Tag Archives: autism

Dietary supplement snake-oil neurobollocks

neurozanAs a wise lady once said, “If you want to sell something, stick a brain on it.” Or in this case, the prefix ‘neuro’. And then the suffix ‘zan’ – whatever the hell that’s supposed to mean. Neurozan dietary supplements are widely advertised in the UK, and the parent company, Vitabiotics, markets a bewildering variety of dietary supplements targeted at different demographic groups.  The Neurozan supplements come in two varieties, original and plus, with the only difference being the ‘plus’ version includes some omega-3 capsules as well. They retail at around £10 for 30-odd tablets. 

A pubmed search for ‘neurozan’ yields precisely zero results, so it appears that there’s no published work on the effects or effectiveness of these supplements. Despite this, the website proclaims ‘Each Neurozan® tablet combines all round nutritional support with a careful balance of vitamins and minerals based on a wealth of published research.’ They contain a long list of vitamins and minerals (the kind you normally find in any multi-vitamin supplement) plus a few ‘special’  ingredients such as gingko biloba and 5-HTP – both of which may actually be psychoactive compounds, but you’d need a considerably larger dose to see any possible effects. A good detailed discussion of the list of ingredients in Neurozan is available in this post on the Ministry of Truth blog.

The research on dietary supplements suggests that with very few exceptions (pregnant women, other people with specific medical conditions) taking a daily multivitamin supplement is unnecessary, as long as you’re generally healthy and eat a sufficiently varied diet (review papers: 1, 2, 3). To be fair to Vitabiotics they studiously avoid making any particularly egregious claims on their website about the effectiveness of Neurozan. They use typical weasel/marketing phrases like “[contains] important nutrients to help contribute to normal cognitive function”, which essentially mean nothing at all.

Other neuro-snake-oil merchants are much bolder in the claims they make though. FOCUSfactor pills are the same old blend of vitamins and fish-oils, yet claim to be ‘Clinically shown to improve memory, concentration and focus’. Hilariously, in tiny text at the bottom of the website are the words “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.” They’re very proud of a ‘clinical study’ that apparently showed improvements on a particular memory test after six weeks of taking their product, however the study’s never been published in any form, and the smart money says it probably never will be.

765There are hundreds more of these products available, with the only real difference between them being the aggressiveness of their advertising and the variety (probably some are more constrained by local advertising regulations than others) of maladies they claim to treat. Really, little has changed since the 19th Century days of Clark Stanley. As long as people can be induced to buy magic potions, unscrupulous people will make money selling them, the only difference now is that to be convincing, you have to put the word ‘Neuro’ on the bottle somewhere.

Utterly shameless diagnostic brain imaging neurobollocks

The impish Dr Amen, with (presumably) some fans. Wonder if he's planning on scanning their brains?

The impish Dr Amen, with (presumably) some fans.

Christian Jarrett’s article in Psychology Today (“Your 5-Step Self-Defence Program Against Neuro-Nonsense”) that I linked to in my previous post briefly mentioned diagnostic SPECT (Single-Photon Emission Computed Tomography) imaging, and the paper he cites (Chandler and Chatterjee, 2011 – open access – yay!) goes into some more detail about this particular brand of neurobollocks. After looking into it myself a little bit, I was absolutely stunned that some doctors a) had the gall to to continue offering these diagnostic methods and treatments to people, and b) that they were allowed to continue doing so by medical regulators (I guess that’s the USA’s free-market, laissez-faire approach to medical care – gotta love it!).

So, a little background. A common theme in neuroimaging research is attempting to identify differences in the brains between different groups of people. Male/female, musicians/non-musicians, schizophrenics/non-schizophrenics, whatever. This is all very interesting and worthwhile – if we can identify a common brain pattern or structure that is different in say, schizophrenia then we may be able to devise better treatments that target it. Voxel-based morphometry is one common method of looking at differences and assesses the relative size/shape of different brain structures, but there are lots of other methods that either look at anatomical or functional differences. The important point here is that you always need a group of people of each type that you want to compare. People’s brains vary pretty widely in the size and shape of the sulci and gyri, and in the amount/location of functional activity that you see in a given task. What is being sought in these studies is a reliable difference that is consistent across the group, and remains as a statistical effect, once all the (random) individual variation has been taken into account. Many people’s brains are a bit funny-looking, but 99 times out of 100 it’s just normal individual variation.

What this means is that developing imaging-based biomarkers that reliably indicate particular states or conditions in an individual is fraught with difficulty. Some progress is apparently being made in this endeavour, but a lot of people are still very sceptical about the idea, and rightly so.

