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the supposed yeast syndrome

Tue Jan 14 14:38:00 EST 1997

In response to the latest query about the "yeast syndrome," let me venture to
reply on the basis of no specific knowledge but some background in both yeast
and infectious diseases.  The etiology of many human diseases is unknown, and
many of these are speculated to be due to infectious agents of various sorts,
including viruses, bacteria, protozoa and fungi.  However, proof of such
etiology classically depends on fulfilling Koch's postulates, or modified
versions used for organisms which can't be grown in culture (like Pneumocystis
carinii) or can't be inoculated into new hosts to test their disease causing
potential for ethical reasons (like HIV).  In the absence of proof, speculation
is a good thing if it generates new and better tests of the hypothesis, but a
bad thing if speculation is mistaken for fact and patients are subjected to
inappropriate diagnostic tests or treatment.  I think it is important for the
data supporting such causality to be critically evaluated; I suspect that the
"yeast syndrome" model will not stand such evaluation.

One problem in much medical experimentation is that so-called "trials of
therapy" are generally not valid.  It is not valid to take a patient with an
unknown syndrome, treat with an anti-fungal drug, and then diagnose the disease
as fungal if they get better.  The problem is that there really is a placebo
effect, and most diseases will probably get better eventually whether or not
they are treated (for which we physicians are quite thankful).  The efficacy of
therapy can only be judged by the double-blinded control trial.  I would be
extremely suspicious of "therapeutic testimonials" lacking this gold standard.

Michael J. Leibowitz, MD, PhD
UMDNJ-Robert Wood Johnson Medical School

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