Monthly Archives: March 2015

Methyl Bromide and Strawberries .. Shock .. Horror .. Oh, Wait a Minute.

The Conversation

Ian Musgrave, Senior lecturer in Pharmacology at University of Adelaide

There was an article on the ABC site this morning which gave us this alarming headline “Pesticide banned worldwide still used to grow 70pc of Australian strawberries”. Shocking!

Except, well, there were a few teeny tiny but important details missing. Like the fact that the rest of the world is still using the “banned” pesticide too.

Methyl Bromide (the substance involved) has been withdrawn worldwide under the Montreal protocol as it is a potent greenhouse gas (not because of toxicity, as many people have assumed from the headlines). However, world wide, there are exemptions for the use of methyl bromide as a fumigant for quarantine and production purposes (QPS) and some special (critical use) exemptions, it’s not just us. In 2005 Australia, stopped the use of methyl bromide for all but the exempt QPS uses, and for a few uses for which there was no suitable alternative to methyl bromide.

Just like the rest of the world.

In 2012 around 12,000 metric tonnes of methyl bromide were used around the world for various QPS and critical exemption purposes, Australia’s agricultural use was 32 tonnes at this time (Japan’s was 216 metric tonnes and the US 923 metric tonnes for comparison). Critical use exemptions, the ones that allow the strawberry farmers to fumigate their soil, must be applied for each year.

Like everyone else in the world, Australia developed plans to phase out the remaining methyl bromide use. Since 2005, when methyl bromide use in general was phased out, Australia has been replacing methyl bromide in the critical use exemption and (to a more limited extent) QPS categories with alternatives, dropping from 112 metric tonnes in 2005 to 32 metric tonnes in 2015.

Methyl bromide is an important pesticide fumigant, and is used to kill pathogens and pests in imported produce and some produce for export. Finding alternatives is not straight forward, for example, phosphine, one of the alternative fumigants, is highly flammable, so new handing procedures are needed to combat the risk of fire.

While reducing the amount of methyl bromide entering the atmosphere is important, the significant risk to the Australian biota and agricultural production from invasive pests and pathogens has to be weighted against the fact that human produced brominated compounds represent less than 0.03% of the total halogens released into the atmosphere, and that unlike CFC’s, which last in the atmosphere for decades, methyl bromide’s half life in the atmosphere is less than a year.

Given the relatively small impact of methyl bromide, and the continuing reduction of methyl bromide (see here for a comparison of the progress and the contribution of the US vs the rest of the world), Shock! Horror! headlines about Australia’s use for strawberries are unwarranted.

In the strawberry growing industry, methyl bromide is used to destroy pathogens and pests in the soil the strawberry runners are planted in. In Queensland and Tasmania, methyl bromide has been replaced. However, for the soils in the Victorian strawberry growing areas, the alternative fumigants aren’t as effective.

Other fumigants are being researched, but it takes time to find something that is reasonably safe, reasonably cheap and effective. One of the potential replacements, methyl iodide, has been withdrawn from the market, so the hunt is still on for a viable replacement. It may be that we have to grow our strawberries under soil-less conditions to stop disease and pest losses.

So, like all other countries, Australia has phased out methyl bromide, except for quarantine and other critical uses for which there is no effective alternative (again, just like other countries). Since 2005 we have systematically reduced the amount of methyl bromide for these uses, and are undertaking research to reduce the amount even further.

Oh, and in case you are worried that methyl bromide contaminates the strawberries, methyl bromide breaks down in the soil, and the strawberries that grow much later do not come into contact with it. There is no toxicity issue here at all.

The ConversationThis article was originally published on The Conversation. (Reblogged by permission). Read the original article.


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Turtle extinction event bodes ill for our waterways

The Conversation

Ricky Spencer, University of Western Sydney

A number of distressed and dead turtles were found by canoeists in the Bellinger River on the north coast of New South Wales on Wednesday February 18 this year. At that time, it was reported by NSW National Parks and Wildlife rangers, NSW Wildlife Information, Rescue and Education Service (WIRES) volunteers and local residents that 30 turtles were affected.

Several days later, the tally increased to 52 and, as of today, more than 300 turtles are dead. But the real toll is far greater, with many more washed away during a flood in late February.

Yet the peril of this one turtle species is more than an isolated issue. It gives us a window into the health of the entire ecosystem around the Bellinger River, and suggests something is very wrong.