However, Dr Amen, (of the eponymous ‘Amen Clinics‘) is certainly not one of those people. He’s been using diagnostic SPECT imaging for years, and has clinics in six major US cities. Dr Amen uses SPECT imaging to diagnose ADHD, anxiety, depression, addiction, autism, ‘marital conflict'(?!), and for generally healthy people who want to lose weight, or just ‘optimise’ their brain. How does taking a SPECT image of their brain help with this? It’s not really clear, but unsurprisingly, Dr Amen has a slick-looking brain-training-like program (‘The Amen Solution’) that promises all the usual bollocks, and an online store filled with his (many!) books, DVDs, etc. plus (of course) his own brand of dietary supplements. So, basically, I’m guessing that the results of the SPECT scans in his clinics typically indicate that the patient needs to complete a course of his brain-training, or supplements, or both.

Just to be clear – there’s absolutely no way that a SPECT scan of an individual can show up anything useful in diagnosing these disorders. Dr Amen is charging people thousands of dollars, and injecting them with radioactive substances, for absolutely no sound medical reason. 

Why use SPECT? The spatial resolution of the images is crap, and no-one uses it for clinical or research work that much anymore. However, it’s the cheapest of the 3D imaging techniques that can show functional activation. MRI scanners are expensive to buy and maintain, and need fairly large facilities. PET scanners use short-lived radio-isotopes, meaning you have to synthesise them yourself and use them immediately – you need a team of chemists and a well-kitted out laboratory. SPECT uses off-the-shelf isotopes with long half-lives; much, much cheaper and easier.

Dr Amen is a funny one, to be honest. Unlike the Brain Balance Center charlatans , he at least has some medical training and certification, and he publishes some research papers, occasionally even in peer-reviewed journals. He may perhaps be a true believer in what he’s doing, which makes him less mendacious but unfortunately also more stupid. Of course, where one quack leads others will follow, and copycat clinics have sprung up, also using SPECT, and claiming similar things; Dr SPECT scan, and CereScan are two of them. Dr Amen’s slick, media-savvy approach (he seems to be a regular on those dreadful audience-whooping, self-help TV shows they have in the US) marks him out as a serious operator though. Because he has some appropriate training, and has published some research, the Amen Clinics only gets a 9 out of 10 on the Neurobollocks rating scale; I know, I know, I’m just too generous sometimes, it’s a problem.

You can read more about the radiant Dr Amen and his techniques here, and there’s also an interesting Q & A with him over on QuackWatch.

Brain Balance Centers: total and utter neurobollocks

Masthead from the Brain Balance Center's website. "clinically proven"!

Masthead from the Brain Balance Center’s website. “Clinically proven”, and oooh… “holistic”. Marvellous.

Brain Balance Centers are a network (actually, to be precise, a network of franchises) of treatment centers spread across the United States, currently operating in 54 locations; most of the major US cities. They offer a treatment called the ‘Brain Balance Program’ that claims to be able to improve:

1. Academic performance
2. Social abilities
3. Cognitive function
4. Sensory and motor skills
5. Visual-spatial organizational skills
6. Immunity and nutritional health

They also claim to effectively treat pretty much any developmental disorder under the sun, including autism, ADHD, Asperger’s, Tourette’s and dyslexia, without the use of any drugs. This is because all these disorders are (apparently) caused by an “underlying functional imbalance or under-connectivity of electrical (brain) activity within and between the right and left sides of the brain.”

Any alarm bells ringing yet? They should be. Whenever someone comes along with a miracle-cure for a range of unrelated conditions, and has come up with the equivalent of a Unified Field Theory of neurodevelopmental disorders, something must be a bit fishy. So it appears in this case. There have already been a couple of excellent take-downs of the claims that Brain Balance Centers make. The first is by the really-very-wonderful Emily Willingham, and you can find it here. Emily expertly refutes a number of the key claims, and proceeds to drill down on the list of evidence and references provided on the website. Her conclusion is that the claims are an “enormous steaming pile of bullshit”.

Another great piece on these guys is by Harriet Hall of SkepDoc, and can be found here. This examines in detail a study published in the International Journal of Adolescent Medicine and Health (which at least appears to be a ‘proper’, if obscure, journal). Harriet notes that despite all the waffle about functional disconnection and hemispheric imbalance of the brain, the exercises performed by the kids in the study were relatively simple (such as synchronising movements to a metronome) and the conceptual link between the treatments and correction of the underlying ‘hemispheric disconnection’ is vanishingly tenuous. Most damningly, the study didn’t include a control group, meaning it’s possible (likely?) that any improvement seen was simply a placebo effect (or more precisely, a Hawthorne effect).

