Archive for the 'Science and Medicine' Category

Apr 20 2015

Naturopathy Leaks

In a recent editorial David Brooks makes the point that privacy is important and we should not relinquish it lightly. Among other benefits of privacy, he states:

There has to be a zone where half-formed thoughts and delicate emotions can grow and evolve, without being exposed to the harsh glare of public judgment. There has to be a place where you can be free to develop ideas and convictions away from the pressure to conform.

I agree with this. The law also recognizes this, which is why there is automatic privilege between married individuals. This also came up in discussions of whether or not conversations between the president and his advisers should be private or public, with many making the point that the public’s interests are probably best served if their advice were candid and uncensored. We also recognize the need for attorney-client privilege and the confidentiality of the physician-patient relationship.

At the same time there are benefits to transparency and there are situations in which the public interest is best served by open discussion, even leaking information that some would want to keep private. For example, government communications at some level should be transparent, hence the mini-scandal surrounding Clinton’s e-mails. Courtroom testimony is public, but the deliberations of the jury are private.

Science is one of those things that should be, in my opinion, completely transparent and public. An individual scientist is free to keep their private thoughts private, but scientific deliberations, publications, research, and policy should be not only public but easily accessible.

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Apr 14 2015

FDA and Homeopathy

The skeptical community is abuzz with the announcement by the FDA’s announcement that they are reviewing the “regulatory framework” of homeopathic products and are open to public input. We have written about this at Science-Based Medicine, and as you can imagine, this is a serious topic of discussion among the editors.

Background

The FDA regulates food, drugs, medical devices, supplements, and cosmetics for the purpose of protecting the public health and safety. Congress created the FDA and determines its powers. In the 1938 FDA act, one Senator, Royal Copeland, who was a physician and homeopath, included in the bill that the provision that the Homeopathic Pharmacopeia of the United States (HPUS) would be included in the list of official drugs.

What this means exactly is that homeopathic products are automatically considered drugs by the FDA. Further, any new homeopathic product added to the HPUS in a supplement also counts. All homeopaths have to do, therefore, to get a homeopathic product listed as a drug by the FDA is write it down in one of their supplements to the HPUS. That’s it. No research is necessary, no assurance of safety or efficacy.

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Apr 13 2015

No Jab, No Pay

Australia¬†Prime Minister Tony Abbott has just announced a new policy that will go into effect January 2016 – the “no jab, no pay” policy. Under this policy parents who refuse to vaccinate their children will lose tax exemptions for children. This could cost them up to $11,000 per year (I have also seen estimates of up to $15,000) per child.

This new policy is reported to have bipartisan support and is supported by the Australian Medical Association.

The new policy would not apply to medical exemptions or religious exemptions, but the latter is enforced as a very narrow exemption.

Antivax parents are, of course, protesting, arguing that the new policy infringes on their rights as parents. But does it? The antvax community often makes the argument that they have the right as parents to make medical decisions for their children and the government cannot force them to vaccinate.

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Mar 23 2015

Sting Shows Supplement Regulation Worthless

It seems that the regulation of supplements, homeopathy, and “natural” products in Canada is as bad as the US. The Canadian Broadcasting Corporation (CBC, the equivalent of NPR and PBS in the US) recently conducted a demonstration of just how worthless and deceptive the regulations are.

They created a fake treatment called “Nighton” which they claimed treated fever, pain, and inflammation in children and infants. They then applied to the government for a Natural Product License. On the application they checked all the appropriate boxes amd submitted as evidence copied pages from a 1902 homeopathic reference book. That was it. Five months later their fictitious product was approved as “safe and effective.”

What this means is that when the Canadian government approves a natural product as safe and effective, it is completely meaningless. It is essentially a license to lie to the public about a health product.

It is reasonable to assume that many if not most of the public, if they see a product on the pharmacy shelf with the label, “licensed as safe and effective for fever, pain, and inflammation,” with an official government issued product number, that some sort of testing and quality assurance was involved.

