Only two patients have ever been demonstrably cured of HIV, the virus that causes AIDS. Timothy Brown has not had any detectable virus in his blood since receiving a bone-marrow transplant for leukemia. More recently a child infected with HIV at birth was apparently cured after receiving an early high-dose regimen of anti-retrovirals. These cases are considered “functional cures” – they have no detectable virus even off anti-retroviral medication.

The press has a habit of throwing around the word “cure” prematurely or inappropriately. We hear all the time about a potential “cure” for cancer, for example. Invariably the new treatment in question, if it pans out at all, becomes a useful treatment for cancer – one more tool in our toolbox – but not an outright cure.

I was therefore skeptical of the following headline, “HIV cure months away, Danish scientists say, citing novel new DNA treatment.” Perhaps there are Danish scientists claiming this, but that is a bold claim. I also worry about any clinical claim that a treatment is close. What does that mean, exactly? Either there is compelling clinical evidence of efficacy or there isn’t. You can’t predict the results of future research, so if the evidence isn’t here yet then we simply don’t know. At best such statements are expressing an optimistic hope.

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What was actually in Thompson’s Cattle Powder, Hostetter’s Stomach Bitters, or Hamlin’s Wizard Oil?

Prior to regulation by the FDA, over-the-counter medicine in this country was largely a creation of small businesses. There was a large variety of so-called “patent medicine,” each a proprietary blend of – what?

The term “patent medicine” has nothing to do with being issued a patent. The term refers to a letters patent, which is  essentially permission to use a royal endorsement. Most patent medicines were not actually patented mainly because the promoters did not want to disclose their ingredients.

Instead, such products were branded and their brand heavily marketed.

As a result the ingredients of these patent medicine products were largely unknown. Compounding pharmacists were familiar with the ingredients, however, and often sold cheap knockoffs, making it all the more important for promoters to protect and promote their brand.

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It’s always amusing to see two pseudosciences combined into one greater pseudoscience – it’s like chocolate and peanut butter. It’s not uncommon because those who would embrace one pseudoscience are likely to follow the same flawed logic and process to accept others. My colleague David Gorski has termed this effect “crank magnetism.”

Take, for example, Gian Paolo Vanoli. He has been making international headlines recently because of his claim that vaccines cause homosexuality, which he insists is a disease. The story appears to have been first picked up in English by the Huffington Post – all other reports of this story I have found cite this article as their source.

Because of the date of this article (4/1) I wanted to make sure I had another source, but the only other sources are in Italian. The story does seem to check out – here is one article: Gian Paolo Vanoli: Cricket on the urine that has been around the world. 

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A recently published survey at PLOS One of UK primary care doctors reports that 97% have prescribed an “impure placebo” at least once in their career. Most news reporting of this survey leave off the “impure” bit.

Let’s take a closer look at what this means.

The survey asked about “pure” placebos, which are inactive sugar pills or a similar inactive treatment, and “impure” placebos, which are effective medicines given in a way that might not have a clinical effect. The survey found that only 12% have ever prescribed a pure placebo, and only 1% do it on a regular basis. However, 97% have prescribed impure placebo ever, and 77% on a regular basis.

The survey had a 48% response rate, which is not bad for a survey, but this is why surveys are not considered strictly scientific. The low response rate introduces the potential for systematic bias – perhaps people who choose to respond do so because of a  certain attitude or belief that biases their responses.

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Yesterday I discussed a recent debate in which I participated at UCONN, focusing on the plausibility of homeopathy. Today I will discuss the clinical evidence, and address some of the strategies employed by my opponent in the debate, Andre Saine.

Does Homeopathy Work?

Yesterday I made the case that homeopathy is highly implausible in many ways, and after two hundred years of scientific advance this extreme implausibility has only become greater. Two centuries has apparently not been enough time for homeopaths to make their case and convince the mainstream scientific community. The only reasonable explanation for this is that homeopathy is simply not valid.

I also took the position that overall scientific plausibility must be considered when looking at any new claim – how well does it comport with existing scientific evidence? In medicine this means, when considering clinical evidence for a treatment, that evidence needs to be put into the context of the scientific plausibility of the treatment.

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Six years ago I was asked to participate in a group debate over the legitimacy of homeopathy at the University of CT (there were six speakers, three on each side). This year I was asked to participate in another homeopathy debate at UCONN, but this time one-on-one with Andre Saine ND from the Canadian Academy of Homeopathy taking the pro-homeopathy side. (I will provide a link when the video is posted online.)

While the basic facts of homeopathy have not changed in the past six years, the details and some of the specific arguments of the homeopaths have evolved, so it was good to get updated on what they are saying today. In this post I will discuss some overall patterns in the logic used to defend homeopathy and then discuss the debate over plausibility. In tomorrow’s post I will then discuss the clinical evidence, with some final overall analysis.

Believers and Skeptics

As with the last debate, the audience this time was packed with homeopaths and homeopathy proponents. When I was introduced as the president of the New England Skeptical Society, in fact, laughter erupted from the audience. But that’s alright – I like a challenge. It did not surprise me that the audience, and my opponent, were unfamiliar with basic skeptical principles. Andre, in fact, used the word “skeptic” as a pejorative throughout his presentation.

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I have had to take a two day break from blogging to prepare for a number of presentations I have scheduled. Today I will be engaging in a debate about homeopathy at the University of Connecticut. I did this once before, in 2007. I will give you a full report after the event.

Seating is limited and requires preregistration. But if you are in the area and want to see if there are any spaces left you can e-mail peter_gold (at) goldorluk.com.

March 22, 2013, 1:00 – 3:30 pm
Lowe Learning Center – University of Connecticut Health Center, Farmington, Connecticut

As Carl Sagan observed, “randomness is clumpy,” which means that sometimes, for no specific reason, I write two or more blog posts in a row about the same topic. Perhaps it’s not entirely random, meaning that when a topic is being discussed related news items are more likely to come to my attention.

In any case, there was recently published yet another meta-analysis of acupuncture, this time specifically for low back pain. The findings and interpretation add to the pile of evidence for two important conclusions:

1 – Acupuncture does not work.

2- Acupuncturists refuse to admit that acupuncture does not work.

I would further infer from these two unavoidable conclusions the dire need for a greater understanding of the core principles of science-based medicine.

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Sometimes the targets of our skeptical analysis notice, and they usually are not pleased with the attention.

Last year the Acupuncture Trialists Collaboration published a meta-analysis of acupuncture trials in which they claim, “The results favoured acupuncture.” The report was widely criticized among those of use who pay attention to such things. In my analysis I focused on the conclusions that the authors drew, rather than their methods, while others also had concerns about the methods used.

The authors did not appreciate the criticism and went as far as to publish a response, in which they grossly mischaracterize their critics and manage to completely avoid the substance of our criticism.

To review, the original meta-analysis concluded:

Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.

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The story of a young patient apparently cured of HIV infection, making them only the second case of an HIV cure ever, is buzzing around the internet. It is an interesting and important story, but as is often the case the details are complicated and need to be put into context.

The case was recently presented at a conference, on Retrovirus and Opportunistic Infections. The child was born of an HIV infected mother who did not receive pre-natal care. The mother had high viral loads when she presented for delivery. Not surprisingly, the child was found to be infected shortly after birth, indicating that they were likely infected in utero.

Hannah Gay, a pediatric infectious disease specialist, consulted on the case and decided to treat the infant with higher doses of anti-retroviral therapy (ART) than are typically given. She gave therapeutic doses of ART rather than prophylactic (preventive) doses. She also started the ART drugs earlier than they are typically given, at 31 hours of life.

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