A 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.
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There 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 »
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.
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Last 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.
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In 1918-1919 the world suffered its worst flu pandemic, with 20-40 million people dying (the CDC claims as many as 50 million). The pandemic resulted from the sudden emergence of a particularly virulent flu strain. In 2008 scientists reconstructed the exact strain, which was influenza A (H1N1).
The virus spread rapidly throughout the world, mostly through trade routes, but the mass movement of people resulting from World War I was thought to be a key factor as well.
Recently Bill Gates stated that he does not feel the world is ready if a similar flu pandemic struck. His foundation is concerned with global health, so he pays attention to such issues. He cited the recent Ebola and Zika outbreaks as evidence that our current preparedness is inadequate.
What are the chances of another pandemic similar to 1918-19? New strains of virulent viruses emerge all the time. It seems inevitable that a particularly bad one will appear at some point, but this is impossible to predict. The CDC states that it is unlikely the next bad flu pandemic will be H1N1 because since the 1918 flu strains of H1N1 have been circulating, and therefore there is decent immunity in the population. H1N1 is also included in the annual flu vaccine. (By the way, if you did not get your vaccine yet, it’s not too late. Do it now.)
But there are many strains of flu. Bird flu is an influenza A virus that mostly infects birds, but has started to cross over to human infections. There are also other viruses, like the SARS (severe acute respiratory syndrome) virus.
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Interpreting scientific studies is difficult. You need to have a thorough working knowledge of scientific methodology, statistical analysis, and the specific field of the science itself. Individual studies also need to be put into the context of all the other studies that touch upon the same question.
It also has to be recognized that all scientific studies are imperfect and only look at a slice of a larger question. Even scientific experts can therefore honestly disagree about how best to interpret the evidence, until that evidence becomes overwhelming (and even then there are often outliers with minority opinions).
If you have an agenda other than understanding the best interpretation of all available evidence, it is easy to find evidence you can twist to serve your preferred narrative. You can then (falsely) claim that your position is supported by science. You can also rely on the fact that most of the public will not be sufficiently scientifically savvy to see the flaw in your reasoning.
A recent article by Edward Morgan on the alleged risks of GMO insulin is a great example of this phenomenon. The title is: GMO Insulin Causes Type 1 Diabetes in Type 2 Diabetics, Study Finds. That is not what the study found.
The author has a clear anti-GMO agenda and so they are trying to argue that insulin which is made from genetically modified bacteria (which is how almost all insulin is made today) is dangerous. They do this by cherry picking studies they clearly don’t understand and then misinterpreting them.
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There is persistent tension over the issue of drug regulations. On one side are those who think that before we sell drugs to the public with health claims, we should ensure there is a reasonable amount of objective quality scientific evidence to demonstrate that the drugs are safe and effective. I admit this is the side of the discussion on which I fall, and it is clear that most of the public assumes this is the case.
The other perspective is that requiring too much research and regulation slows the passage of potentially new and lifesaving drugs to the public. Potentially useful drugs should be fast tracked as much as possible. In the extreme version, held by some Libertarians, there should be no regulation (or perhaps minimal regulation for safety) and the free market should sort out what works and what doesn’t.
The Food and Drug Administration (FDA) is the regulatory agency in the US responsible for ensuring the safety of drugs and that efficacy claims are backed by adequate evidence. The FDA, however, is a creature of congress, from which it derives its authority. It can only do what the law says it can do. Within that law the FDA also has a certain amount of discretion. How much evidence is enough is a judgment call. Therefore who heads the FDA can have a significant impact on how tightly or loosely regulated the pharmaceutical industry is at any given time.
The FDA’s mandate is now being threatened from both ends, congressional law and possible picks by Trump to head the FDA.
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Stories take on a life of their own. That is the origin of urban legends, myths, and even religion. A good narrative feeds on itself and can be self-sustaining. It evolves and adapts and finds fertile ground in most human hosts (unless they have been inoculated with a sufficient dedication to facts and logic).
Aspartame, an artificial sweetener that was approved by the FDA in 1981, has been the focus of conspiracy theories ever since. The “holistic medicine” and “natural health” subcultures have largely been responsible for spreading misinformed hysteria about aspartame, first through chain letters and newsletters, and now through the internet.
Ever adapting, they have added some new wrinkles to the legend of aspartame, making sure that their baseless fearmongering is making use of the latest buzzwords.
Aspartame is Safe
First for some background, the anti-aspartame brigade claims that this food additive has been linked to cancer, neurological disorders, and a long list of complaints and diseases. They are simply lying, or the equivalent of lying by cherry picking data, dismissing evidence out-of-hand, and making up whatever claims they need to support their position. Continue Reading »
In February Playboy model and instagram star Katie May died suddenly of a stroke at age 34. Recently TMZ obtained a copy of the coroner’s report from her autopsy which concludes that the stroke was due to a tear in one vertebral artery, which in turn was caused by neck manipulation by a chiropractor.
This is a good time to review the evidence surrounding the issue of chiropractic manipulation and strokes, which is a concern expressed by many experts but largely denied by the chiropractic profession.
Strokes in young people (<50) are extremely rare. A stroke is caused by blockage of an artery feeding the brain leading to lack of oxygen causing injury and even death to brain cells. Arteries can be blocked if a blood clot lodges in the artery (an embolus), or if a clot forms in the artery (a thrombus).
One major cause of young strokes is trauma to one of the four arteries that feed the brain: two carotid arteries in front and two vertebral arteries in back. The trauma can cause a tear in the inner lining of the artery, which is called a dissection. That tear causes turbulence in blood flow, which in turn can result in a blood clot (when blood isn’t flowing it tends to clot). That blood clot or thrombus can block the artery if it gets big enough, or a piece can break off and lodge down stream, either way causing a stroke.
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A Canadian academic, Dr. Mark Loeb, who is a respected infectious disease researcher who knows how to conduct high quality research, wants to study homeopathic nosodes. Nosodes are essentially homeopathic vaccines.
Tim Caulfield, a Canadian professor of health law and policy, thinks the study is misguided and unethical. The two are having a respectful public debate about the risks and merits of doing such a study.
David Gorski and I have actually published in the peer-reviewed literature on the broader question of studying alternative medicine: Clinical trials of integrative medicine: testing whether magic works? It is a bit of a dilemma, and we are seeing that exact dilemma play out on the question of this specific proposed study.
Homeopathy is Pseudoscience
For quick background, both sides in this debate agree that homeopathy is 100% pseudoscientific nonsense. Homeopathy was invented by one person, Samuel Hahnemann, about 200 years ago. It was not based on any scientific research or knowledge base, it did not develop out of emerging knowledge of biology or physiology. It was simply invented out of whole cloth based loosely on the superstitious belief in sympathetic magic – the notion that substances contain a mysterious “essence” that can be transferred to the body and stimulate the life force.
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