Archive for the 'Science and Medicine' Category

Jun 20 2017

Acupuncture in the ED

acupuncture3Acupuncture still doesn’t work. We have thousands of studies collectively showing that it does not matter where you stick the needles or even if you stick the needles. Acupuncture is an elaborate placebo, and nothing else. It is not based on any sound scientific principles or knowledge about anatomy or neurophysiology. It is as much a scientific dead end as homeopathy, the ether, phrenology, and the four humors.

This, of course, creates a dilemma for acupuncture proponents. For a few decades they have been crying for scientific study of what they are sure (from their own anecdotal experience and philosophy) must work, but as the science came in it showed that their favorite treatment did not work. For a while you can get away with criticizing the studies – they are not doing it right. But then acupuncturists design and carry out more and more rigorous studies, accounting for all their criticisms, and acupuncture still doesn’t work.

We are definitely way past the point (thousands of studies over several decades) to conclude that acupuncture is a lost cause. Any intellectually honest scientist at this point would have to conclude they were wrong, and move on. Because this is medicine, and not just abstract science, there is also an ethical component. I could argue that it is now unethical to stick acupuncture needles into patients because we have sufficient evidence to conclude doing so is of zero benefit, and is also invasive and carries some risk.

That, of course, is not what happened. Instead acupuncturists ignored the research, or continued to nitpick and deny. Or they just cherry pick the studies that show what they want (even if they have to misinterpret them). But still they want to sell acupuncture as a modern science-based treatment, but pesky high quality studies keep getting in the way.

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Jun 05 2017

Minnesota Measles

Measles graph 1There is currently a measles outbreak in Minnesota. This was, unfortunately, entirely predictable – not, of course, that an outbreak would occur specifically in Minnesota, but that we would start to see outbreaks in communities with low vaccination rates.

So far Minnesota has seen 73 cases of measles. This is more than any year in the last 20 years (or more, that is how far back the tables go). In fact, that is more than all Minnesota cases combined in the last 20 years (56).

Nationwide we hit our low point for measles in 2004 with only 37 cases, all imported from other countries. This means that measles we eliminated from the US, with no native reservoir and no endemic cases. Measles, of course, has not been eradicated from the world and so we can still have imported cases. Thirty seven cases is down from the millions that would occur each year prior to the introduction of vaccines. The graph shows reported cases, which were as high as 800 thousand, but the CDC estimates that the real number was much higher as most cases went unreported.

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May 11 2017

Open Letter to FDA on Acupuncture

The FDA recently amended their draft proposal for: FDA Education Blueprint for Health Care Providers
Involved in the Management or Support of Patients with Pain. The draft proposal includes this statement:

“Nonpharmacologic therapies – includes psychological, physical rehabilitative, surgical approaches; and complementary therapies.”

And below further defines, ” Complementary therapies – e.g., acupuncture, chiropracty”

Recommending:

“HCPs should be knowledgeable about the range of available therapies, when they may be helpful, and when they should be used as part of a multidisciplinary approach to pain management.”

While the current problems with opioid overuse are significant and adequate pain management remains a challenge, introducing unscientific methods will not help health consumers and will only waste resources. Introduction of these recommendations for unscientific methods does not reflect scientific consensus, but intense lobbying by proponents who stand to financially gain from their inclusion.

Acupuncture specifically has been studied extensively, with thousands of clinical trials, and yet proponents have not been able to demonstrate that acupuncture is effective for any indication, including pain. In short, acupuncture does not work.

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24 responses so far

May 09 2017

More Anti-Vaccine Pseudoscience

ObukhanychAnti-vaccine nonsense is relentless, and spreads through social media like a measles virus in an upscale private California school. Therefore we need frequent skeptical booster shots.

I will usually decide to take on a topic if I see it spreading or if fellow skeptics aren’t sure what the deception is. A story is sending up red flags, but a more expert eye is needed.

Pretty much every word in this headline is wrong or deceptive: Harvard Study Proves Unvaccinated Children Pose No Risk.

First, there is no study. This is not in any way about some new study or research, but simply an article by an anti-vaccine crank, Tetyana Obukhanych. Further, her connection to Harvard seems tenuous and it’s not even clear what her current academic status is. And most importantly, she uses cherry picked, irrelevant, and incorrect information to make her case.

But she appears to be the new darling of the anti-vaccine movement, so let’s take a deeper look. Continue Reading »

9 responses so far

May 01 2017

Surgeons Plan First “Head Transplant”

sergio-canavero-xiaoping-renYou should be skeptical – in general, but certainly of this specific claim.

First I should point out that such a procedure would be a body transplant, not a head transplant. The head would get a new body, because the head is the person.

This story has all the red flags of scam and pseudoscience. I am having a hard time figuring out exactly what the scam is. It may just be an exceptionally self-deluded surgeon, but it is instructive to identify all the reasons this claims is almost certainly nonsense.

Italian neurosurgeon Sergio Canavero has announced that he plans to perform the first “head transplant” by the end of 2017 in China on a Chinese national (as yet unnamed). He has been working with Russian patient, Valery Spiridonov, who has a muscle-wasting disease, but for some reason he is now moving his operation to China.

