Archive for the 'Science and Medicine' Category

Sep 01 2015

Sleep and Health

Getting sufficient sleep is very important to overall health. It is an often overlooked aspect of health. I frequently have patients with multiple complaints who inform me, only when asked, that they have terrible sleep. They did not make the connection between their sleep and their symptoms, however.

Good sleep has been tied to longevity. A review of studies found that getting <6 hours of sleep on average per night was associated with a 12% increased risk of death. The same review found that getting >9 hours of sleep a night was associated with a 30% increased risk of death.

It is difficult to determine cause and effects with these studies. Sleep may simply be a marker for other health variables. People who sleep over 9 hours, for example, may do so because they are unhealthy for other reasons.

Even still, it is plausible that lack of sleep is stressful to the system, especially brain function, and therefore sleep disorders should be identified and treated. Don’t overlook the importance of good sleep.

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Aug 27 2015

FTC Responds to FDA on Homeopathy

The FDA (Food and Drug Administration) recently asked for public comment on its regulatory policies regarding homeopathy. They probably didn’t figure that a fellow federal agency, the FTC (Federal Trade Commission) would respond.

The FTC also recently asked for public comment on how it can better regulate homeopathic product advertising. While the FDA regulates food and drugs (including supplements), the FTC regulates claims that sellers can make about those foods and drugs. The FTC is now complaining to the FDA that their policies are in inherent conflict. They write:

The staff comment notes that the FDA’s regulatory framework for homeopathic drugs, set forth in a 1988 Compliance Policy Guide, does not require that over-the-counter (OTC) homeopathic drugs be approved by FDA as safe and effective if they satisfy certain conditions, including that the product’s label contains an indication for use. Yet the policy guide does not require sellers to have competent and reliable scientific evidence to support the indication for use.

The comment states that given the FTC’s long-standing advertising substantiation policy that health claims must be substantiated by such evidence the FDA’s current regulatory framework may harm consumers and confuse advertisers.

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Aug 25 2015

Anti-GMO in the NEJM

A recent commentary published in the New England Journal of Medicine (NEJM) by Philip J. Landrigan and Charles Benbrook has sparked some controversy. Landrigan and Benbrook are publishing in a medical journal because they claim the issue of genetically modified organisms (GMOs) is a public health issue. They use extremely strained logic and misrepresentation to make their point, however.

Equating GMOs with Herbicides.

The primary logical flaw in their argument is their attempt to equate GMOs with the use of herbicides. They write:

Herbicide resistance is the main characteristic that the biotechnology industry has chosen to introduce into plants.

and

The first of the two developments that raise fresh concerns about the safety of GM crops is a 2014 decision by the Environmental Protection Agency (EPA) to approve Enlist Duo, a new combination herbicide comprising glyphosate plus 2,4-D. Enlist Duo was formulated to combat herbicide resistance.

The authors also acknowledge that:

“ genetically engineered crops can increase yields, thrive when irrigated with salty water, or produce fruits and vegetables resistant to mold and rot.”

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Aug 24 2015

Antivaxxers Still Flogging Thimerosal

I gave a talk on the vaccine controversy over the weekend. I was not surprised that a couple of audience members had a lot of questions taken directly from anti-vaccine propaganda sites. What was interesting was that they were still pushing the idea that thimerosal, a mercury-based vaccine preservative, is linked to autism.

The reason this is interesting and illuminating is that the thimerosal hypothesis is not just mostly dead, it is most sincerely dead. It is pushing up the proverbial daisies.

A Brief History of Thimerosal

Thimerosal was developed as an organomercurial anti-microbial agent shortly after World War I. It was soon discovered that it has great anti-microbial properties and was well tolerated when injected into rabbits or rats even at high doses. This made it superior to anything else available at the time.

Bacterial contamination was a serious problem for vaccines in the first half of the 20th century. Thimerosal in tiny doses, well below safety limits, proved to be an effective agent for preventing contamination. By the 1940s thimerosal was being added to several vaccines for this purpose.

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Aug 21 2015

Risk Factors for Alzheimer’s Disease

A new meta-analysis of 323 studies looks at 93 possible factors associated with the risk of developing Alzheimer’s disease (AD). AD is a neurodegenerative disorder affecting the entire brain that causes a slowly progressive dementia over years.

Dementia is a generic term for a chronic disorder of memory and cognition. AD is a specific disease that causes dementia. It is the most common cause of dementia, responsible for about half of all cases. There are 5.2 million people with AD in the US, most over the age of 65. About one-third of people 85 years or older have AD.

AD, therefore, is a significant cause of a common condition that causes extreme disability and death in the older population. There is currently no cure for AD. Available treatments are considered symptomatic – they improve memory and function modestly but do not alter the course of the disease. Preventing AD, therefore, is very important.

The current meta-analysis looked at cohort studies and case-control studies. These are two different types of observational studies, meaning that they are observing what happens or has happened to people but does not randomize people to different groups. It is difficult to draw conclusion about cause and effect from observational studies because of possible confounding factors. The advantage, however, is that they can observe large populations. In the current analysis the researchers looked at 93 factors with >5,000 subjects in the pooled studies.