Close to the brink

The dead turtles are all from one species, the Bellinger River Snapping Turtle (Myuchelys georgesi), which is a species that only exists in a 25-kilometre stretch of the Bellinger River. The risk of extinction is high.

Infected Bellinger River Turtle with septicemic cutaneous ulcerative disease visible around the eyes.
Source: Rowan Simon
Mortality for infected turtles is 100%. Source: Rowan Simon

National parks have been closed indefinitely and plans are in place to recover healthy turtles from the wild. There are already few juvenile turtles in any Australian river because of sustained annual fox predation, close to 100%.

So the reality is that, even with active management, recovery of the species will take more than a decade if the current disease doesn’t wipe them out.

Ill turtles display symptoms of blindness, growths around the eye (septicemic cutaneous ulcerative disease, or SCUDs) and are extremely lethargic and emaciated. The mortality rate of infected animals is 100%. High mortality combined with an extremely limited range means that this is quite possibly a rapid extinction event.

Window on our waterways

Turtles are an evolutionary success story, having persisted for over 220 million years. Australian freshwater turtles face many threats that permeate every life-history stage, from egg to adult.

The life history of turtles involves high but fluctuating rates of egg and juvenile mortality, which is balanced by extreme iteroparity (i.e. they are long-lived and highly fecund). Threats to adults are generally low.

Human activities have impacted this successful life strategy by increasing mortality of eggs and young, as well as adults. Nest predation rates are extraordinary high and adult turtles frequently become victims of road kill or are killed by foxes as they emerge to nest or disperse.

Turtles are also drowned at water regulation points in wetlands (eg. carp screens), in fishing nets or in irrigation pumps, and killed by fishers. An article from 2012 described that:

[…] a combination of human-induced changes has created a downward spiral so powerful that – without strategic intervention – much of the great turtle lineage will have disappeared by the close of the 21st century.

The possible extinction of an ancient lineage and iconic animal is tragic, but the consequences for the health of our rivers are even more significant.

In most systems, turtles rival fish as the highest vertebrate biomass. They are the major vertebrate nutrient recyclers (i.e. scavengers), a significant herbivore and the top predator.

Scavengers serve an important function by stabilising food webs and are critical in redistributing nutrients. Thus turtles provide a critical ecosystem service by removing decaying animal matter from the environment.

Significant numbers of dead turtles are symptomatic of something wrong with a river or wetland. Given their various roles in an ecosystem, indicators of biological health don’t come much better than freshwater turtles.

The Bellinger River Snapping Turtle consumes food, such as insect larvae, that are highly sensitive to pollution, increased sedimentation or general water conditions. In a river, which changes almost daily because of rainfall, insect populations respond rapidly and are affected by natural changes.

The turtle is adapted to boom-bust cycles of the river and resilient to natural shortages of food. However, if there are chronic issues with the food supply, then turtles will be impacted.

A healthy Bellinger Snapping Turtle. Source: Arthur Georges

Watch the turtles

The crisis with the turtles in the Bellinger River may signal broader effects of a change or breakdown in ecosystem function in the river.

The last mass freshwater turtle mortality event occurred in the lower lakes of South Australia during the millennium drought, when salinity levels rose and many turtles perished after becoming entrapped by growths of marine tubeworms on their shells.

The value of turtles as indicators of aquatic ecosystem health is that their health relates to medium to long-term changes in the river, rather than annual or seasonal fluctuations that occur in potentially environmentally volatile systems.

They are also long-lived and turtles can bio-accumulate toxins in their shells. Regular sampling (shell or nails) of marked individuals can be used to monitor long-term exposure to toxins and pollutants in the river – something that snapshot monitoring of water quality may miss.

Turtles are threatened by chronic reproductive failure, exotic predators, disease, habitat modification and habitat loss. Potential for any recovery is limited by ongoing threats and limited capacity for populations to increase.

The current disease threatening to drive the Bellinger River Snapping Turtle to extinction is a potential window into a long-term breakdown of ecosystem services. The possible extinction of a long-lived ancient species that has survived several million years might be a significant warning sign of the current state of our freshwater environments.

The ConversationThis article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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When science meets parliament

The Conversation

Olivia Carter, University of Melbourne

Boarding the flight back from Canberra felt like stepping back through the magic wardrobe from Narnia.