The primary reason for skepticism is that we simply do not have the technology to pull off this kind of operation. I have previously reviewed the history of head transplant research. I also wrote about Canavero in 2013 when he first started making such claims. Continue Reading »

37 responses so far

Mar 03 2017

Trump’s Dangerous Plan to Deregulate Pharmaceuticals

Trump-FDADuring Trump’s recent address to Congress he referred to 20 year-old Megan Crowley who has Pompe’s disease.

“Megan’s story is about the unbounded power of a father’s love for a daughter,” Trump said. “But our slow and burdensome approval process at the Food and Drug Administration keeps too many advances, like the one that saved Megan’s life, from reaching those in need.”

This statement, an unwarranted and factually-challenged attack on the FDA is all the more frightening when put into context. He has appointed to the FDA Jim O’Neill, who said in 2014:

“We should reform FDA so there is approving drugs after their sponsors have demonstrated safety—and let people start using them, at their own risk, but not much risk of safety. Let’s prove efficacy after they’ve been legalized.”

Not requiring evidence for efficacy for drugs would be an unmitigated disaster. It also makes not sense – the concept of “safety” cannot be entirely separated from efficacy. Drugs are evaluated and their use determined by risk vs benefit. You cannot do a risk vs benefit assessment if there is no data on benefit.

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Feb 24 2017

Practicing Evidence-Based Medicine

SBM-coverAn excellent article in ProPublica by David Epstein discusses the problem of doctors not adhering to the best evidence-based standards. The full article is worth a read, and I won’t just repeat it here, but I do want to highlight a few points which align well with what I have been writing here and at SBM for years.

The essential problem is that there is a disconnect between the best evidence-based standards and what is actually practiced out in the world. There are actually two problems here. The first is the scientific evidence itself. The second is the alignment of practice to this evidence.

Scientific evidence in medicine has a few challenges. There is publication bias, researcher bias, p-hacking, the decline effect, and problems with replication. What all of this adds up to is that there is a lot of published preliminary evidence, most of which is wrong in the false positive direction. There is a tendency, in my opinion, of adopting treatments prematurely.

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14 responses so far

Feb 21 2017

Potential New Pain Drug from Snail Venom

Cone-SnailResearchers have published in PNAS promising results from a snail venom analogue used in the treatment of pain. This is exciting for a number of reasons, even if the current compounds under study do not pan out.

Pain is a difficult clinical problem. There are limited options for treating chronic pain and we can quickly run out of options if patients cannot tolerate certain classes of drugs. What we really need are entirely new classes of pain medication, and that is what this new approach promises.

There are essentially two neurological components to pain: there is the physical sensation, and then there is the emotional component. It is interesting to ask the question, why does pain hurt? There is nothing about the sensation itself that is inherently painful. Any sensation is just nerve cells firing and carrying signals to areas of the brain that interpret those signals. Pain hurts because pain pathways specifically connect to the emotional centers in the brain to create a negative experience.

For further background, clinically it is helpful to distinguish different types of pain. There is nociceptive pain, which is the nervous system appropriately sensing damage and generating protective painful sensations. There is also neuropathic pain, which is the nervous system malfunctioning and producing inappropriate pain that is not protective. We further divide pain into acute and chronic. Finally, we consider the context of the patient, such as whether or not they are terminal.

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Feb 20 2017

Human Gene Editing

CRISPR-human editingThe recent rapid development of CRISPR technology, which has made gene editing fast, affordable, and accurate, has rekindled the ethical debate about human gene editing. Last week a special panel put together by the National Academy of Sciences gave a “yellow light” to human germline gene editing – saying that such editing might be ethical once the risks were properly assessed.

Germline editing means that the changes would be part of the gametes, the sperm or egg, and would therefore be passed down to offspring. If gene editing were done to a fertilized then this would affect all cells, including the germ cells.

By contrast somatic cell editing would affect only adult cells and not be passed down to the next generation. Such editing would only affect the individual.

The ethical controversy over germline editing is that such changes essentially can become a permanent part of the human population.

What Changes are Acceptable?

The NAS report essentially lays out two criteria for human germline editing. The first is that research shows that such editing is safe in humans without any unintended consequences. They want to make sure that dangerous changes to the human genome will not enter the human population. This is, of course, a perfectly reasonable criterion.

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21 responses so far

Feb 17 2017

The Science of Smoking Bans

smoking-banIn a recent article for Slate, Jacob Grier argues that the science used to justify widespread bans on smoking in public places was flawed. Recent more robust research has show little to no health benefit from such laws, he argues. While he has a point regarding the arc of scientific evidence, I think he is going too far in the other direction in his conclusions about the science.

Second Hand Smoke

The current consensus of evidence is that there are health risks to second hand smoke, although they are statistically small. Debate centers around the magnitude of the effect, with few doubting that there is a negative health effect. Negative health effects include heart attacks, lung cancer, stroke, and exacerbation of asthma. On a population level, even small increased risks result in large numbers of excess deaths and negative health outcomes. The CDC estimates, for example, that second-hand smoke exposure results in 34,000 excess cardiac deaths each year.

Increased recognition of the health risks of passive smoke exposure lent significant political weight to anti-smoking efforts, resulting in a cultural shift over the last 30 years. As a result smoking has largely been banned in most indoor public places and many work places.

The empirical question on which Grier focuses is the impact of those smoking bans on health outcomes. He does a fairly thorough review of the literature, although I think his review is biased to make his point, that the health benefits of such bans have been overplayed and maybe don’t exist.

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97 responses so far

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