Archive for the 'Science and Medicine' Category

Oct 03 2014

Are Health Apps Helpful?

There seems to be an app for everything, although we are just at the beginning of this new technology. It is a very recent phenomenon that many people in industrialized nations are walking around with a hand-held networked computer. This creates a new opportunity – to have constant access to applications that can help us run our lives. Even though there are already millions of apps, we really are just beginning to explore this opportunity.

One category of apps that seem to have a great deal of potential are health-related apps. There are apps to help people count calories, track their migraines, track their exercise, or even look up medical information or take a crack at diagnosing their own symptoms. There are apps to help you quit smoking or using alcohol, manage your medications, track your diabetes, or to provide some automatic therapy for mental illness.

The UK’s NHS maintains a list of approved health apps with hundreds of vetted apps you can browse.

In there are some useful ideas, and not-so-useful ideas. Trial and error will sort that out over time, and there are probably some killer health apps waiting to be developed.

How evidence-based are typical health apps, however? How would we even study that question?

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Sep 26 2014

FDA Takes On Essential Snake Oils

The Food and Drug Administration (FDA) is tasked with ensuring quality and transparency in the foods and drugs that are sold to consumers. This is a daunting task, and by all accounts the FDA is commonly understaffed, without the resources to thoroughly do its job. Further, politics often hamstrings the agency, so they don’t have the actual authority to do their job.

The most egregious example is the Dietary Supplement Health and Education Act of 1994 (DSHEA). This law (courtesy of Hatch and Harkin) effectively removed “supplements” out of the control of the FDA, and broadly defined supplements to include herbal drugs and other products that are not actually dietary supplements.

Essentially DSHEA created two categories of consumable health products. Drugs, by definition, are any products for which specific disease claims are being made. If you say your pill or ointment treats diabetes, then it’s a drug, because diabetes is a disease. A supplement, by definition, makes no claims to cure or treat a disease, but is allowed to make “structure function” claims. This is a giant loop hole manufactured by DSHEA and wrapped as a present for the supplement industry, at the expense of consumers.

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Sep 18 2014

Artificial Sweeteners and Diabetes

A new study published in Nature is getting a lot of press, and it seems making a lot of people worried. The Nature News article discussing the study has the headline: Sugar substitutes linked to obesity. I think this headline is misleading. Here’s a breakdown of what the study does and does not tell us.

The study’s title is more descriptive, as one might expect: Artificial sweeteners induce glucose intolerance by altering the gut microbiota. The authors (A team led by Eran Elinav of the Weizmann Institute of Science in Rehovot, Israel) studied three noncaloric artificial sweeteners (NAS), saccharin, sucralose, and aspartame. They fed mice that either had a microbiota (bacteria colonizing their gastrointestinal system) or those that were germ free either NAS or control food without NAS. After 11 weeks the mice fed NAS showed signs of glucose intolerance – their blood sugar rose more when challenged with a dose of sugar.

They also found that mice treated with antibiotics did not have this response. Further, they performed fecal transplants from NAS treated mice to germ-free mice and found that the glucose intolerance transferred with the bacteria.  They also cultured bacteria with NAS and transplanted that into mice, who then became glucose intolerant.

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Sep 15 2014

Stem Cell Transplant First

NeurologicaBlog is very meta. I like to not only communicate science, but explore how best to communicate science, including thinking about how to communicate the need to think about thinking. (Cue the endless meta-regression.)

For example, there is often much to criticize about how science news is reported in the general media. Part of the problem is that science mostly advances by accumulating baby steps. ¬†Baby steps, however, don’t always make for compelling headlines, and so every advance becomes a “breakthrough,” every mystery has scientists “baffled,” and every study may some day lead to the cure for cancer, rid us of the common cold, or produce a piece of technology similar to that found in popular science fiction.

Part of the challenge of being a skeptical science communicator is to convey simultaneously the deserved awe of cool science, including the potential implications of genuine advances, while also discussing the need for caution in interpreting results, and essentially throwing a wet blanket on premature hype. It can be a delicate balancing act.

I had all this in mind when I approached the main topic of today’s post – a rather exciting and anticipated advance in stem-cell technology. Japanese researchers have created a sheet of retinal epithelial cells from a patient’s own skin cells. First they had to induce pulripotency on the skin cells, which essentially turns them into stem cells (iPS cells). Then they had to coax these created stem cells into becoming the desired cell type which in this case is retinal epithelial cells.

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Sep 05 2014

Ashya King and Proton Beam Therapy

These cases are always heart-breaking and difficult to write about, but many people have been asking me about the Ashya King case and there are are few points worth exploring.

For background, Ashya King is a 5-year old boy living with his parents in the UK. He has a type of primary brain tumor called a medulloblastoma. This is the most common type of malignant brain tumor in children, and typically is located in the back of the brain, in what is called the posterior fossa.

His parents, who are understandably concerned and want the best treatment for their son, would like him to receive a new type of therapy called proton beam therapy. His UK doctors do not feel this specific treatment is indicated. In desperation, Ashya’s parents removed him from his UK hospital and drove him to their vacation home in Spain. Their plan was to obtain proton beam therapy in Spain.

