Feb 24 2017

Practicing Evidence-Based Medicine

SBM-coverAn excellent article in ProPublica by David Epstein discusses the problem of doctors not adhering to the best evidence-based standards. The full article is worth a read, and I won’t just repeat it here, but I do want to highlight a few points which align well with what I have been writing here and at SBM for years.

The essential problem is that there is a disconnect between the best evidence-based standards and what is actually practiced out in the world. There are actually two problems here. The first is the scientific evidence itself. The second is the alignment of practice to this evidence.

Scientific evidence in medicine has a few challenges. There is publication bias, researcher bias, p-hacking, the decline effect, and problems with replication. What all of this adds up to is that there is a lot of published preliminary evidence, most of which is wrong in the false positive direction. There is a tendency, in my opinion, of adopting treatments prematurely.

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Comments: 5

Feb 23 2017

Natural News Delisted from Google

natural-news-pseudoscienceIt appears that Google has removed all Natural News content from their indexing. This means that Natural News pages will not appear in organic Google searches.

This is big news for skeptics, but it is also complicated and sure to spark vigorous discussion.

For those who may not know, Mike Adams, who runs Natural News, is a crank conspiracy theorist supreme. He hawks snake oil on his site that he markets partly by spreading the worst medical misinformation on the net. He also routinely personally attacks his critics. He has launched a smear-campaign against my colleague, David Gorski, for example.

A few years ago Adams put up a post in which he listed people who support the science of GMOs to the public, comparing them to Nazis and arguing that it would be ethical (even a moral obligation) to kill them. So he essentially made a kill-list for his conspiracy-addled followers. Mine was one of the names on that list, as were other journalists and science-communicators.

In short Adams is a dangerous loon spreading misinformation and harmful conspiracy theories in order to sell snake oil, and will smear and threaten those who call him out. He is an active menace to the health of the public.

Adams is a good example of the dark underbelly of social media. It makes it possible to build a massive empire out of click-bait and sensationalism.

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Comments: 78

Feb 21 2017

Potential New Pain Drug from Snail Venom

Cone-SnailResearchers have published in PNAS promising results from a snail venom analogue used in the treatment of pain. This is exciting for a number of reasons, even if the current compounds under study do not pan out.

Pain is a difficult clinical problem. There are limited options for treating chronic pain and we can quickly run out of options if patients cannot tolerate certain classes of drugs. What we really need are entirely new classes of pain medication, and that is what this new approach promises.

There are essentially two neurological components to pain: there is the physical sensation, and then there is the emotional component. It is interesting to ask the question, why does pain hurt? There is nothing about the sensation itself that is inherently painful. Any sensation is just nerve cells firing and carrying signals to areas of the brain that interpret those signals. Pain hurts because pain pathways specifically connect to the emotional centers in the brain to create a negative experience.

For further background, clinically it is helpful to distinguish different types of pain. There is nociceptive pain, which is the nervous system appropriately sensing damage and generating protective painful sensations. There is also neuropathic pain, which is the nervous system malfunctioning and producing inappropriate pain that is not protective. We further divide pain into acute and chronic. Finally, we consider the context of the patient, such as whether or not they are terminal.

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Comments: 3

Feb 20 2017

Human Gene Editing

CRISPR-human editingThe recent rapid development of CRISPR technology, which has made gene editing fast, affordable, and accurate, has rekindled the ethical debate about human gene editing. Last week a special panel put together by the National Academy of Sciences gave a “yellow light” to human germline gene editing – saying that such editing might be ethical once the risks were properly assessed.

Germline editing means that the changes would be part of the gametes, the sperm or egg, and would therefore be passed down to offspring. If gene editing were done to a fertilized then this would affect all cells, including the germ cells.

By contrast somatic cell editing would affect only adult cells and not be passed down to the next generation. Such editing would only affect the individual.

The ethical controversy over germline editing is that such changes essentially can become a permanent part of the human population.

What Changes are Acceptable?

The NAS report essentially lays out two criteria for human germline editing. The first is that research shows that such editing is safe in humans without any unintended consequences. They want to make sure that dangerous changes to the human genome will not enter the human population. This is, of course, a perfectly reasonable criterion.

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Comments: 20

Feb 17 2017

The Science of Smoking Bans

smoking-banIn a recent article for Slate, Jacob Grier argues that the science used to justify widespread bans on smoking in public places was flawed. Recent more robust research has show little to no health benefit from such laws, he argues. While he has a point regarding the arc of scientific evidence, I think he is going too far in the other direction in his conclusions about the science.

Second Hand Smoke

The current consensus of evidence is that there are health risks to second hand smoke, although they are statistically small. Debate centers around the magnitude of the effect, with few doubting that there is a negative health effect. Negative health effects include heart attacks, lung cancer, stroke, and exacerbation of asthma. On a population level, even small increased risks result in large numbers of excess deaths and negative health outcomes. The CDC estimates, for example, that second-hand smoke exposure results in 34,000 excess cardiac deaths each year.

Increased recognition of the health risks of passive smoke exposure lent significant political weight to anti-smoking efforts, resulting in a cultural shift over the last 30 years. As a result smoking has largely been banned in most indoor public places and many work places.

The empirical question on which Grier focuses is the impact of those smoking bans on health outcomes. He does a fairly thorough review of the literature, although I think his review is biased to make his point, that the health benefits of such bans have been overplayed and maybe don’t exist.