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Aug 11 2015

Bishops Meddle in Health Care

The headline almost says it all: Catholic Bishops In Kenya Call For A Boycott Of Polio Vaccines. Catholic Bishops, or any religious officers, have no business meddling in public health care. NPR reports:

“the country’s Conference of Catholic Bishops declared a boycott of the World Health Organization’s vaccination campaign, saying they needed to “test” whether ingredients contain a derivative of estrogen. Dr. Wahome Ngare of the Kenyan Catholic Doctor’s Association alleged that the presence of the female hormone could sterilize children.”

Where did they get this idea? From conspiracy theories. That’s it. There is no medical or scientific reason, no credible investigative journalism, and no evidence to suspect that vaccine (the polio vaccine or any other) contain estrogen compounds that will sterilize children.

This is an old conspiracy theory in Africa, based on the idea that “The West” wants to sterilize Africans in order to control their population and keep them down. This is pretty typical fear mongering – based on fear from outsiders who wish the community harm. It is a form of mass delusion.

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Aug 06 2015

Registering Studies Reduces Positive Outcomes

The science of science itself is critically important. Improvements in our understanding of the world and our technological ability to affect it is arguably the strongest factor determining many aspects of our quality of life. We invest billions of dollars in scientific research, to improve medical practice, feed the world, reduce our impact on the environment, make better use of resources, to do more with less.

It seems obvious that it is in our best interest for that scientific research to be as efficient and effective as possible. Bad scientific research wastes resources, wastes time, and may produce spurious results that are then used to waste further resources.

This is why I have paid a lot of attention to studies which look at the process of science itself, from the lab to the pages of scientific journals. To summarize the identified problems: most studies that are published are small and preliminary (meaning they are not highly rigorous), and this leads to many false positives in the literature. This is exacerbated by the current pressure to publish in academia.

There is researcher bias – researchers want positive outcomes. It is easy to exploit so-called
“researcher degrees of freedom” in order to manufacture positive results even out of dead-negative data.  Researcher can also engage in citation bias to distort the apparent consensus of the published literature.

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Aug 03 2015

The Holistic Doctor Murder Conspiracy

The antivaccine and CAM (complementary and alternative medicine) communities love a good conspiracy. When you live on the fringe of science and reason, conspiracy theories are your bread and butter. You need some reason to explain why the mainstream scientific community does not endorse your version of reality. It can’t be that the evidence doesn’t support your position, so it must be a conspiracy.

It is therefore no surprise that when a series of CAM practitioners die within a short period of time, antivaxxers see a conspiracy. A conspiracy would support their narrative so nicely, they just know it has to be true.

This story started with the death of Jeff Bradstreet, a “holistic” doctor who believed that vaccines caused his son’s autism. He was overtly anti-vaccine, supported the discredited mercury hypothesis of autism, and treated autism (including his son’s) with a variety of biomedical treatments including chelation therapy and hyperbaric oxygen.

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Jul 30 2015

Big Data and Personalized Medicine

Jun Wang, a famous Chinese geneticist, announced that he is going to shift his career into developing an AI (artificial intelligence) system that correlates genetics, behavior, and environmental factors with personal health. The goal is to provide individual recommendations about health and lifestyle based upon those factors.

In this case AI does not refer necessarily to a self-aware computer but just an intelligent system, like the AI that determines the behavior of characters in video games, or that won Jeopardy against human champions.

The real centerpiece of Wang’s vision is the data. He wants to build a database including the genomics data from one million people (and eventually much more), and correlate those genetic factors with lifestyle, environment, and health. What he is proposing, essentially, is using big data and AI systems to take the next step in personalized medicine.

Personalized medicine is currently a popular buzzword – you will find it frequently on alternative medicine sites. This is not because CAM practitioners are ahead of the curve. Rather, they latch onto the latest concepts and then make up the details as they go. It’s easy when you don’t have to do actual research or be science-based.

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Jul 28 2015

Anecdotes and Cannabis Oil

An article making the rounds has this claim in the headline: This Man Was Given 18 Months To Live. Here’s How He Illegally Cured His Cancer. The article further explains that he “cured” his cancer with cannabis oil. This is highly misleading for multiple reasons.

This and other articles tell the story of David Hibbit, a 32 year old man who was diagnosed with bowel cancer in 2012. First, let me say that of course I wish nothing but the best for Mr. Hibbit. I hope his cancer is completely gone and he lives a long life with his family. Cancer is a serious and scary disease. It has touched my family, and I am sure statistically it has touched most people reading this.

That, in fact, is why we have to be so careful when relating stories about cancer. Patients have serious and high-stakes decisions to make about how they are going to treat their cancer. Luring them to bad decisions with false promises and misleading but highly emotional stories is irresponsible.

The core of bad reporting about cancer is the anecdote – the heartfelt story of an individual fighting cancer. Such stories are almost universally highly misleading. The public is being given an emotional narrative, not useful information.

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