Jan 23 2017

Acupuncture for Infantile Colic

crying+babyRecently scientists published initial results from an ambitious project to reproduce the results of 50 influential cancer studies. The first five studies resulted in one clear failure to replicate, two partial replications, and two with uninterpretable results.

This is how science works. No one study is definitive, because there are simply too many ways to generate spurious results (even without fraud and with the best intentions). Replication is the final arbiter – any result that is real should consistently reproduce. Results that are spurious will be inconsistent.

These are the core lessons that I have been repeating here and on SBM – most studies are flawed and their results are unreliable. Most false studies are false positive. Even experienced and well-meaning researchers can fall victim to p-hacking and other subtle errors. You can only arrive at a reliable conclusion by looking at a mature and robust research program involving numerous studies and replications. The various replication projects that are under way are confirming this overall impression.

Let’s turn to one of my favorite examples: acupuncture. Acupuncture involved sticking thin needles into specific areas of the body in order to provoke specific clinical benefit, such as pain reduction. There have been several thousand studies of acupuncture. When you review all the research you find, put simply, that acupuncture does not work, for anything. There is no specific effect here, one that is reliably found when appropriately controlled for. The entirety of the research is highly consistent with the conclusion that acupuncture is nothing more than a theatrical placebo.

Continue Reading »

Comments: 4

Jan 20 2017

Questions on GMOs

gmo-cartoons-good-fat-100Genetically Modified Organisms (GMOs) remain the one issue on which there is the greatest disparity of opinions between scientists and the general public. Even among self-identified skeptics, people who make a genuine effort to align their opinions with the scientific evidence, there remains great distrust of GMOs and the companies who produce them (such as Monsanto).

This disparity is partly due to the decades-long campaign by Greenpeace and the organic lobby to demonize GMOs. It is much easier to fearmonger than to reassure. I think we have started to crawl back toward reality on this issue, but we have a long way to go. We started with the low-hanging fruit, correcting the outright lies.

It is much more difficult to dispel the vague sense that there is something menacing about GMOs. We have a deep emotional connection to food that we perhaps don’t even recognize. It is easy to trigger our emotion of disgust, and we have apparently evolved to err on the side of avoiding anything that may be tainted. The image of unnatural “frankenfood” still clings to our culture and is hard to dispel.

Continue Reading »

Comments: 116

Jan 19 2017

2016 Warmest Year on Record

giss-1880-2016It’s official – 2016 is the warmest year on record, since we have been tracking global temperatures since 1880. This is the third year in a row that the current year has been the warmest, 2014 and 2015 were also the warmest years on record. In fact, 15 of the warmest years on record have all been since 1998 inclusive. The last time we had a coldest year on record was 1911.

That the Earth is warming is now undeniable, but that does not stop people engaged in motivated reasoning from denying it. The graph to the right shows temperature variance from average since 1880. It is visually very compelling.

Here is how motivated reasoning works, however. Someone without ideological skin in the game would fairly assess all the data, acknowledge uncertainty and complexity, but arrive at the fairest conclusion. Motivated reasoning exploits uncertainty and complexity to deny the reality which is causing cognitive dissonance brought about by a conflict between reality and ideology.

As you might imagine, there is a lot of complexity in determining average global temperatures. It’s not as if the Earth has a magical thermostat. There are various places to measure temperature, from surface temperature, high altitude temperature, and ocean temperature. You can also use various methods, including ground stations and satellites. Further, you have to correct for any potential source of artifact. For example, there is the heat-island effect. As cities grow they generate more heat, and if you have a temperature measuring station near a city it will measure this heat.

Continue Reading »

Comments: 165

Jan 17 2017

Gene Cernan, Last Man to Walk on the Moon, Dies

Cernan-Apollo17“We leave as we came and, God willing, as we shall return with peace and hope for all mankind.”

Those were the last words that Eugene Cernan spoke while on the moon, the last person to step foot there. Twelve people total walked on the moon during the Apollo missions: Neil Armstrong, Buzz Aldrin, Pete Conrad, Alan Bean, Alan Shepard, Edgar Mitchell, David Scott, James Irwin, John Young, Charles Duke, Eugene Cernan, and Harrison Schmitt. Cernan was one of only three who went to the moon twice. Of the twelve, six are now still alive.

