Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

Zamboni and the Occult Art of “CCSVI”

Posted by Colin Rose on February 10, 2010

Due to the proliferation of “CCSVI” (more than 300,00 hits on Google) since CTVGlobemedia ignited the firestorm of junk science  I am forced to add a new blog to reply to the latest outbreaks of hysteria. Our earlier blog comments in general on Zamboni’s fantasy and events before today.

True believers of “CCSVI” had been blogging excitedly about a press conference by a Dr. Zivadinov at the University of Buffalo who somehow managed to fund a Doppler ultrasound study of the neck veins of MS patients and normal volunteers. He may have received funding from Fondazione Hilarescere, a foundation run by Zamboni that doles out money to himself and his friends.

A diagram of "abnormal" venous flows in the head as imagined by Dr. Marian Simka, a Polish acolyte of Dr. Zamboni. Zivadinov was looking for such patterns in his "CTEVD" study. We guess that those red arrows pointing up imply blood is pushing against the brain causing MS. Blockage of an internal jugular vein does not raise intracranial pressure and, therefore, cannot cause damage to the brain. The paraevertebral venous plexus can handle venous drainage from the brain.

At any rate, here we have an example of science by press conference, a sure sign of junk science. Real scientists do not talk to the press until their work has been exhaustively reviewed by peers and published in a respectable journal.

One really can’t comment on the details of this “study” until the techniques and results are published, if ever.  However, a few general observations can be made. Even if Zivadinov is putting his results in the best light, the study exposes the surreality of “CCSVI”. “CCSVI” was diagnosed by Combined Transcranial and Extracranial Venous Doppler Evaluation (CTEVD). This technique has never been adequately described, published or validated by comparison with catheter hemodynamic measurements. It seems that just about any venous flow pattern can be created by manoeuvring the subject in different positions and by using different phases of the respiratory cycle. Certain of these flow patterns are then selected by unknown criteria and deemed to be “CCSVI”. Such selection is highly subjective which is why attention to blinding of the tester is extremely important. We have no details about how the tester was blinded. When one believes that one should find a certain result one is very attentive to even the slightest hint of the diagnosis.

How “CCSVI”, however diagnosed, can lead to brain pathology without a substantial increase in jugular venous pressure has never been explained by Zamboni or Zivadinov.

So, one can put no confidence in any numbers Zivadinov reported at his press conference. But if we are to take his results at face value they reveal the absurdity of “CCSVI”. He is claiming that 25% of the healthy population has “CCSVI” a condition declared by Zamboni to require immediate “liberation” by jugular vein stenting. Only 55% of MS patients have “CCSVI” but Zamboni had claimed 100% had it. There are two possibilities. Zivadinov is not using the same criteria for “CCSVI” as Zamboni or 45% of MS patients really don’t have MS. The latter is unlikely. So even two initiates in the occult art of “CCSVI” diagnosis can’t agree on the criteria. Then how will the rest of the world learn to diagnose “CCSVI” if it really exists?

Take a hint, true believers, “CCSVI” is really just normal variation in venous anatomy, not a disease.

25 Responses to “Zamboni and the Occult Art of “CCSVI””

  1. sanjiva86 said

    I have to agree that it is disconcerting to see a scientist going to the press with data that has not been peer reviewed. The results will only be presented at a conference in April, so that leaves two months for this idea (and possibly, false hopes) to simmer in the minds of MS patients before the results get a preliminary review from other scientists. I strongly suspect this is just a PR manoeuvre by the U of Buffalo group to get more research funding through various societies and patient groups.

    The stories in the press don’t describe how blinding is done, and if the patient’s symptoms are very conspicuous, it would be fairly easy to break the blind. And in this kind of a study, adequate blinding is paramount. Otherwise it’s $5 million being spent on research that doesn’t tell us much at all.

    Zivadinov has apparently also said that patients should be offered this diagnostic test. I cannot understand the rationale for this (well, other than $$$). Even IF Zivadinov’s preliminary findings are to be taken as corroboration of Zamboni’s finding that CCSVI is correlated with MS, it says nothing about whether it plays a causal role or if surgical interventions will benefit patients. So what exactly is the clinical significance of getting a CCSVI diagnosis?