I had been attending the annual Science meets Parliament event on behalf of The Psychology Foundation of Australia. I was one of 200 scientists representing the “science” of everything from crystallography through to entomology.

As a research academic, you are always aware that your research – and in some instances your entire career – depends on the decisions and opinions of “the government.” But I have to confess that exactly what “the government” meant in this context was not something I had thought much about.

Sure I understood that there is no bottomless pool of money. Nor was I ever so deluded as to think that every good person and every good project could – or even should – be supported by public funds. However, the mechanics of how decisions are made and the role that different groups and individuals play in this process was totally foreign to me.

One of the main things I gained from my two days in Canberra was a greater appreciation of how hard our politicians work. Or more importantly, how many different demands they have on their time and their attention.

After a day of talks we were all invited to a Gala Dinner where we heard from both Ian Macfarlane, Minister for Industry and Science, and the Leader of the Opposition Bill Shorten.

The talks were interesting, but it was the conversation I had with the politician assigned to our table, Senator Christopher Back, that gave me a glimpse into the lives of our politicians. Just as our meal arrived, bells started ringing and lights started flashing – a signal for him to leave immediately to cast a vote. As he sat back down the bells went again and he was off one more time.

He explained that the bells (and the accompanying votes) continue from morning to late evening on each sitting day. More surprising was his comment that he is normally only able to spend 20 days a year in his local Perth office as he is either in Canberra or travailing for work the remaining time. I can’t imagine how hard it would be to perform the juggling act between work and family in the political setting.

Now, all of this is not to let the politicians off the hook. It does not reduce the need for good decisions. Rather, I now understand why we are so often encouraged to engage with the public and do everything we can to increase awareness and interest in the work being done by scientists across the country.

Nobel Laureate Brian Schmidt is a vocal advocate for science and is able to connect with politicians at the highest level.
Source: AAP Image/Alan Porritt

We are competing against so many other stories and agendas that the first task is to break into the media cycle and simply bring an issue to the attention of the public and the politicians. To then maintain their interest long enough to actually inform or persuade them is only going to be possible through the exhaustive and coordinated efforts of strong leaders.

It was in respect to this last point that I was left feeling optimistic and genuinely inspired by the two people who are most visibly championing our cause at the moment: Australia’s Chief Scientist, Ian Chubb, and Nobel Laureate, Brian Schmidt.

While it is unsurprising that our Chief Scientist is an outspoken advocate of Australian science, we should all be thanking the Nobel gods that they awarded The 2011 prize for Physics to a Canberra local, who is not only passionate about supporting science, but is also one of the rare bread that seems as comfortable talking to politicians as he does with scientists.

Now we just have to cross our collective fingers that by the time the budget is announced, Professor Chubb (and all of those behind him) have done enough to convince “the government” that science matters. Or, more importantly, that those doing it are a resource that add value to this country and are worthy of support.

The ConversationThis article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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Theodore Roosevelt on critics

Theodore “T.R.” Roosevelt Jr. (October 27, 1858 – January 6, 1919) was an American politician, author, naturalist, soldier, explorer, and historian who served as the 26th President of the United States.

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Arthur Koestler on genius

Arthur KoestlerCBE (5 September 1905 – 1 March 1983) was a Hungarian-British author and journalist. Koestler was born in Budapest and, apart from his early school years, was educated in Austria. In 1931 Koestler joined the Communist Party of Germany until, disillusioned by Stalinism, he resigned in 1938. In 1940 he published his novel Darkness at Noon, an anti-totalitarian work, which gained him international fame. Over the next 43 years from his residence in Great Britain, Koestler espoused many political causes and wrote novels, memoirs, biographies, and numerous essays. In 1959, he published a history of astronomy and cosmology entitled The Sleepwalkers.  In 1968, he was awarded the Sonning Prize “for outstanding contribution to European culture” and, in 1972, he was made a Commander of the Order of the British Empire (CBE). 

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Winston Churchill on democracy

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Infections of the mind: why anti-vaxxers just ‘know’ they’re right

The Conversation

Thom Scott-Phillips, Durham University

Anti-vaccination beliefs can cause real, substantive harm, as shown by the recent outbreak of measles in the US. These developments are as shocking and distressing as their consequences are predictable. But if the consequences are so predictable, why do the beliefs persist?

