Archive for the 'Science and Medicine' Category

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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69 responses so far

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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14 responses so far

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 – this 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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193 responses so far

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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13 responses so far

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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11 responses so far

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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10 responses so far

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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29 responses so far

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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16 responses so far

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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31 responses so far

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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19 responses so far

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