    • aldo29 said

      Colin, you are missing something really fundamental here,and you espouse knowledge just like the ‘peptic ulcer’ etiology of ‘a combination of too much acid,pepsin and defects in the protective lining of the stomach and duodenum as well as ingesting certain fatty and spicy foods’ was medical school dogma before it gave way to innovative research findings of ‘well..actually most are caused by a H.pylori bacterial infection of the stomach lining’…oops.

      Colin, have you really put in the time and effort to read and analyse the interrelated published papers (of which there are dozens) in detail or have you just read a few blogs, skimmed a few papers and viewed third party media material?

      Folks, lets analyse Colin’ arguments one by one:

      ARGUMENT 1:
      Colin, your assertion of

      “How ‘CCSVI’, however diagnosed, can lead to brain pathology without a substantial increase in jugular venous pressure has never been explained by Zamboni or Zivadinov.”

      shows you have missed (or avoided reading) the paper entitled

      “Venous Collateral Circulation of the Extracranial Cerebrospinal Outflow Routes” in the (I am sure you would agree) ‘reputable’ Scientific Journal “Current Neurovascular Research, 2009, 6, 204-212”

      where it is clearly and unambiguously stated

      “..The significance of collateral circle is still neglected. To the contrary, substitute circles are alternative pathways or vicarious venous shunts, which permit the drainage and prevent intracranial hypertension..”.

      The ‘no hypertension therefore no pathology’ red herring you espouse is just one of many fantasies just like the legend of your complete and comprehensive knowledge and understanding of anatomy, physiology and hemodynamics.

      Colin, what is your next argument?

      • Colin Rose said

        Please send me a pdf of the paper you quote. However, I have seen no evidence that bilateral internal jugular vein occlusions can be bypassed significantly by collateral venous circulation. Does this paper show evidence for this? At any rate, if there were enough such collaterals to normalize cerebral venous pressure the blockages could not cause brain pathology.

      • aldo29 said

        1. How do I forward PDFs to you Colin?
        2. What type and level of evidence is acceptable to you?
        3. Cerebral venous outflow via secondary vessels (collaterals) rather than primary vessels (Internal Jugular and Vertebral Veins) is impaired and such impairment is known to produce cerebral dysfunction in many clinical and animal studies. The cause of alternate outflow pathways appears to range from vessel narrowing to stenoses. Additionally a large number of CCSVI identified individuals also have a IJV Valve Incompetence. The latter IJVVI itself is seen in patients who have an elevated central venous pressure, such as congestive heart disease, tricuspid valve regurgitation, primary pulmonary hypertension and chronic obstructive pulmonary disease. The factual basis of the latter statement is published material by Dresser, Fisher and Doepp et al in separate journals.

      • Colin Rose said

        From a clinical point of view the only evidence that is acceptable to science is a randomized, sham-operated, blinded controlled trial of “liberation”, if it can ever be done. So far, Zamboni has never been able to quantify “CCSVI”, an essential prerequisite to scientific investigation. When he made some attempt at blinding, Zivadinov found “CCSVI” in 25% of the normal population; that is a strong hint that “CCSVI” is a highly subjective, unquantifiable interpretation of Doppler images.

        Zamboni has stated that “CCSVI” is not associated with increased upstream venous pressures. To explain how “abnormal” veins can cause MS Zamboni resorts to “reflux”, a mysterious, unmeasurable, unreproducible fantasy that only he and his acolytes can diagnose and treat.

        If high venous pressure caused MS then, as you mention, many patients with right heart failure or tricuspid insufficiency would have MS. In my 35 years of cardiology practice I have never seen one of these patients with MS and, to my knowledge, an association has never been published.

  2. notms said

    The Buffalo study only used 2 of the 5 qualifying looks. It looked at the neck and head but not at any of the veins associated with the Spinal Column or lower than the collarbone. They also used people who were CDMS, or CIS, in the study and included them in the MS population. There was also a group of people that were borderline and when they threw those numbers out it jumped the incidence up.