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Mar 19 2015

Science Journalism and Homeopathy for Depression

I was recently pointed to an excellent article by an Irish journalist, Jonathan McCrea, about homeopathy. He discussed the topic on his radio show, and was highly critical of the practice. In response a homeopath wrote in a letter complaining that the shows was too negative, and McCrea wrote a nice reply pointing out the scientific evidence. He quoted science-based medicine extensively, as well as systematic reviews.

It’s wonderful to see a science journalist who is not a scientist themselves do such a great job. As he explained himself in the reply, a good journalist will reflect the consensus of expert opinion. He also pointed out the dangers in medical nonsense and clearly understands his duty as a journalist when reporting on such issues – so good for him.

Here is the money quote from the homeopath:

What I would like to point out to your presenters is that never, in all their dismissal of homeopathy, do they seem to take into consideration the homeopaths who practice this particular brand of ‘heresy’ (heresy according to their own particular view of the world that is). If it is nonsense as they claim, then we are all either stupid, deluded or charlatans who take people’s money for something which we know does nothing. I may be many things but I am neither stupid, deluded nor a charlatan as anyone who knows me will verify. Neither are those thousands of doctors and vets who have changed from using conventional medicine to homeopathy. No homeopath or user of homeopathy comes to it from ‘belief’. We come to it from trying it, sometimes from curiosity, but often in desperation when other things haven’t worked. Then when we see it works we try it again. Then it works again and we try it more often, and it keeps working. Not every time, any more than antibiotics, or any other medicine works every time. But enough, more than enough to make us trust it.

This is a typical response – the appeal to anecdotal evidence. Clearly this homeopath does not understand the scientific position. She sets up an interesting forced choice straw man, that critics think homeopaths are either stupid, deluded, or charlatans. First, these are not mutually exclusive states. But then she equates these possibilities to using treatments which “we know does nothing.” That is a non-sequitur, however. If a homeopath is stupid or deluded then they don’t know that what they are using does nothing.

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Mar 10 2015

Naturopathic Delusions

I want the public to fully understand what naturopaths are, because I don’t think that they do. This is a situation common to many cults and pseudosciences – there is a superficial layer of reality that represents the public face of the group, largely crafted for marketing purposes, and then there is the deeper layer of utter nonsense that most people don’t see. Homeopathy is a great example. Unless you are a skeptic or true believer, chances are you think homeopathy is some form of herbalism, rather than the magic potions that it is.

Naturopathy is similar. The superficial marketing level presentation of naturopathy is that its practitioners are medically trained and emphasize nutrition, lifestyle, and natural remedies. I attended a lecture at Yale by a naturopath who summarized their training as, “Everything you get in medical school, plus nutrition.” (The first claim is patently wrong, and the second falsely assumes that medical training does not include nutrition.)

The marketing, however, is working. After a recent article about naturopathy we posted on our Facebook page we had this comment:

How can you stop believing whole food, herbs, sunshine, fresh air, good water, exercise and human touch (which are the foundation of naturopathic medicine) are worse for you than allopathic poisons?

Marketing propaganda successfully internalized.

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Mar 09 2015

Basic Science Should Inform Clinical Science

Last year David Gorski and I published an article in which we argue that it is a waste of resources and ultimately counterproductive to conduct clinical trials of a treatment that is so scientifically implausible it might as well be “magic.” Homeopathy, for example, fits squarely into this category. The alternative medicine (CAM) community did not respond favorably to our arguments.

A recent article by Sunita Vohra and Heather Boon directly critiques our article. Vohra and Boon are both involved in homeopathy research, so this is no surprise. In their brief article they essentially repeat the standard CAM talking points about scientific research, without really countering the position that David and I have described. In their article, in my opinion, they demonstrate the utter intellectual bankruptcy of the CAM position. They repeat points that have been deconstructed years ago, without ever addressing the counterpoints.

The core of the disagreement is about the relative role of various kinds of scientific research in evaluating medical therapies. The position of science-based medicine (SBM) is that rigorous efficacy trials are required to truly know if a treatment is safe and effective (that aspect of our position we share with standard evidence-based medicine or EBM). Further, this clinical evidence must be put into the context of all the rest of science, right down to basic laws of physics, summarized as an overall scientific judgement about the plausibility of the treatment. This basic science plausibility should also be used to guide the expenditure of our limited resources in conducting expensive and resource-draining clinical trials. At the same time, solid evidence from clinical trials can inform basic science by suggesting possible biological mechanisms.

