Archive for the 'Science and Medicine' Category

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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Feb 09 2015

Three Person IVF

The United Kingdom’s House of Commons has recently voted to allow so-called three person in vitro fertilization. This opens the door to the UK being the first country to provide such a procedure.

The purpose of three person IVF is to allow a woman who carries a genetic mutation for a mitochondrial disorder to have her own genetic children without passing on the disease.

Mitochondria are organelles in every cell that produce energy. They are essentially the power plants of the cell. Evolutionarily they are likely the result of a symbiotic relationship between a prokaryote and eukaryote, meaning that the mitochondria were once independent living cells. They carry their own genes, and in fact have their own slightly different genetic code (evidence of their ancient origin).

There are a number of genetic diseases known as mitochondrial disease because they represent mutations in the mitochondrial genes. Since mitochondria are almost completely passed down through the maternal line, so are such diseases. The female eggs contain all the cellular structures of the fertilized egg, while the sperm contributes only its packet of DNA (although a stray mitochondrion might sneak through).

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Feb 03 2015

Vaccine Debate Heats Up

We seem to be going through a spasm of debating vaccines (if social media is any guide), probably provoked by the Disneyland measles outbreak (102 cases in January, mostly stemming from the outbreak). This recent outbreak has finally garnered the attention of the public at large who are starting to realize that antivaxxers are a threat to public health. This resulted in a wave of criticism.

At first it seemed like the antivaxxers were just going to lay low and ride out this recent outbreak, but I guess the tide of anti-antivax was just too great. Now they are starting to push back with, of course, greater levels of crazy, driving even more criticism. The debate has percolated up to the political class, with the predictable embarrassing comments by clueless politicians. And around it goes.

Given that I have been covering this issue for over a decade, I guess I have to jump back into the fray.

A recent Pew Poll regarding whether or not vaccines should be required is very interesting. It shows no significant difference by sex, race, or income (Hispanics were slightly more pro-vaccine). However, there was a significant age effect: 18-29 year olds were 59% in favor of required vaccinations, with increasing numbers in each age category, and 65+ year olds being 79% in favor. The question is – is this an age effect or a generational effect? If the latter then we could see waning support for requiring vaccines in the future.

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Jan 29 2015

Anti-Vaccine Tropes Stirring

The Disneyland measles outbreak has the anti-vaccine movement on the ropes a bit. As I and pretty much all of my colleagues at Science-Based Medicine have predicted for years, once previously contained infectious illnesses start to seriously return, public opinion will shift against the anti-vaxxers.

We are seeing more mainstream stories like this one, Mom: Family that refused vaccination put my baby in quarantine, from CNN, and this one, Vaccine deniers stick together. And now they’re ruining things for everyone, from the Washington Post. As I mentioned in my earlier post, The Onion also nailed it with this satire, I Don’t Vaccinate My Child Because It’s My Right To Decide What Eliminated Diseases Come Roaring Back.

Of course, the cranks are unmoved. Their position is not based on a rational assessment of the evidence, and therefore evidence will not move them from their perch. What they have been doing is repeating tired anti-vaccine tropes. Unfortunately they are getting some exposure from residual false balance in the media.

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Jan 27 2015

Disneyland Measles Outbreak Hubbub

This is an ongoing story that isn’t over yet. As it has been raging for days now, most people have probably heard that there is a big measles outbreak starting in Disneyland in California. There are now 87 confirmed cases of measles, 50 of which can be directly linked to Disneyland. Of the 42 people so far whose vaccination status is known, 34 were unvaccinated, 3 were partially vaccinated, and 5 were fully vaccinated.

Yes, this is caused by those who are not vaccinated

One thing is absolutely certain from these numbers – this outbreak has largely been caused by those who are not vaccinated. As you can see, most of those affected are unvaccinated. The vaccination rate for MMR is about 90% in the US. This means those who are unvaccinated were about 67 times more likely to be infected with measles in this outbreak than those fully vaccinated.

If vaccination rates were higher, then herd immunity could have stopped or severely limited the spread of the disease. That is the point of herd immunity – if enough people are protected then the virus is less likely to find a vulnerable host and continue the spread. The vaccine is about 97% effective in those fully vaccinated, which is why there were a few vaccinated people who contracted the disease.

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Jan 09 2015

Antibiotic Resistance and New Antibiotics

Humans have a massive footprint on our ecosystem. Enough so that we have to think carefully about anything we do on a large scale, such as agriculture, industry, shipping (because of invasive species), and using drugs to fight bacterial infections.