    Then again, I know someone who had Revimmune and is running now, I also know someone who had there veins unplugged and the lesions – more than 4 of them- in their head started healing for the first time in 10 years of having the disease. However this is all anecdotal. So is the Simmelweis reflux.

    Colin, I am soooooo glad you are not my doctor. If I had MS I would run to doctors willing to think outside the box rather than going to a doctor bending over backwards to make the Big Pharma companies money. I am sure they are proud.

    • Colin Rose said

      I have no connection with any drug company. In fact I am hated by drug companies for my stance against promotion of drugs, like statins, for lifestyle diseases.

      • dialedin1970 said

        Yet you use quotes from doctors like Freedman to further your stance when he is one of the biggest drug pushers in Canada. You are an insult to doctors everywhere. The fact that you teach medicine in our country and have such a limited knowledge of the body is a disgrace.

        Dr Zamboni et al haven’t stolen a dime from me. They’ve worked on this for years and have put out numerous papers and studies that your huge ego couldn’t possibly let you read for fear of humiliation, yet you call them thieves. I’m sure as a tax payer here you’ve stolen money from me posting this trash on the internet while you should be working.

        Since you only seem capable of gaining medical knowledge through the media, this will be a waste of time, but I’ll do it anyways. Here’s a link to some reading for you, it has links to most every paper and study about ccsvi. I doubt you’ll read any of it, for reasons listed above, but at least it’ll be there should you chose to educate yourself on something before coming here to pi$$ and moan about it.

        http://www.thisisms.com/ftopict-7098.html

  3. moreconcerned said

    I like how people on the internets are accusing a cardiologist with a phd. in physiology who teaches at mcgill of knowing nothing of, well, physiology because he doesn’t agree with their laymans understanding of what what some other doctor is saying.

    Colin – I’ve read that Zamboni has a financial stake in commercializing his modified ultrasound or whatever. I tried asking over at http://www.thisisms.com/ftopic-11796-days0-orderasc-0.html
    but have only received evasive answers or allusions to “big pharma”.

    Any thoughts/info about this?

    • Colin Rose said

      Yes, it is puzzling that the true believers accept at face value the word of a varicose vein surgeon and disparage the comment of neurologists and a cardiologist.

      He may have a financial stake in Esaote but it is not likely to be a big deal since the market is small but he almost certainly get something for giving courses on how to use the machine. More important is that transcranial doppler is useless. One is trying to look through bone that reflects sound waves at a mishmash of vessels with blood flowing in all directions; any pattern can be seen and interpreted in light of the patient’s diagnosis. That is why “special training” is required.

      Zamboni probably gets most of his return from “CCSVI” via the Foundation he set up http://www.fondazionehilarescere.org/eng/index.html, the Scientific Committee of which is him and his friends to whom they dole out the money. As far as I can see there is no arm’s length vetting of grant proposals.

  4. aldo29 said

    Hey you guys..are you still here discussing this topic? Wake up smell the coffee and move on. We all have…Colin….boring.

  5. Colin Rose said

    I’ll stop blogging when Zamboni admits he has deceived desperate people and indemnifies patients who have spent much money on his fantasy and doctors who have spent much time trying to calm anxious patients fearful that they are not being instantly cured by “liberation.”

    • aldo29 said

      That’s more like it Colin!
      …comedy and farce is entertaining.

      pontificating self-serving fixated

      deluded tunnel-visioned closed-minded

  6. moreconcerned said

    Aldo29 said

    May 23, 2010 at 20:56
    Hey you guys..are you still here discussing this topic? Wake up smell the coffee and move on. We all have…Colin….boring.

    I guess that was kind of half directed at me? I was just wondering how CCSVIers justify their denunciations of dissenters by alluding to financial interests when Zamboni et al. must be equally financially interested.

    I wake up and smell the coffee every morning, or at least shortly afterwards. And i’m not a part of any “we” except in a very broad sense of being human.