It is not simply that anti-vaxxers don’t understand how vaccines work (some of them may not, but not all of them). Neither are anti-vaxxers simply resistant to all of modern medicine (I’m sure that many of them still take pain killers when they need to). So the matter is not as simple as plain stupidity. Some anti-vaxxers are not that stupid, and some stupid people are not anti-vaxxers. There is something more subtle going on.

Naïve theories

We all have what psychologists call “folk” theories, or “naïve” theories, of how the world works. You do not need to learn Newton’s laws to believe that an object will fall to the floor if there is nothing to support it. This is just something you “know” by virtue of being human. It is part of our naïve physics, and it gives us good predictions of what will happen to medium-sized objects on planet earth.

Naïve physics is not such a good guide outside of this environment. Academic physics, which deals with very large and very small objects, and with the universe beyond our own planet, often produces findings that are an affront to common sense.

A life force. Food by Shutterstock

As well as physics, we also have naïve theories about the natural world (naïve biology) and the social world (naïve psychology). An example of naïve biology is “vitalistic causality” – the intuitive belief that a vital power or life force, acquired from food and water, is what makes humans active, prevents them from being taken ill, and enables them to grow. Children have this belief from a very young age.

Naïve theories of all kinds tend to persist even in the face of contradictory arguments and evidence. Interestingly, they persist even in the minds of those who, at a more reflexive level of understanding, know them to be false.

In one study, adults were asked to determine, as quickly as possible, whether a statement was scientifically true or false. These statements were either scientifically true and naïvely true (“A moving bullet loses speed”), scientifically true but naïvely false (“A moving bullet loses height”), scientifically false but naïvely true (“A moving bullet loses force”), or scientifically false and naïvely false (“A moving bullet loses weight”).

Adults with a high degree of science education got the questions right, but were significantly slower to answer when the naïve theory contradicted their scientific understanding. Scientific understanding does not replace naïve theories, it just suppresses them.

Sticky ideas

As ideas spread through a population, some stick and become common, while others do not. The science of how and why ideas spread through populations is called cultural epidemiology. More and more results in this area are showing how naïve theories play a major role in making some ideas stickier than others. Just as we have a natural biological vulnerability to some bacteria and not others, we have a natural psychological vulnerability to some ideas and not others. Some beliefs, good and bad, are just plain infectious.

Here is an example. Bloodletting persisted in the West for centuries, even though it was more often than not harmful to the patient. A recent survey of the ethnographic data showed that bloodletting has been practiced in one form or another in many unrelated cultures, across the whole world.

Paraphernalia. (Source: Peter Merholz, CC BY-SA)

A follow-up experiment showed how stories that do not originally have any mention of bloodletting (for instance, about an accidental cut) can, when repeated over and over again, become stories about bloodletting, even among individuals with no cultural experience of bloodletting.

These results cannot be explained by bloodletting’s medical efficiency (since it is harmful), or by the perceived prestige of western physicians (since many of the populations surveyed had no exposure to them). Instead, the cultural success of bloodletting is due to the fact that it chimes with our naïve biology, and in particular with our intuitive ideas of vitalistic causality.

Bloodletting is a natural response to a naïve belief that the individual’s life force has been polluted in some way, and that this pollution must be removed. Anti-vaccination beliefs are a natural complement to this: vaccinations are a potential poison that must be kept from the body at all costs.

At an intuitive, naïve level we can all identify with these beliefs. That is why they can satirised in mainstream entertainment.

In Stanley Kubrick’s great comedy Dr. Strangelove, the American general Jack D. Ripper explains to Lionel Mandrake, a group captain in the Royal Air Force, that he only drinks “distilled water, or rainwater, and only pure grain alcohol”, because, he believes, tap water is being deliberately infected by Communists to “sap and impurify all of our precious bodily fluids”. The joke works because Ripper’s paranoia is directed at something we all recognise: the need to keep our bodies free from harmful, alien substances. Anti-vaxxers think they are doing the same.

The ConversationThis article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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The 2015 flu vaccine – what’s new, who should get it and why

The Conversation

Aeron Hurt, WHO Collaborating Centre for Reference and Research on Influenza

It’s that time of year again when scientists and doctors make predictions about the impending influenza (flu) season and we must decide whether to go out and get the flu vaccine.

The government-funded flu vaccine will be available from 20 April, a month later than most years, as the vaccine has been reformulated to cover a new strain. But some GPs may offer the vaccine privately before then.

