I am covering the in-patient service this month and so I am more busy than usual. I am trying to keep my blogging schedule without change, but it’s challenging, so forgive me if I occasionally miss a post or I am late.

For that reason, for my post today I am simply going to respond to a comment on my recent post on acupuncture and migraines. In response to this, frequent commenter, Sonic, wrote:

The conclusion that acupuncture does not work does not coincide with the evidence presented.

From the 2009 Cocrane review:

“Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment.”

This implies that acupuncture is a safe and effective treatment compared to the “proven” prophylactic drug treatment.

A drug company could go to the FDA with a study that showed their treatment to be better than the existing proven treatment and get approval based on that fact.

The conclusion that it is possible that the exact placement of the needles may not be as important as thought, does not invalidate the therapy.

Just because there might be a mistake in exactly how something works does not invalidate that it does work. The studies quoted would indicate that acupuncture works as well as or better than any other current therapy.

There is nothing in the evidence to indicate that the therapy did not work better than any existing therapy and better than doing nothing.

The fact that something works better than the proven therapy means that it works.

To conclude otherwise is to misread the evidence as presented.

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On a recent episode of Fringe (a rather mediocre, in my opinion, series on the supernatural), the investigators come across apparent cases of spontaneous human combustion (SHC).  Popular Mechanics decided to write an article about the science behind SHC (it turns out there isn’t any) and luckily contacted me to give them the skinny. You can read the article here.

SHC is a fun pseudoscience in that there is nothing concrete at stake – no health claims, no products, no concerns about squandering limited research funds. It’s purely a scientific question, one highly amenable to skeptical analysis.

In order to understand SHC imagine the following scene: An elderly woman who lives alone is found dead in her apartment. She is the victim of fire; her body is mostly reduced to ash, and only the ends of her arms and legs remain. The ashen outline of her head lies upon the hearth of her fireplace, the iron grill of which has been knocked to the side. There are signs that a fire recently was burning in the fireplace. A brown greasy substance coats the walls and ceiling near the body, but otherwise the room is unharmed.

Now set aside all common sense and reason, and you’ll have a typical case of spontaneous human combustion.

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My post from yesterday sparked a lot of discussion about the cost-effectiveness of medicine. This is a deceptively complex topic, so I thought I would discuss it briefly today.

Essentially what cost-effectiveness means is the most bang for the health care buck.  If you want to read up on how this concept is applied in detail you can read this open-source online course from Johns Hopkins. This give an overview of the current system for quantifying cost-effectiveness.

The system considers quality of life years – how many years of life at what quality will how many people have without and then with a specific intervention. Is the expense of that intervention worth the increase in overall quality of life years? For these calculations, everyone is treated equally. Quality of life is very subjective, but there are ways to pseudo-quantify it, such as surveys about depression, pain, mobility, independence, etc.

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It must be tough being a highly visible politician – specifically taking questions from the public. You can get hit with highly technical questions in any area, often posed by someone with a narrow agenda and a great deal of information with which they can plan rhetorical mines. I don’t expect politicians to have all the technical details for any such issue at their fingertips. Experienced politicians, however, have learned how to handle such situations – the first rule of which is not to pull facts out of your butt.

George Bush’s most famous such gaffe, in my opinion, is when he said that the “jury is still out” on the question of evolution. Right – only greater than 98% of all scientists agree that evolution is a scientific fact, but we’re still waiting on the other 1% or so of hold outs.

Obama is not likely to get tripped up on the evolution issue, but he is vulnerable when it comes to science and medicine. Unscientific medical modalities and practitioners have found allies on both sides of the political aisle. The impending health care reform has also mobilized the CAM (complementary and alternative medicine) troops who are trying to twist the health care agenda to serve pseudoscience.

At a recent town meeting Obama received the following question and gave the following answer:

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Those who advocate for strict scientific standards in medicine are often asked, “what’s the harm” of someone pursuing unconventional medicine? If people want to engage in a little hope, even if it’s a false hope, it might make them feel better and it won’t cause any harm.

Often the questioner assumes that the unscientific remedies are themselves harmless. This is not always a reasonable assumption. Some unscientific treatments are directly harmful, or carry a non-trivial risk. But that is not the limit to the harm that can be caused by pursuing such remedies.

For me the biggest harm of unscientific medicine is that it fosters a distruct of science-based medicine and practitioners and faith in bizarre notions of health and illness and in treatments that do not work. Someone who feels that acupuncture helpe their back pain may then rely upon it when they get cancer.

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One of my earliest blog posts in NeuroLogica was exposing clinics in China that are offering stem-cell therapy for a range of neurological disorders. The post focused on Dr. Hongyun Huang and his clinic, but there are, unfortunately, many others. A new Chinese stem cell clinic, Beike Biotechnologies, has been in the news recently, showing that the practice, if anything, is growing in China.

The use of stem cells to treat neurological injury or degenerative disease is certainly a promising idea. In 10-20 years such treatments may not only be a reality, they may revolutionize our approach to some diseases. But there is a long lead up of scientific research before a new biomedical technology becomes a reality – if it ever does. This often means that there is a long period of media hype preceding scientific reality. This has been especially true for stem cells, likely resulting from the ethical controversy and partial Bush Administration ban on stem cell research.

There are a number of clinics and companies around the world, but especially in China, taking advantage of this premature media hype, and the desperation of people with serious injury. They are offering stem cell treatments now, and claiming stunning rates of cures. At the same time they are offering zero scientific evidence to back up their claims. That is a formula well known to those of use who pay attention to health fraud – stunning claims combined with a lack of rigorous scientific evidence = fraud. At least that is a reasonable default assumption until the evidence is presented.

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In 1918 the Spanish Flu (named after the country of origin of the first identified case) swept the globe, killing 20-40 million people – more than the First World War (which killed 15 million) which was just ending. When an epidemic spreads to multiple regions, especially multiple countries or continents, it becomes a pandemic. Flu pandemics happen every 40 years or so, and we are due for one now.

This is probably partly why there has been so much news attention, even some mild hysteria, surrounding recent outbreaks of swine flu, beginning in Mexico. It is hard to say how many cases and how many deaths there have been so far, because information from Mexico is spotty. Specifically it id difficult to say if people who have died with flu-like symptoms really had the swine flu or something else. Estimates are that about 150 people have died in Mexico with the swine flu. It is clear that we are dealing with a new strain.

Some Background on Influenza

But first, a little background. The influenza or flu virus is an RNA virus that comes in three genera – A, B, and C. Influenza A is the most common type. It can infect mammals and birds, with aquatic birds being its natural endemic host. Each year there is a seasonal epidemic of Influenza A, infecting millions of people and killing 100-200,000 – mostly the very old, the very young, and the sick.

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