Archive for the 'Science and Medicine' Category

Oct 20 2014

Defending Sick Children

One of the most difficult issues that skeptical physicians face is dealing with children sick with cancer whose parents refuse standard therapy. These cases are always highly charged, because the stakes are extremely high. Obviously the stakes are highest for the child as their life is literally on the line. The stakes are also high for society, however, because they force a specific decision regarding the relative rights of parents vs the responsibility of the state to care for minors.

Two recent cases once again raise these issues. One comes from Western Australia where 10-year-old Tamara Stitt was diagnosed with liver cancer. Her oncologist recommended chemotherapy. Her parents were (understandably) concerned about the side effects of chemotherapy.

He said he and his wife decided against chemotherapy for their daughter because of its horrific side effects and because he felt threatened by doctors.

Mrs Stitt testified that she believed her daughter had a 100 per cent chance of being cured with natural therapies, and she had initially responded well to such treatment.

Her parents decided against chemotherapy and instead chose “alternative” therapies including clay wraps, herbal teas and a healthy diet. Tamara’s cancer predictably progressed until her parents finally relented. Tamara received chemotherapy in El Salvador, but it was too late, and unfortunately she died of her cancer.

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Oct 14 2014

Ebola and Human Error

It has been fascinating, and a little scary, to watch the first ever Ebola epidemic from the comfort of my Connecticut environs – about as far from the epidemic as you can get. Two thoughts keep coming back to me. The first, as this epidemic progresses and the CDC and WHO keep advancing their predictions about how bad it’s going to get, is this question: are we witnessing the unfolding of a major epidemic or even pandemic? Are we going to look back at the second half of 2014 and wonder how no one recognized how serious this is going to get?

Of course, I do not want to overstate the situation, stoke unnecessary fears, or come off as sensationalist. So I, like the CDC, will point out that the probability of a pandemic is extremely small. Unlike West Africa, most industrialized nations have a robust healthcare infrastructure and we’ll be able to deal with an outbreak before it gets out of control.

But this leads me to my second thought – how did it get so bad in the first place? The story is essentially a story of human error. The current epidemic represents a failure at many levels. This is not about finger pointing, but recognizing human limitations and frailty.

By all accounts the current Ebola epidemic is overwhelming the governments and the infrastructure in West Africa where it is still spreading, and in fact increasing geometrically. The world is reacting, some have charged, too late to this crisis. In fact, an Ebola rapid response infrastructure should have been in place, ready to squash any outbreak in its infancy.

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Oct 06 2014

Italy Smacks Down “Rogue” Stem Cell Clinic

Cases such as this highlight for me the need to have a clear understanding of the actual issues that underlie controversies. With regard to medicine, there is a clear need for a standard of care in order to protect the public from snake oil, charlatans and incompetence.

Promoters of therapies and health products that do not meet a reasonable standard are always distracting from the real issue by trying to make it about something else – freedom, conspiracies, East vs West, or philosophy. This unfortunately works, at least with some people.

However, if you ask people – do you think medical treatments should be supported by sound science, most will say yes. Do you think the government should protect the public from harmful or useless products with deceptive claims, most think this is already the case.

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Oct 03 2014

Are Health Apps Helpful?

There seems to be an app for everything, although we are just at the beginning of this new technology. It is a very recent phenomenon that many people in industrialized nations are walking around with a hand-held networked computer. This creates a new opportunity – to have constant access to applications that can help us run our lives. Even though there are already millions of apps, we really are just beginning to explore this opportunity.

One category of apps that seem to have a great deal of potential are health-related apps. There are apps to help people count calories, track their migraines, track their exercise, or even look up medical information or take a crack at diagnosing their own symptoms. There are apps to help you quit smoking or using alcohol, manage your medications, track your diabetes, or to provide some automatic therapy for mental illness.

The UK’s NHS maintains a list of approved health apps with hundreds of vetted apps you can browse.

In there are some useful ideas, and not-so-useful ideas. Trial and error will sort that out over time, and there are probably some killer health apps waiting to be developed.

How evidence-based are typical health apps, however? How would we even study that question?

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Sep 26 2014

FDA Takes On Essential Snake Oils

The Food and Drug Administration (FDA) is tasked with ensuring quality and transparency in the foods and drugs that are sold to consumers. This is a daunting task, and by all accounts the FDA is commonly understaffed, without the resources to thoroughly do its job. Further, politics often hamstrings the agency, so they don’t have the actual authority to do their job.

The most egregious example is the Dietary Supplement Health and Education Act of 1994 (DSHEA). This law (courtesy of Hatch and Harkin) effectively removed “supplements” out of the control of the FDA, and broadly defined supplements to include herbal drugs and other products that are not actually dietary supplements.

Essentially DSHEA created two categories of consumable health products. Drugs, by definition, are any products for which specific disease claims are being made. If you say your pill or ointment treats diabetes, then it’s a drug, because diabetes is a disease. A supplement, by definition, makes no claims to cure or treat a disease, but is allowed to make “structure function” claims. This is a giant loop hole manufactured by DSHEA and wrapped as a present for the supplement industry, at the expense of consumers.