So, who should consider getting the vaccine and who gets it for free? And are we really in for a bad flu season in Australia?

How does the vaccine work?

The flu vaccine helps prevent us from getting the flu each season. It contains dead, broken-up bits of flu viruses that are expected to circulate during the upcoming season.

Once injected into our arms, the pieces of dead virus stimulate our body’s immune response to produce antibodies, which act as a defence that can rapidly swing into action when a live flu virus infects our nose and throat.

Because the viruses in the vaccine are dead, they can’t give us flu.

What’s new about flu vaccines in 2015?

For the first time, Indigenous children are able to access free flu vaccine in Australia.

This is important because Aboriginal and Torres Strait Islander children are five times more likely to be hospitalised with flu and pneumonia than non-Indigenous children. Indigenous children are also 17 times more likely to die from flu or pneumonia than non-Indigenous children.

Australia’s vaccine has been updated to protect against the harmful new A(H3N2) viruses. (Source: El Alvi/Flickr, CC BY)

This year a new flu vaccine, known as “quadrivalent”, will be available. This type of vaccine contains four flu viruses compared with three in the normal trivalent vaccine. The additional flu strain provides extra insurance that may be useful if unexpected viruses begin to circulate.

However, it’s likely that the standard trivalent vaccine will cover the great majority of the flu A and B strains expected to circulate in Australia this winter.

The quadrivalent vaccine won’t be available via the government’s free flu vaccine program and will be more expensive than the standard trivalent vaccine if purchasing it privately.

Who should get the flu vaccine?

For certain members of the community, catching flu can lead to severe illness or death. It is these “high-risk” groups (listed below) that should actively avoid catching it. Getting the flu vaccine is a major step towards achieving protection from flu.

Certain groups of individuals at high risk of developing severe illness or complications if infected with flu are eligible for free flu vaccine via the federal government. These are:

  • Anyone aged 65 years or over
  • Aboriginal and Torres Strait Islander people aged 15 years or over
  • Aboriginal and Torres Strait Islander children aged between six months and five years
  • Pregnant women
  • Anyone with with medical conditions that can lead to severe influenza, including people with heart disease, severe asthma and diabetes. A full list of eligible medical conditions can be found here.

Within the over-65 age group, a high proportion of people are vaccinated (more than 70%).

But although the flu vaccine is provided free of charge to vulnerable people, many still don’t get it. Less than 30% of pregnant women and Indigenous people receive the flu vaccine. Only half of those with medical conditions that can lead to severe influenza get vaccinated.

Fit, healthy children can’t always fight off a flu. (Source: Chaikom/Flickr)

Although not included in the government’s free flu vaccine program, children under the age of two years are also highly susceptible to flu.

Once infected with flu, young kids are more likely to be hospitalised with severe illness than those in the over 65 age group. About half of young children who die from the flu are otherwise healthy with no underlying medical conditions or known risk factors.

Most children who die from flu are not vaccinated. Therefore the idea that fit, healthy infants can simply “fight off” a flu infection without any problem is not always true.

Another benefit of preventing flu in children is that it reduces the spread of infections to other vulnerable family members such as grandparents.

What’s in store for us this winter?

The one predictable thing about flu, is that it is unpredictable! However, we often look to the northern hemipshere’s winter flu season to give some insights into what might be expected here.

The recent flu season in the United States and most of Europe was dominated by the A(H3N2) strain of flu. This virus has historically been associated with increased severity in the elderly.

There has been a lot of media coverage about bad vaccine match in the northern hemisphere. This is because most of the serious influenza was caused by the A(H3N2) viruses which had changed over the five to six months when the vaccine producers were manufacturing the vaccine. But the other components of the vaccine were well matched.

Our vaccine has been updated to protect Australians against the new A(H3N2) viruses.

So, if you or a loved one fall within the high-risk groups described above, getting the vaccine remains the most effective way to avoid the inconvenience and potentially severe health risks of the flu – and passing it on.

The ConversationThis article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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Orthorexia nervosa: when righteous eating becomes an obsession

The Conversation

Rebecca Charlotte Reynolds

Orthorexia nervosa, the “health food eating disorder”, gets its name from the Greek word ortho, meaning straight, proper or correct. This exaggerated focus on food can be seen today in some people who follow lifestyle movements such as “raw”, “clean” and “paleo”.