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Comments: 95

Feb 16 2017

More Anti-Vaccine Nonsense from Trump and Kennedy

kennedy-deniroWe have an anti-vaccine president. One of my concerns about Trump the candidate was that one of his most consistent positions over the years was blaming vaccines for the alleged autism epidemic (there isn’t one, by the way). Once elected it did not take long for this to manifest as a policy priority. In January Trump met with RFK Jr. to discuss him heading an Orwellian commission on vaccine safety and scientific integrity.

At a recent meeting with educators, Trump continued to express his false belief in a “tremendous increase” in autism:

“Have you seen a big increase in the autism with the children?” Trump asked Jane Quenneville, the principle of a Virginia public school that specializes in special education. Quenneville responded that she had.

Trump continued: “So what’s going on with autism? When you look at the tremendous increase, it’s really such an incredible — it’s really a horrible thing to watch, the tremendous amount of increase. Do you have any idea?”

“The autism?” Really? Continue Reading »

Comments: 15

Feb 14 2017

Science – We Have a Reproducibility Problem

reproducibility-smallJohn Ioannidis has published an interesting commentary in JAMA about the current reproducibility crisis in basic and clinical scientific research. Ioannidis has built his career on examining the medical literature for overall patterns of quality. He is perhaps most famous for his study showing why most published research findings are wrong.

The goal here is to improve the science of science itself (or “metascience,” like “metacognition”). As science has progressed a few things have happened. The questions are getting deeper, more complex, and more subtle. Research methods have to be more rigorous in order to deal with these more subtle questions.

The institutions of science have also grown. Science is big business, which means that there are “market forces” which push institutions, scientists, and publishers into pathways of least resistance and maximal return. These pathways may not be optimal for quality research, however.

The stakes are also getting higher. We now have professions and regulatory schemes that are supposed to be science-based. If we take medical products, for example, the public is best served is products are safe and effective and truthful in the claims made for them. We need scientific research to tell us this, and we need to know where to set the bar. How much scientific evidence is enough? We can only answer this critical question if we know how reliable different kinds of scientific evidence are.

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Comments: 32

Feb 13 2017

Immigration and Crime

Prevalence-of-CrimeDoes legal or illegal immigration increase crime? That is an empirical question that should be answerable through rigorous research. Whatever the answer, it should inform our policy priorities and decisions. At the very least, if we are going to have a national conversation about immigration, the established facts should serve as common ground.

When you are done laughing (or crying) you might be interested to read about recent research into the correlation between patterns of immigration and various types of personal and property crime. Researchers have previously looked at this question by focusing on individuals – are immigrants more or less likely to commit crimes than native born Americans? Let’s consider that question first.

The research overwhelmingly shows that first generation immigrants, whether legal or illegal, are less likely to commit all types of crime at all ages than the native born. Interestingly, by second generation the statistics look more like native born crime rates, so it does not take long to assimilate in this regard. As an aside, this, of course, does not include crossing the boarder illegally itself, but it has been pointed out that being an undocumented immigrant is not a criminal offense, but a civil offence.

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Comments: 138

Feb 10 2017

Heartland on Global Warming – Case Study in Propaganda

heartland-institute-unabomberH. Sterling Burnett, writing for the Heartland Institute blog, wrote a revealing post titled: Energy Restrictions, Not Climate Change, Put Civilizations at Risk. In my opinion it is a classic example of misleading propaganda, worthy of deconstruction as a case study.

What Is Propaganda?

I always endeavor to be as clear, thorough, and fair in my writing as possible. I am not saying I always succeed, but that is my goal. I have been influenced by my scientific background where clarity and accuracy rises to the level of obsession in the technical literature. It’s not possible to achieve that level in a non-technical blog, but it is a good ideal.

Propaganda is the opposite of clear, thorough, and fair. The purpose of propaganda is to persuade the reader to an ideological or political opinion, or to impugn or cast doubt on other people or other ideas. Being persuasive in an of itself does not make communication propaganda. In order to rise to that level there has to be a willful distortion of facts, a selective use of arguments and information, and the marshaling of any points that suit your ends, regardless of how fair they are.

Propaganda, like pseudoscience, exists on a spectrum. This further means that there is a demarcation problem – there isn’t going to be a bright line beyond which communication is clearly propaganda.

Burnett’s article shows multiple dramatic examples of what constitutes propaganda, and so should serve as an instructive example. This is not surprising since The Heartland Institute is an ideological think tank. They are not a scientific organization. Continue Reading »

Comments: 61

Feb 09 2017

The Super Bowl and Hindsight Bias

Brady SB51Full disclosure – I have been a Patriots fan since in the 1980s. I suffered through a couple long decades of rooting for a mediocre team, including the worst (at the time) Super Bowl defeat at the hands of the Bears. Then along came Belichick and Brady, and it has been a wild ride as a fan.

Super Bowl LI was perhaps the pinnacle – the Patriots came back from a 25 point deficit to tie the game and then win in sudden-death overtime. I feel genuinely bad for Falcons fans, but perhaps worse for those who stopped watching the game in the third quarter because they thought it was over. Those who stayed through to the end were rewarded with historically epic football.

(As an aside, I am a fan simply because it is fun to have a team to root for. Don’t read too much into it.)

What is interesting, from a critical thinking perspective, about the game is the way in which we construct narratives to explain random events, or at least events that have an element of randomness or “luck” involved. At half-time the Falcons were up 21-3 and the discussion among the commentators was all about how well the Falcons were playing and everything the Patriots were doing wrong. The Falcons had “momentum” and the Patriots had to figure out a way to steal this elusive “momentum” back.

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