Dismukes

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The Dismukes Study

A randomized, double-blind trial of nystatin therapy for the candidiasis
hypersensitivity syndrome. N Engl J Med 1990 Dec 20;323(25):1717-1723

The Dismukes study was an inconclusive but very interesting study published in 1990 in the New England Journal of Medicine. If you read this study, be sure to get the journal and read the entire report and not just the Medline summary. The Medline summary leaves out very important information that appeared in the report.

Many mainstream doctors who do not believe in CRC have distorted the results of this study and claimed that it supports their position. It does not.

At the time the study was done, no reliable lab tests existed to confirm or deny the condition. Such tests exist now, and confirm its existence. At the time of the study, the only way to show that a person did or did not have the condition was to attempt to treat the person and see if that person got better.

The Dismukes study used 15 different symptoms to test if the patients got better. The test for each of these symptoms had a p < .05 meaning that the odds of the patient getting a positive on the test by chance alone was less than 5% or 19 to 1. With such odds and 15 tests, we might expect one test to yield a false positive.

Overall, patients did little better than those on placebo. On the other hand, 4 out of the 15 tests yielded positives. The probability of this occurring is p < .006 or 180 to 1.

Every doctor who believes in the condition will tell you that it must be treated with a combination of diet and antifungals. Antifungals alone, especially weaker antifungals such as nystatin, are insufficient for resolving CRC. The Dismukes study used nystatin alone and achieved mixed results.

The study acknowledged this limitation by stating:

Proponents of the existence of the candidiasis hypersensitivity syndrome urge that the avoidance of foods containing yeast or mold and reduction of dietary carbohydrates are essential components of therapy. Accordingly, the argument can be made that the differences between treatment regimens in our study population might have been more significant if low-carbohydrate or yeast-free diets had been incorporated into the study design. Because any attempt to regulate and monitor the eating patterns of the patients in an outpatient study would have added greatly to an already highly complex study design, we chose not to include diet as a variable.

In the end, the report urged further study of the condition. The accompanying New Journal of Medicine editorial also urged further study. People who are not familiar with the Journal might interpret this as a polite brush-off. The New England Journal of Medicine is one of the most respected medical journals in the world because it says what it means and means what it says. The Journal is very precise in its use of language. It is unusual for The Journal to urge further study. If it says that further study is warranted, it means it.

Editorial

The same issue of the Journal contained an editorial which urged further study and stated that the study "is only a beginning" and "will not end the controversy".

Letters

Vol. 324, pgs. 1392-1394 shows some interesting letters about the study.

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