The last author on that paper is a guy named FR Carrick, and all the authors’ affiliations are listed as the “The FR Carrick Institute for Clinical Ergonomics, Rehabilitation and Applied Neuroscience”; and this is where it gets really interesting. Dr Carrick is a specialist in ‘Chiropractic Neurology’. Chiropractic is a branch of alternative medicine with a fairly wacky history (founded in 1895 by a magnetic healer named DD Palmer), and essentially aims to treat health issues by manipulation of the spine. Debunking chiropractic is well beyond the scope of this piece, but let’s just note that there is a paucity of evidence for effectiveness in any condition other than low-back pain, and even there, evidence is pretty mixed. ‘Chiropractic neurology’ as a discipline then, is highly suspect.

It turns out the FR Carrick Institute of whatever whatever has a very glossy and slick webpage, that on closer inspection, really doesn’t contain a whole lot of content. The Wikipedia page for the institute gushes on at some length about the incredible research happening at the Institute, and the “faculty of world class scientists and clinical researchers” employed there (clearly in need of some de-biasing, Wikipedia) but the only personnel mentioned on the website are in the ‘Management’ section: Dr Gerry Leisman and Dr Robert Melillo. Gerry Leisman seems to have had a somewhat chequered career at several universities in the US and UK. Interestingly, in 1994 he was sanctioned by the NIH office of research integrity for falsely claiming to have a MD degree from the University of Manchester (amongst other things).

Dr Robert Melillo (and congratulations for making it, if you wondered where I was going with this digression…) as well as being the executive director of the FR Carrick Institute for advanced alternative navel-gazing is also the founder of… you guessed it! The Brain Balance Centers! Let’s look at his list of eminent-sounding qualifications listed on the site shall, we?

“…adjunct professor of functional neuroanatomy for the graduate doctoral neuropsychology program at Touro College, NY and Leeds Metropolitan University, England.”

Well, they sound like academic appointments at genuine, if hardly wildly-prestigious institutions. Unfortunately,  a search of the Leeds Metropolitan University website produces no hits for “melillo”. A search of the Touro college site also comes up blank (except for a Nicholas P. Melillo – oooh, so close!).

“He is also an associate professor of clinical neurology and childhood behavioral disorders at The Carrick Institute, in FL.”

This Carrick Institute in Florida (not to be confused with the one mentioned above, in New York state!) appears to be a teaching school concerned with chiropractic neurology, and has a loooong list of associate/assistant professors.

“He holds a master’s degree in Neuroscience and is currently completing his PhD in Clinical Rehabilitation Neuropsychology.”

No indication of where he obtained his Masters degree, or where he’s working on his PhD. I’m betting that it might be in one of the FR Carrick Institutes… Incidentally, if he doesn’t have a PhD, or any medical qualifications, why is he calling himself ‘Dr’?

“He is board certified in Chiropractic Neurology and is the former chairman of the American Board of Chiropractic Neurology.”

Meh.

“He is also President of the Foundation for Cognitive Neuroscience.”

The what, now? I can’t find anything online about a Foundation for Cognitive Neuroscience, in fact a google search for “Foundation for cognitive neuroscience” +melillo returns precisely zero results.

My point in all this is not to expose this guy as some kind of fraud, fun though that might be. I find it interesting that Dr (?) Melillo’s background is obviously in chiropractic treatment, and he’s found a gosh-darn-whizzo way of spinning this out into a national network of treatment centers for children. Interestingly, chiropractic isn’t mentioned anywhere on the Brain Balance Center site at all, and it’s not clear if the treatments are derived from chiropractic theory/practice. This paper from 2008 notes that chiropractic has something of an image problem, and is declining in popularity – re-packaging it as ‘hemispheric integration therapy’ for developmental disorders is a good wheeze – it allows a complete break with the previous practices, and allows you to pander to the fears of time-poor, cash-rich parents (a course of treatment is reported to cost around $6000).

So, will your child benefit from treatment at a Brain Balance Center? Possibly they will; regular sessions of individual attention and structured exercises of almost any kind are probably good for children. Will they benefit more than if you just took them to the park to ride their bike every weekend? Most likely not.  The neuro-inspired claims that the Brain Balance Center makes are an incoherent muddle of utterly fly-blown bullshit, built on the foundation of an alternative therapy (chiropractic) which itself is highly suspect. Don’t waste your hard-earned money people – it’s an out-and-out scam.

What this means, is that the Brain Balance Centers receive the highest honour it’s possible for this humble blog to bestow – a mighty 10 out of 10 on the NeuroBollocks rating scale!

Finally, just to leave you in a good mood, here’s Eddie Izzard with a brief bit on chiropractors:

**Update**

I’ve just been sent a link to another piece I wasn’t aware of by Jon Brock. Jon is a developmental disorders researcher in Australia, and became aware of a video discussing one of his papers by a chiropractor called David Sullivan, who it turns out, is connected to the various Carrick institutes, and Robert Melillo, and runs Keystone Chiropractic Neurology. The article is well worth a read, and there’s a lot of good discussion in the comments section too.