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Aug 22 2014

What’s The Harm – Ebola Edition

A common defense of implausible treatments is the question – “what’s the harm.” In other words, implausible therapies might help and can’t hurt, so there is no harm in trying. Is this a valid argument, however?

In trying to assess which side of a controversy has the better position I look toward logic and evidence. Evidence is critical, of course, but in fields outside my expertise I have to rely upon experts to interpret that evidence and put it into a broad and deep scientific context. In controversies, often the data itself is not the core issue, but which data to trust and how to interpret that data.

Therefore, when evaluating various controversial positions, it is very helpful to determine which side has the better arguments. If there is a dramatic asymmetry with one side relying heavily on logical fallacies, that is often very telling. Further, on any particular point you can follow the exchange through to completion and see which side ultimately has the better position.

For example, creationists argue that evolution violates the second law of thermodynamics which states that in any system entropy should increase. Scientists counter that the second law only applies to closed systems and the Earth is an open system, receiving energy from the sun. Creationists then counter that the universe is a closed system and so entropy should be increasing in the universe. Scientist counter further that entropy is increasing in the universe but this does not preclude local decreases in entropy where energy is available, such as the biosphere of the Earth. Creationists then respond by changing the subject. In other words – they have no response. They are wrong and have lost the argument.

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Aug 21 2014

Researching Magic

David Gorski and I have just published a paper in Trends in Molecular Medicine titled: Clinical trials of integrative medicine: testing whether magic works?

While we have published literally thousands of online articles discussing these issues here, at Science-Based Medicine, and other venues, it’s great to get an article in the peer-reviewed literature, which hopefully will spark more of a discussion in academic circles.

The full article is available online at the link above, but here’s a quick summary of the main points:

The question is – should we devote limited research resources to investigating CAM (complementary and alternative medicine) methods? Those resources include not only money, but researcher time, available patients, and space for reporting and discussion at conferences and in the published literature. CAM is actually a false category, in my opinion, used really as a marketing strategy and not a meaningful designation. It makes it difficult to answer this question, because we first have to operationally define CAM. (As an aside, “integrative” medicine is essentially the same as CAM, just a different marketing term.)

The real question is – how far down the scale of plausibility should we go in allocating research resources? Should it matter?

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Aug 14 2014

An App To Monitor Parkinson’s Disease

In 2000 Michael J. Fox began a non-profit organization to support research into Parkinson’s Disease (PD). This was shortly after he was diagnosed with the disease. Since then Fox has been the model celebrity spokesperson and advocate. (He doesn’t kibitz, he just raises awareness and supports the science.)

Now his foundation, together with Intel, have developed a wearable device and accompanying app that can monitor the symptoms of PD in real time 24 hours a day. This is an interesting application of technology, and something that we are beginning to see more, and will likely increase in future.

PD is a neurodegenerative disease affecting a part of the brain called the substantia nigra. Neurons in that structure produce and release dopamine. These neurons are part of a circuit (the extrapyramidal system) that essentially monitors and adjusts the sensitivity or gain of the motor system. It’s a sensitive feedback loop that keeps our movement smooth. If the gain is turned up too high then we would constantly be moving and writhing. If it’s turned down too low, then we start to freeze. People with PD have the gain turned down too low.

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Aug 12 2014

Tocco’s Anti-vaccine Narrative

Part of the scientific approach to knowledge is to integrate information at various levels. It’s important to get the tiny facts correct, but you also have to put those facts into progressively broader and deeper frameworks. Theories are informed by facts which in turn make sense only in the context of the theory.

I try to take this approach with topics on this blog, by not only spending time addressing specific facts but also trying to see the big picture. For example, Mary Tocco, who is an anti-vaccine activist, was recently given space for a guest column on Michigan Live. I will go through and deconstruct her specific claims, but it’s also helpful to view her article in the broader social context.

Tocco is part of Michigan Opposing Mandatory Vaccination, or MOM (how can you not love “mom”). In her article she writes:

“The authors labeled Michigan Opposing Mandatory Vaccines an anti-vaccine group. Our organization is about protecting parental right to choose whether or not to use vaccines as a method of health care for themselves and their children.”

From this one paragraph we can see many of the threads currently weaving through culture. The big picture is that there is an ideological struggle going on between those who take a science-based worldview and believe that rational regulations should be based on the best science available, and those who wish to promote some other agenda that is not science-based.

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Aug 04 2014

Ebola Pseudoscience

It is natural for there to be a certain amount of fear and uncertainty surrounding the reported outbreak of a deadly virus. The recent ebola outbreak is the worst in history, with over 800 deaths reported out of over 1,400 infections (case fatality rate so far of 57%).

Crises like these tend to bring out the best and the worst in people. Health care workers are literally risking their lives to contain this outbreak. Meanwhile, charlatans are coming out of the woodwork to exploit the crisis to spread their nonsense.

Ebola was first discovered in 1976. The virus exists in central and western Africa, and outbreaks are usually small, involving isolated villages. The virus can exist in fruit bats, which is the usual reservoir that spreads to humans. Other animals can be the vector, however, including chimpanzees, gorillas, monkeys, forest antelope and porcupines. Once a human infection occurs, however, the virus can spread from person to person.

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