Cernan and Schmitt were the two astronauts of the Apollo 17 mission, the last mission of the Apollo program, to walk on the moon. They lifted off from the lunar surface on December 14, 1972. That means this year it will be 45 years since a person last walked on the moon. We are fast approaching half a century since the end of the Apollo missions.

I was only 8 years old in 1972, but I avidly followed the Apollo program. From my perspective at that age the Apollo program had existed my entire conscious life. To me it was just something that we did. I remained a fan of NASA, the space program, and all things having to do with space travel since then. I would have considered it unthinkable that we would not return to the moon in the next 50 years. Surely by 2001, which seemed far in the future, Kubrick and Clarke’s vision of a permanent moon base was likely a reasonable extrapolation.

So why haven’t we been back to the moon? Should we return to the moon?

Continue Reading »

Comments: 17

Jan 13 2017

Cognitive Biases in Health Care Decision Making

decision-makingThis was an unexpected pleasant find in an unusual place. The Gerontological Society of America recently put out a free publication designed to educate patients about cognitive biases and heuristics and how they can adversely affect decision making about health care.

The publication is aimed at older health care consumers, but the information it contains is applicable to all people and situations. It is a well written excellent summary of common cognitive biases with a thorough list of references. There are plenty of other resources that also review this material, including my own Teaching Company course, but this is a good user-friendly reference.

What is most encouraging about this publication is the simple fact that it recognizes that this is an issue. It is taking knowledge of psychology and applying it to the real world, recognizing the specific need for critical thinking skills in the public. This could have easily been produced in many different contexts – not only any medical specialty, but investing your money, buying a home, choosing a college, or evaluating news reports.

The report is aimed simultaneously at health care providers and patients. It is primarily a guide for providers for communicating with older adults, accounting for cognitive biases in decision-making, but at the same time will help consumers communicate with their providers and make better decisions.

Continue Reading »

Comments: 208

Jan 12 2017

Curcumin Hype vs Reality

CurcuminCapsA recent systematic review of the alleged health benefits of curcumin show that, yet again, hype based on “traditional use” is not a reliable guide.

Curcumin is a spice that makes up about 5% of turmeric, a yellow spice used in many curries. It is also a traditional herbal treatment. The health claims made for curcumin are numerous – WebMD has this entry:

Other preliminary lab studies suggest that curcumin or turmeric might protect against types of skin diseases, Alzheimer’s disease, colitis, stomach ulcers, and high cholesterol. Based on lab studies, turmeric and curcumin might also help treat upset stomach, scabies, diabetes, HIV, uveitis, and viral infections.

The systematic review had two main findings:

No double-blinded, placebo controlled clinical trial of curcumin has been successful. This manuscript reviews the essential medicinal chemistry of curcumin and provides evidence that curcumin is an unstable, reactive, nonbioavailable compound and, therefore, a highly improbable lead.

Let’s take the second point first, bioavailability. In order for a drug to be useful when taken orally it has to have adequate bioavailability. This means it needs to be relatively stable, it has to be absorbed in adequate amounts through the GI tract, and then it has to survive a first pass through the liver and be distributed in the body in such a way that it gets to its target tissue is sufficient concentration to have a clinical effect.

Continue Reading »

Comments: 17

Jan 10 2017

Cleveland.com Doubles Down on Fail

vaccine-shot-promoThere are several phases to a serious gaffe. First, there are the conditions which led to or allowed the gaffe to occur. Then there is the gaffe itself. There is then the response of the person or institution who committed the gaffe – which is perhaps the most important phase . Finally, there may or may not be a long term correction of the underlying conditions.

Over the weekend, as I discussed yesterday, Dr. Daniel Neides, Medical Director and Chief Operating Officer of the Cleveland Clinic Wellness Institute, published an anti-vaccine screed on cleveland.com. I won’t bother debunking the anti-vaccine pseudoscience again, just read my post from yesterday. You can also read David Gorski’s excellent take down at Science-Based Medicine.

