for doctors to use. And unprofitable.)
This is the Placebo Controlled Trial, where you expect to see Regression to Mean, a herd effect that only occurs for deadly toxins, and for profitable "herd" treatments, but does not apply for holistic treatments (go on, work it out).
This is the Placebo Controlled Trial, where long-term adverse effects commonly do not exhibit themselves, largely because of a narrow definition of "success".
(We know that from long experience, of course. But long experience, we now know, is not Acceptable Evidence. Not Good Science.)

.. Peer-reviewed by, well, by peers who have a vested interest in maintaining their authority, and are often personally or departmentally funded by, oh, the major money-spinners of medicine.
.. And are products of the very systems they seek to maintain.

... In major Journals, independently edited, owned by, oh, the major money-spinners of medicine.
.... Who, very altruistically, often donate large sums to the very best political parties.

So, Good Science nowadays depends solely on this excellent method of Scientific assessment.

Except, it seems, when it doesn't.
Except when someone can be found to stand up and challenge what looks like a positive advance in health Science.
(Science, remember , depends on such challenges to the status quo. Or is it to stopping unprofitable advances? I forget.)

Except when powerful lobbies (and, oh, major money-spinners of medicine) don't actually like the well-published, augustly peer-reviewed DBPCRCTsWNDOs.
Maybe they get a sniff of something there, that might actually make people healthy.
A healthy herd, remember, is very, very bad for their business, especially if it's unprofitable to muscle in, because basic nutritional medicine is not patentable.

And if "alternative medicine" were effective, remember, it would become just "medicine".
Unles it can't be profitably be patented, of course. Then it becomes just "banned".

Have I got that straight?

So, in matters of our personal health, Good Science (& Profits) must rule.
It's for our own good, after all.

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Prebiotics to gain recognition

Posted by Larry Whetstone,

Actually, as a dietitian , Millie should evaluate the benefits of the prebiotic soluble fibre ,Inulin , in the dietary regimen spoken of in the comment below. The cost of this functional food ingredient which induces the acidic gut, is far below that of the transiting , non-indigenous , dead or live , encapsulated, commercially manufactured probiotic strains of bacteria that are being promoted incessantly through all forms of the media. Eventually prebiotics' functionality will be recognized and calmly promoted as soluble fibre that actually maintains a healthy gut and immune system.

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Tweedledee Millie thread

Posted by Dr Robert Verkerk,

Tweedledee's and Millie's divergent opinions highlight the nub of the problem. Millie's years of clinical experience, a form of evidence that was intended to be an important element in healthcare decision-making according to the original definition of evidence-based medicine (JAMA, 1992; 268(17): 2420-5), now apparently counts for nothing. Which other branch of science has so completely divorced itself from observational and empirical evidence? High-quality RCTs are a useful adjunct to the evidence base, but they should not be the sole source of evidence. It's interesting that those that attempt to invalidate clinical experience are very rarely clinicians. Nor are they patients who have experienced major improvements in health that were associated, at least temporally, with an altered nutritional regimen including probiotic supplementation.

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