Archive for the 'Science and Medicine' Category

Jul 14 2017

Goop Strikes Back

goop-kimmelGwyneth Paltrow has been using her celebrity to promote a “lifestyle brand” she calls “Goop.” The site recommends all sorts of medical nonsense, like detox, earthing, putting stuff up your vagina, and the usual scaremongering about “toxins” or whatever. Recently I wrote about Goop’s promotion of magical stickers that are alleged to align and balance your vibrations.

Deservedly she has received push back from science communicators who are trying to raise the level of scientific literacy and critical thinking in the world. The concern is that she is spreading misinformation and pseudoscience, which is increasingly harmful in our modern technological world.

One highly vocal critic has been Dr. Jen Gunter, an OB who is particularly offended by the fact that Paltrow wraps her pseudoscientific misinformation in “female empowerment.” I’m sorry, but taking advantage of women by scaring them and selling them nonsense is not empowering – it’s exploitation. Apparently Goop has been stung by this criticism, and decided to hit back. The results are predictably awful, but do provide an opportunity to deconstruct some popular anti-intellectual nonsense.

“Team goop” begins:

As goop has grown, so has the attention we receive. We consistently find ourselves to be of interest to many—and for that, we are grateful—but we also find that there are third parties who critique goop to leverage that interest and bring attention to themselves.

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13 responses so far

Jul 13 2017

The Fragility of Truth

homeopathy5There is a lot to be horrified about regarding the alternative medicine (CAM) industry. The industry largely trades in fraud and misinformation at the expense of the public’s health. But I often find myself most dismayed by what the industry says about the relationship between humans and reality.

I have discussed over the years the many ways, mostly revealed through psychological research, but also with many specific examples, in which people build their narratives about the world and how these narratives trump reality and often even basic logic. If you ever doubt the ability of people to erect a false narrative and worship it as truth, remember that there are people who believe, in the 21st century, that the Earth is flat.

Humans, however, also have science, philosophy, logic, and reason. We have managed, especially in the last few centuries, to collectively crawl out of a deep pit of self-deception and slowly accumulate real knowledge about the universe and how it works. As a species we have this weird dual nature, at times rigorously rational, and at others hopelessly gullible and ideological.

What is perhaps most concerning about the CAM phenomenon is what it tells us about the balance between reason and deception. Sitting on top of the last few centuries of scientific progress, it certainly seems like science and reason are winning. But perhaps this vantage point gives us a biased perspective. Over this period we have largely shifted from a pre-scientific view of the world to a scientific one. Science then showcased its power by picking a lot of the low-hanging fruit – answering the easiest questions to answer.

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214 responses so far

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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10 responses so far

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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8 responses so far

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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17 responses so far

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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3 responses so far

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