Suffice it to say the column was full of misinformation and common anti-vaccine tropes that are long debunked. The publication of a dangerous anti-science rant by Cleveland Clinic’s Director of the Wellness Center was, of course, the gaffe.

The conditions that led to that gaffe are obvious, and something about which my SBM colleagues and I have complained for years- the infiltration of alternative medicine pseudoscience into academic medical institutions. Cleveland Clinic has an “integrative medicine” center headed by Mark Hyman, who co-authored an anti-vaccine book. The Wellness Center itself embraces all sorts of vitalistic nonsense and pseudoscience.

As David says – no one should be surprised when the director of a center that embraces quackery publishes an article that embraces quackery. Continue Reading »

Comments: 109

Jan 09 2017

Anti-vaccine Nonsense at Cleveland Clinic

This is what happens when you compromise your academic and professional integrity in order to embrace a popular fad. The Cleveland Clinic, which is historically an excellent medical institution, has the Cleveland Clinic Wellness Center, which is a center of so-called “alternative” medicine.

Such centers are a Trojan horse. They are sold to naïve academics as providing “patient centered” warm and fuzzy symptomatic treatments. Meanwhile they are really centers for pseudoscience and health fraud. They use the respected names of venerable institutions to legitimize nonsense.

The Cleveland Clinic now has to face the PR nightmare of allowing the foxes into the henhouse (actually they built a new henhouse just for the foxes).

On January 6th Dr. Daniel Neides, Medical Director and Chief Operating Officer of the Cleveland Clinic Wellness Institute, published an anti-vaccine screed on the institution’s blog. The article is full of typical anti-vaccine misinformation, and is a serious embarrassment to the Cleveland Clinic. It will also embolden the anti-vaccine movement, who can point to the article to make vaccines seem controversial and convince more confused parents not to vaccinate their children.

Continue Reading »

Comments: 55

Jan 06 2017

Another Child Dies of Medical Neglect

seth-johnsonLast year 7-year-old Seth Johnson died of pancreatitis. His parents, Timothy and Sarah, are now on trial for one count of child neglect.

These are always heartbreaking stories, especially for a parent. Strong and conflicting emotions are stirred – on the one hand I feel anger and resentment toward the parents, who allowed their child to needlessly suffer and die. At the same time I also feel sorry for the parents. There is nothing worse than the death of a child, except feeling responsible for that death yourself. The state can add little to the emotional punishment they must be  already experiencing (although they should try damn hard).

Seeing such parents as victims is not a popular position. It is much easier to see them as villains, even demons. I always strive to see reality in all its complexity, and as a result I often conclude that such parents are some combination of villain and victim. My thoughts also come with the huge caveat that I am getting all my information from the media, and do not have direct access to the medical information or the parent’s story.

Continue Reading »

Comments: 145

Jan 05 2017

The Misinformation Wars

As we collectively try to climb out of the smouldering rubble that was “the truth” in 2016 (by which I mean basic intellectual integrity), many people are speculating and trying to wrap their brain around what exactly is happening. Of course, the arbitrary transition to a new calendar year changes nothing. We are still living in the same world that produced the 2016 election.

Many writers have characterized what happened as the “weaponization” of bullshit or misinformation. This is not entirely new, but it did seem to reach new heights, or to cross over some fuzzy threshold to a new level or prominence. The “weaponized” meme is also mainstream; Donna Brazile, for example, is saying that the hacked DNC e-mails were “weaponized” against them.

The two other similar memes that emerged this past year were “post truth” and “fake news.” These were added to older notions of “echochambers” or the fact that many people are living in information bubbles (whether they know it or not).

I think all of these concepts are essentially correct. We are in the midst of a misinformation war (actually many wars on many fronts). Unfortunately, it seems that the side which includes the mainstream media, the experts that provide them with information and analysis, professional journalists and academics, is losing. They are losing primarily because they have not yet adapted to the new battleground – social media. They are like the British fighting in neat rows with their visible red uniforms, while the rebels fire at them concealed behind trees and stone walls.

Continue Reading »

Comments: 116

Next »