American doctor Steven Bratman coined the term “orthorexia nervosa” in 1997 some time after his experience in a commune in upstate New York. It was there he developed an unhealthy obsession with eating “proper” food:

All I could think about was food. But even when I became aware that my scrabbling in the dirt after raw vegetables and wild plants had become an obsession, I found it terribly difficult to free myself. I had been seduced by righteous eating.

Bratman’s description draws parallels with many modern dietary fads that promise superior health by restricting whole food groups without a medical reason or even a valid scientific explanation.

Raw food followers might meet regularly to “align their bodies, minds and souls” by feasting on “cleansing and immune-boosting” raw foods. Such foods are never heated above 44˚C, so “all the living enzymes in the food remain intact”. No gluten, dairy or “sugar” is allowed.

Clean eaters may follow similar regimes, removing gluten, dairy and even meat from their diets. You might overhear a discussion about “superfood green smoothie” recipes after a yoga class that also happened to “cleanse your gall bladder”.

And finally, around the corner, paleo pushers may “beef up” together with a Crossfit class, followed by a few steaks. Again, with paleo, there is no gluten – or any grains for that matter – and no dairy or other such “toxins” are allowed.

How common is orthorexia?

There is a blurry line separating “normal” healthy eating and orthorexia nervosa, but one way to define the condition is when eating “healthily” causes significant distress or negative consequences in a person’s life.

They may be “plunged into gloom” by eating a piece of bread, become anxious about when their next kale, chia or quinoa hit is coming, or eat only at home where “superfood” intake can be tightly controlled.

Such behaviours can have a significant impact on relationships with family members and friends, let alone on their mental health.

Under the paleo regime, steak is in but dairy is out. (Source: Taryn/Flickr, CC BY-SA)

Orthorexia nervosa is not a clinically recognised eating disorder but researchers have developed and tested questionnaires in various populations to get an idea of its prevalence.

Italian researchers developed the ORTO-15 questionnaire in 2005, with a cut-off score below 40 to signify orthorexia nervosa. Scores above 40 can still signify a tendency to pathological eating behaviours and/or obsessive-phobic personality traits.

Questions include: “Does the thought about food worry you for more than three hours a day?” and “Do you feel guilty when transgressing your healthy eating rules?”

Using this questionnaire and cut-off value of 40, another Italian research group reported a prevalence of orthorexia nervosa of 57.6%, with a female-male ratio of two-to-one. However, using a cut-off value of 35, the prevalence reduced to 21%.

Most studies have been conducted in population sub-groups that may be at increased risk for orthorexia nervosa, such as health professionals. Again using the ORTO-15 and a cut-off value of 40, the prevalence of orthorexia nervosa in Turkish medical doctors was 45.5%, in Turkish performance artists it was 56.4% (81.8% in opera singers to 32.1% in ballet dancers) and in ashtanga yoga teachers in Spain, 86.0%.

Using another questionnaire, the Bratman Test, 12.8% of Austrian dietitians were classified as having orthorexia.

You can test your own tendencies towards orthorexia nervosa using this Bratman test here and access support services via the National Eating Disorder Collaboration page and Body Matters Australasia.

Is it a mental disorder?

Orthorexia nervosa is not listed in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5), which psychologists and psychiatrists use to diagnose mental disorders. The DSM-5 currently lists anorexia nervosa, bulimia nervosa, binge-eating disorder, “other specified feeding or eating disorder” and “unspecified feeding or eating disorder”.

Some clinicians argue orthorexia nervosa should be recognised as a separate eating disorder and have proposed clinical DSM diagnostic criteria. They note distinct pathological behaviours with orthorexia nervosa, including a motivation for feelings of perfection or purity rather than weight loss, as they see with anorexia and bulimia.

Under a strict raw food diet, no gluten, dairy or ‘sugar’ is allowed. (Source: Marta Gal/Flickr, CC BY-NC-SA)

Others disagree and argue that it falls in current eating disorder or other mental disorder categories. As Bratman explained in 2010:

At times (but not at all times) orthorexia seems to have elements of OCD (obsessive compulsive disorder). It may also have elements of standard anorexia. But it is often not very much like typical OCD or typical anorexia.

It’s clear that more research is needed on orthorexia nervosa, including its diagnosis and potential DSM listing as an independent eating disorder.

