New response on BMJ B12 article

[Sleepybunny]

Hi All,

There was a new response on recent BMJ article B12 Deficiency by B. Wolffenbuttel by a haematologist.

Just wondered what people thought.

Link to article

bmj.com/content/383/bmj-202...

Link to responses

bmj.com/content/383/bmj-202...

[Nackapan]

Thankyou.

I thought thr MMA test useful ??

Other items s breath of fresh air

[Cherylclaire Forum Support in reply to Nackapan]

Useful to me !

[Technoid]

In his article response states:

"To confound readers further the authors critique the subjective laboratory assays (a well recognised issue) without consideration of measurement of uncertainty or as clinical practice requires, how to apply a level of certainty."

How can certainty be applied to a measurement that experts agree is inadequate and not up to the task? I understand the frustration with wanting to get to a point where values of one or more assays could reliably be used to rule out a diagnosis but the simple fact is, there is no way to do that.

Wanting it to be so, because you want your job to be easier, doesn't make it so. Neither Bruce nor his co-authors have some magic wand they can wave to fix all this, as many critiques seem to be implying that they should have.

And he makes a dig at the symptoms, saying they could be correlation, not causation, an unsurprising opinion from someone with little real-world experience of the symptoms experienced by B12 deficient individuals. With a large enough sample set, the recurrence of particular symptoms makes it increasingly implausible that many of them could be just "correlation". Along with the alleviation or reduction in said symptoms after effective treatment.

As a conclusion he goes for the most snide comment imaginable on a scientific/clinical journal:

"The article by Wolffenbuttel et al is timely, but perhaps would have been better described as an opinion piece. "

Basically saying this is nothing more than an opinion (expert opinion is at the bottom of the evidence hierarchy). Essentially telling evidence based medical practitioners not to take the whole thing too seriously.

I wouldn't take this haematologists opinion too seriously. Bruce has a much more advanced grip on the real world of B12 deficiency, what symptoms actually occur, and what kind of treatment programs work or do not work.

A lot of good research works needs to be done to find out why treatment programs of EOD or even more frequent work better when there is currently no good physiological explanation for why it would be so.

He should spend less time whining about expert opinion which is way more knowledgeable than his own and more time researching or working with others on how to improve the assays, develop new ones, or understand the physiological necessity for ultra-frequent treatment schedules.

Otherwise it is just more hot air and ignorance from someone unfamiliar with the field.

[JanD236 in reply to Technoid]

Well said Technoid!

[Budsa in reply to Technoid]

Some good points. Maybe you could make this a response to the article response on the BMJ site?

[boisland in reply to Technoid]

Technoid -Thank you so much for your response.. This hematologist has no idea the years of research & on hands experience made by Bruce..

[Sleepybunny]

For others reading this thread.

B.Wolffenbuttel wrote a recent PAS article.

Only One Chance

pernicious-anaemia-society....

He is also one of the authors of an Mayo Clinic article I often recommend people read and pass on to their doctors.

"The Many Faces of Cobalamin (Vitamin B12) Deficiency"

[WiscGuy]

Great man!

[Cherylclaire Forum Support]

Thanks for keeping an eye on this, Sleepybunny !

Important that we are all aware of these replies following articles: they can sometimes give an indication of how the medical profession views/ranks B12 deficiency in terms of severity of this as a condition.

Having lived with the results of B12 deficiency for at least 7 years now, I can honestly say that I have now had all the further investigation that the NHS has to offer, thanks to a concerned GP - and am reconciled with self injecting twice a week as the nearest I can get to managing my own particular set of symptoms. NOT a cure and not back to my old self, not even sufficiently reliable a result to be employable. Still, glad that I turned up to all of the tests, scans, consultants appointments. I wouldn't have wanted to have missed out on an alternative/ additional explanation. "Nil else" there to find.

So, as far as the possibility of "other interventions"* being "useful for at least some symptomatic individuals, alongside standard, or more frequent, vitamin B12 replacement", my own reply would be "No thanks, I'm good for interventions."

*Intervention:

1) the act or an instance of intervening

2) interference, esp. by a state in another's affairs

3) mediation

(Oxford Compact English Dictionary)

So surely, in this critique, some clarity of intention is required.