    Also, if you have moved on, why did you come check here?

    • aldo29 said

      moreconcerned (really?!?..come on!) what are you on about?…that reminds me though…there’s this wordpress subscription management link at the end of the email (which informs one of new posts) hit the delete…and voila’…you may now safely exist in your own little world and from now on consider yourself truly ignored.

  7. moreconcerned said

    I like this blog, why would I delete my subscription management?
    I was referring to you who said you have moved on.

    also, concerned was already taken so i wrote more in front of, no more, no less….

  8. The theory of venous drainage issues causing neurodegenerative disease is not new. I have been writing about it for well over twenty years now. What’s more, MS is just the tip of the iceberg and baby boomers and neurodegenerative diseases are the iceberg. While I agree with Zamboni in part, I have certain issues regarding his theory, which ccsvi fails to explain. I just posted one of those issues on my blog. The title of the post is “CCSVI and MS Demographics.” My blog is called “The Downside of Upright Posture” at uprightdoctor.wordpress.com.

  9. I’m impressed. How is it possible to be so closed-minded and still remember to breathe? You’re throwing the baby out with the bath water, mister. I’ll just point to one specific thing, your comment to the illustration of erroneous venous flows, where you say “We are particularly intrigued by patterns B and C in which venous blood in the internal jugular veins (IJV) is flowing upwards towards the head. If this ever happened for more than a second one’s eyes would pop out of one’s head.” Really, is that so? Because both my IJVs show cerebral flow, with spontaneous contrast and colour doppler. The endocrinologist was surprised, to say the least, he’d never seen anything like it. And this was both when lying down and when sitting up, at rest. I have this constantly, but my eyes have not popped out of my head. How come?

    • Colin Rose said

      Where was your test done? Did the operator know that you had MS before doing the scan? How much did you pay to have it done? Were you convinced before the study that you must have “CCSVI”?

      Your endocrinologist is right to be surprised. It is very easy to manipulate position of Doppler probes and patient positions and breathing state to show just about anything in neck veins. There is no standardized procedure for studying venous flow in neck veins because there has never been and still is no reason to do so. There is no way you could have bilateral blocked IJV`s. Don`t have “liberation.”

      • The test was done by the endocrinologist, he knew that I had MS, was not familiar with ccsvi, and I paid a standard specialist consultation fee (NOK 460). I did not do a Valsalva manouver or anything like that. He tried to see if he could do anything to make the flow thoracal, but didn’t manage. I was not at all convinced I’d have ccsvi, but wanted to have it checked. And it expains, imo, the facial numbness, the pressure in my ears, the very weird sensations down the (in)sides of my neck to name a few things. I’m not claiming ccsvi is the cause of MS, but I can’t see why it’s not interesting to see what proper blood flow will do. Why should I not have a “liberation?” What would you suggest I do? I think it’s a major flaw to just look at one thing and imagine that a drug will help for instance (your photo of the month proves my point), and that health has to do with mental attitude, spiritual connectedness, diet and exercise combined. But what when I get sick from exercise? Anything that raises my blood pressure increases my numbness, how will you explain that?

      • Colin Rose said

        An endocrinologist doing a Doppler scan of neck veins? What training did s/he have in this technique, if any? I suggest you get a second opinion and don`t tell the operator what is your diagnosis.

        Hypertension, per se, causes no symptoms except headache and nose bleeds if very high acutely. Long term uncontrolled hypertension can cause strokes and heart failure.

        I can be very sure you have no significant blockages in your jugular veins (no one has), so forget “liberation.”

  10. My wife had a fabulous improvement after the treatment in August. I have been reading up and apparently the blood has a very specific flow pattern in the brain. Some vein blood from the nose and throat goes back into the brain, and wraps around and cools an incoming artery as it drains back to the heart. Through the azagus in the day upright and jugular at night. Guess the jugular was blocked and her brain overheated at night. It took about 4 hours for the brain fog and headaches to go away in the morning. She does not have brain fog anymore

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