It’s also important to consider that people can move between mental disorder classifications. Sometimes labels may not be as important as providing solutions to patients with disordered eating, such as cognitive-behavioural therapy.

Striking a balance

As a nutritionist and a recovered sufferer of bulimia, I leave you with some advice:

Don’t trust all-devoted kale consumers, including health professionals and celebrities, if their advice isn’t based on scientific evidence.

Don’t make food the most important focus of your life. As Bratman says:

Rather than eat my sprouts (or kale) alone, it would be better for me to share a pizza with some friends.

Try to be a balanced food consumer with a “mostly and sometimes” mantra.

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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Still no good evidence that most complementary medicine works

The Conversation

Ian Musgrave

The complementary medicine industry has been quick to respond to an opinion piece by Cassandra Wilkinson in The Australian newspaper on the lack of evidence for many complementary medicines, and particularly complementary medicines for children.

Alan Bensoussan of the National Institute of Complementary Medicine claimed in a follow-up letter to the Australian that complementary medicines included many well-established medicines (scroll down for the letter). He claimed that these well-established complementary medicines include medicines that prevent spina bifida in newborns, osteoporosis in the elderly, macular degeneration, cognitive decline, and childhood bronchitis.

Except, well, they don’t. You can search for clinical trials of complementary medicines for the above complaints that show them to be “well-established” and you will come up empty handed. You will find one or two studies suggesting that there might be a beneficial effect of some complementary medicine (see here for the inconsistent evidence for Ginkgo and macular degeneration), but nothing “well-established”.

Similarly, a search of systematic reviews, which look at the overall evidence from multiple studies, turns up nothing, although one treatment for osteoarthritis (not osteoporosis) glucosamine, might be beneficial in some patients. This is hardly “well-established” though.

If you go to the web site of the National Center for Complementary and Alternative Medicine and look up “bronchitis” you get the following “There is not enough evidence to support the use of any complementary health practices for the relief of asthma”. If you look up cognitive decline, you get a page that shows all current complementary therapies either do not help (and this includes the favoured herb, Gingko) or have not enough evidence.

So where does Alan Benoussan’s claim come from? Some clarification comes from an article in Pharmacy News, where Steve Scarff, regulatory and scientific affairs director of the Australian Self Medication Industry, also claimed that there is a growing evidence base to support the use of complementary medicines. Mr Scarff used as examples of clinically-supported complementary medicines “calcium and vitamin D for osteoporosis, omega-3 fish oil for heart disease, folate for pregnant women in preventing spina bifida, iron supplementation for anaemia, and evidence to support St John’s Wort for depression”.

One problem here, all but one (St. John’s Wort) of these are conventional medicine, not complementary medicine. It was conventional medicine that researched the physiology, did the clinical trials and developed the therapies and approaches, not complementary medicine (calcium and vitamin D for osteoporosis (note that this is not “one size fits all” medication), omega-3 fish oil for heart disease, folate for pregnant women in preventing spina bifida). Just because you sell vitamin pills doesn’t mean you get to appropriate the hard work of medical researchers and clinicians.

“Complementary” use of vitamins is usually use of high dose vitamins, such as high dose vitamin C for colds and flu’s (which doesn’t really work) or high dose antioxidant vitamins (high dose fat soluble antioxidant vitamin are actually associated with slightly worse outcomes and in some cases a slight increase in death). And vitamin supplementation of healthy, non-vitamin deficient people also has no benefit.

St. John’s Wort does have a modest anti-depressant effect (although very variable due to wide differences in composition). It also has significant side effects and very serious interactions with conventional medicines, so is not recommended for therapy. People have died because of it. Information on the side effects of St. John’s Wort from points of sale are generally very poor and most consumers will be unaware of them (see also here)

The claims from the National Institute of Complementary Medicine and the Australian Self Medication Industry does nothing to address the issues brought up in the opinion piece, namely that there is no evidence that complementary medicine works for children and that between 70-90% of complementary medicines surveyed did not meet regulatory requirements (71% had manufacturing or quality problems). As well, complementary medicine sponsors drag their feet when asked to remove non-compliant medicines (see here and here).

This is what the National Institute of Complementary Medicine and the Australian Self Medication Industry should be dealing with, not claiming the work of conventional medicine as complementary medicine.

The ConversationThis article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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