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Sep 18 2014

Artificial Sweeteners and Diabetes

A new study published in Nature is getting a lot of press, and it seems making a lot of people worried. The Nature News article discussing the study has the headline: Sugar substitutes linked to obesity. I think this headline is misleading. Here’s a breakdown of what the study does and does not tell us.

The study’s title is more descriptive, as one might expect: Artificial sweeteners induce glucose intolerance by altering the gut microbiota. The authors (A team led by Eran Elinav of the Weizmann Institute of Science in Rehovot, Israel) studied three noncaloric artificial sweeteners (NAS), saccharin, sucralose, and aspartame. They fed mice that either had a microbiota (bacteria colonizing their gastrointestinal system) or those that were germ free either NAS or control food without NAS. After 11 weeks the mice fed NAS showed signs of glucose intolerance – their blood sugar rose more when challenged with a dose of sugar.

They also found that mice treated with antibiotics did not have this response. Further, they performed fecal transplants from NAS treated mice to germ-free mice and found that the glucose intolerance transferred with the bacteria.  They also cultured bacteria with NAS and transplanted that into mice, who then became glucose intolerant.

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Sep 15 2014

Stem Cell Transplant First

NeurologicaBlog is very meta. I like to not only communicate science, but explore how best to communicate science, including thinking about how to communicate the need to think about thinking. (Cue the endless meta-regression.)

For example, there is often much to criticize about how science news is reported in the general media. Part of the problem is that science mostly advances by accumulating baby steps.  Baby steps, however, don’t always make for compelling headlines, and so every advance becomes a “breakthrough,” every mystery has scientists “baffled,” and every study may some day lead to the cure for cancer, rid us of the common cold, or produce a piece of technology similar to that found in popular science fiction.

Part of the challenge of being a skeptical science communicator is to convey simultaneously the deserved awe of cool science, including the potential implications of genuine advances, while also discussing the need for caution in interpreting results, and essentially throwing a wet blanket on premature hype. It can be a delicate balancing act.

I had all this in mind when I approached the main topic of today’s post – a rather exciting and anticipated advance in stem-cell technology. Japanese researchers have created a sheet of retinal epithelial cells from a patient’s own skin cells. First they had to induce pulripotency on the skin cells, which essentially turns them into stem cells (iPS cells). Then they had to coax these created stem cells into becoming the desired cell type which in this case is retinal epithelial cells.

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Sep 05 2014

Ashya King and Proton Beam Therapy

These cases are always heart-breaking and difficult to write about, but many people have been asking me about the Ashya King case and there are are few points worth exploring.

For background, Ashya King is a 5-year old boy living with his parents in the UK. He has a type of primary brain tumor called a medulloblastoma. This is the most common type of malignant brain tumor in children, and typically is located in the back of the brain, in what is called the posterior fossa.

His parents, who are understandably concerned and want the best treatment for their son, would like him to receive a new type of therapy called proton beam therapy. His UK doctors do not feel this specific treatment is indicated. In desperation, Ashya’s parents removed him from his UK hospital and drove him to their vacation home in Spain. Their plan was to obtain proton beam therapy in Spain.

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Aug 22 2014

What’s The Harm – Ebola Edition

A common defense of implausible treatments is the question – “what’s the harm.” In other words, implausible therapies might help and can’t hurt, so there is no harm in trying. Is this a valid argument, however?

In trying to assess which side of a controversy has the better position I look toward logic and evidence. Evidence is critical, of course, but in fields outside my expertise I have to rely upon experts to interpret that evidence and put it into a broad and deep scientific context. In controversies, often the data itself is not the core issue, but which data to trust and how to interpret that data.

Therefore, when evaluating various controversial positions, it is very helpful to determine which side has the better arguments. If there is a dramatic asymmetry with one side relying heavily on logical fallacies, that is often very telling. Further, on any particular point you can follow the exchange through to completion and see which side ultimately has the better position.

For example, creationists argue that evolution violates the second law of thermodynamics which states that in any system entropy should increase. Scientists counter that the second law only applies to closed systems and the Earth is an open system, receiving energy from the sun. Creationists then counter that the universe is a closed system and so entropy should be increasing in the universe. Scientist counter further that entropy is increasing in the universe but this does not preclude local decreases in entropy where energy is available, such as the biosphere of the Earth. Creationists then respond by changing the subject. In other words – they have no response. They are wrong and have lost the argument.

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Aug 21 2014

Researching Magic

David Gorski and I have just published a paper in Trends in Molecular Medicine titled: Clinical trials of integrative medicine: testing whether magic works?

While we have published literally thousands of online articles discussing these issues here, at Science-Based Medicine, and other venues, it’s great to get an article in the peer-reviewed literature, which hopefully will spark more of a discussion in academic circles.

The full article is available online at the link above, but here’s a quick summary of the main points:

The question is – should we devote limited research resources to investigating CAM (complementary and alternative medicine) methods? Those resources include not only money, but researcher time, available patients, and space for reporting and discussion at conferences and in the published literature. CAM is actually a false category, in my opinion, used really as a marketing strategy and not a meaningful designation. It makes it difficult to answer this question, because we first have to operationally define CAM. (As an aside, “integrative” medicine is essentially the same as CAM, just a different marketing term.)

The real question is – how far down the scale of plausibility should we go in allocating research resources? Should it matter?

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