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Feb 19 2015

Phantom Acupuncture

There are two basic schools of thought when it comes to acupuncture, which is the practice of placing thin needles into alleged acupuncture points in order to have a therapeutic or symptomatic effect. The “traditional” interpretation is that the needles are stimulating a physiological response of some kind at the acupuncture points. Within this school there is a range of opinions as to whether this response is due to a biochemical, neurological, or another known biological response or whether it is due to the still more traditional (but actually less than a century old) belief that the needles are manipulating the life force or Qi.

The other school holds that acupuncture is essentially an elaborate placebo. (Note Рthis article contains all the references necessary to support my statements below, so I will not repeat them.) Any apparent response is a non-specific response to the attention of the practitioner, expectation, distraction from pain, simple regression to the mean, and other illusory effects.

Each school makes different predictions about the various lines of evidence that can be brought to bear to resolve this question. There have been in total several thousand clinical studies looking at the apparent effects of acupuncture. These have failed to convincingly reject the null hypothesis, meaning that they have not demonstrated a clear biological response to acupuncture for any indication. The better controlled studies consistently show that needle location does not matter (sham acupuncture), and that needle insertion does not matter (placebo acupuncture). You can literally have a non-acupuncturist randomly poke someone with toothpicks and get the same response as the full acupuncture treatment.

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Feb 16 2015

New Caveatus Emptora Superfood Medicinal Supplement

About once a week I get a question about a specific supplement, often new but sometimes a supplement that has been around for a while. The questioner wants to know if there is any value to the product. I suspect they often already know the answer, but it’s hard to resist the promises being made. I can give a generic answer, an emphatic, “No,” because the marketing of such products is just as generic. You literally can substitute the name of any new supplement you wish to market into the copy.

Snake oil purveyors are looking for the next exotic plant from a tropical location that they can sell as a supplement. It doesn’t matter what it is. Science and evidence do not even enter the equation. They want to know – can they get a supply of it, or even corner the market. If they cannot get enough of the plant it doesn’t matter. They will fill their bottles with wheat, alfalfa, or other fillers. Then they put it in a bottle, plug in the standard claims, do a little marketing, and rake in the millions. That’s it. Sometimes they deliberately adulterate their supplement with actual drugs, especially if they are for weight loss or erectile dysfunction.

Does the new exotic supplement from Gondwanaland, Caveatus Emptora, really work? No! It’s a scam. Save your money.

There are a few standard types of these scams. Here is the most recent miracle supplement about which I was asked, but I will swap out the name so as not to give it the slightest additional exposure.

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Feb 10 2015

Regulating Supplements

While I try to stick in these articles to science and critical thinking, and try to minimize any expression of my personal ideology or political opinion, I make no secret of the fact that I support fair and effective government regulation of all aspects of healthcare. This is partly because I feel the evidence strongly supports this position, but also I am a physician so it is my additional duty to advocate for the health of my patients and society.

The inadequate regulation of the supplement industry has recently been in the news and possibly (hopefully) this issue is coming to a head, perhaps sufficiently to garner the political will to revise current regulations.

First let me point out that I consider the pharmaceutical industry and the supplement industry to be essentially the same thing, the only real difference being the different rules for their regulation. They are different regulatory categories, but the companies making drugs and supplements have significant overlap. Further, the market forces are largely the same, the major difference being that for non-over-the-counter drugs a doctor’s prescription is needed.

I am often accused by defenders of supplements, homeopathy, and “natural” medicine of favoring the pharmaceutical industry, or at least giving them a pass. This is simply not true. I favor strong regulation of the pharmaceutical industry. I have specifically advocated reforms, such as registering clinical trials so drug companies cannot hide data. I favor recent reforms limiting conflicts of interest between physicians and pharmaceutical companies, and the full disclosure of any potential conflicts when they occur. I am against pharmaceutical industry practices, such as ghost authoring white papers to promote their products. There have been numerous multi-billion dollar settlements for pharmaceutical companies breaking the rules that govern the marketing of their products.

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