The development of antibiotic resistance is a particular worry of mine, and one that I feel does not get proportional attention in the media. It is quite possible that in the future more people will die from antibiotic resistant bacteria than global warming, food shortages, or disrupted ecosystems (depending on how each of these things develop).

We are already seeing more deaths from drug-resistant bacteria, longer hospital stays, and greater costs. I have seen this change during my career. When I round in the hospital I now have to don protective garments before entering many patient rooms because they are infected or even just colonized with a resistant strain of bacteria.

There is no way around the fact that were are engaged in a war with the subset of bacterial species on this planet that are capable of infecting humans. We have been winning for a while, but the bacteria are now rallying.

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Jan 05 2015

Cancer Risk Largely Bad Luck

This is one of those glass-half-full / glass-half-empty news items. Different headlines reporting on the same study present the results in opposite ways. The BBC, for example, writes, “Life choices ‘behind more than four in 10 cancers.’” Meanwhile the press release from Johns Hopkins states, “Bad Luck of Random Mutations Plays Predominant Role in Cancer, Study Shows.”

The Hopkins headline is more accurate. The BBC headline is not just focusing on life choices vs bad luck, it actually gets the data wrong.

What the researchers did was look at the replication rate of stem cells in different tissue types (they did not include breast cancer and prostate cancer as they could not find published replication rates). They then compared differences in these rates to differences in adult cancer rates in the same tissues. For example, colon cancer is more common than cancer of the small intestine, and colon cells replicate more frequently than small intestine tissue. (In mice, this is reversed, but the correlation holds.)

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Jan 02 2015

How To Create a Fad Diet

Fad diets pop up on a regular basis. I believe that is because they are so easy to manufacture and there is a ready made market for them. Add to that the fact that it is difficult to lose weight. There is also a great deal of misinformation out there about diet and health, so the environment is very friendly to pop pseudoscience.

If you want to create your own fad diet, here is a handy formula. These things pretty much write themselves.

#1 – You need a catchy title, usually taking the form of “The blank Diet.” You can fill in the blank with almost anything. For example, a recent fad diet is called “the bulletproof diet.” This doesn’t say anything about the diet itself, it’s just a catchy phrase, a brand. You can fill in the blank with a title that does reflect the diet itself, but this is optional. Creating a catchy title is actually the most creative work you have to do in making a fad diet.

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Jan 01 2015

2014 Was a Bad Year for Homeopathy

I have been saying for several years that if there is a pseudoscientific medical treatment that is especially vulnerable to critical analysis it’s homeopathy. There’s a lot of nonsense in the world of medicine, but homeopathy takes the prize. First, it is complete and utter nonsense.

There is no need to equivocate. Homeopathy violates basic scientific knowledge in physics, chemistry and biology. It is transparent witchcraft that cannot possibly work by any known or even semi-plausible mechanism. Further, clinical studies unsurprisingly show that it does not work, for anything.

And yet the public does not generally understand what homeopathy actually is. The most common belief is that homeopathy is natural or herbal medicine. Rather, homeopathy is based upon several dubious notions. The first is that like cures like, and idea based on sympathetic magic and not science or any knowledge of the real world. Further, the actual starting ingredients are based upon a fanciful and often absurd interpretation of this dubious notion, leading to things like using duck liver to treat the flu.

None of this actually matters, however, because most homeopathic remedies are diluted beyond the point that there is any chance of a single molecule of starting ingredient remaining. All of this is supposed to work, however, because the potion is “activated” by shaking it.

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Dec 29 2014

Pertussis Evolving

New evidence suggests that strains of the bacterium, Bordetella pertussis, which is responsible for whooping cough, may be evolving to evade immune protection afforded by the pertussis vaccine.

The research, led by Dr Andrew Preston from the University of Bath, evaluated surface proteins from the 2012 whooping cough outbreak. They found that surface proteins that are included in the acellular pertussis vaccine were evolving faster than surface proteins not included in the vaccine. The authors point out that this was happening even prior to the introduction of the vaccine, but has accelerated since the vaccine.

It is not yet clear what, if anything, this means for the effectiveness of the acellular pertussis vaccine. However, the concern is that circulating strains of B. pertussis will continue to evolve, diminishing the protection provided by existing vaccines.

Whooping cough is a potentially serious illness, primarily affecting infants. There was an outbreak in the UK in 2012 with 10,000 confirmed cases and 14 infant deaths. In the US that same year there were over 48,000 cases reported (not necessarily confirmed) and 20 deaths.

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