Archive for the 'Science and Medicine' Category

Jun 16 2016

NEJM Article On Randomized Clinical Trials

RCTHere is a curious article published recently in the New England Journal of Medicine (NEJM): Assessing the Gold Standard — Lessons from the History of RCTs. The article discusses the history and current role of randomized controlled trials (RCTs) in medical research and practice.

This is, of course, a very complex and important issue, worthy of serious discussion. The article, in my opinion, is a mixed bag. It correctly points out many of the issues with RCTs, but I feel draws the wrong conclusions from them.

Flawed or Broken

Flawed does not necessarily mean broken. I feel this concept applies frequently to such discussions, and if it is not explicitly explored then we end up just serving our own bias.

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7 responses so far

Jun 13 2016

Stem Cell Treatment for Multiple Sclerosis

ms cortex-above-ventriclesThere has been a lot of reporting about a new stem cell treatment for multiple sclerosis (MS). The results are genuinely interesting, even exciting, but preliminary and need to be put into perspective.

MS is an autoimmune disease of the central nervous system, affecting the brain and spinal cord. Actually, it is a category of several diseases that are largely defined clinically, such as relapsing remitting MS and chronic progressive MS. These distinctions are meaningful because they do predict response to certain existing treatments. Relapsing forms of MS tend to respond to chronic immune modulating drugs, while progressive forms tend not to respond.

The immune system in MS patients is faulty, targeting the myelin around axons in the brain and spinal cord. Myelin is the insulation that allows axons to conduct. When the myelin breaks down due to inflammation this slows conduction, and if severe enough can even stop it completely. Symptoms depend on where these inflammatory lesions occur in the nervous system. If a motor pathway is affected, then weakness will result.

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6 responses so far

Jun 07 2016

Integrating Magic and Religion into Health Care

CARE-spoon bendingThe University of Alberta has become the latest battleground between advocates of science-based medicine and proponents of integrating magic and religion into our health care systems. In 2014 the university founded an Integrative Health Institute (IHI), which is headed by Sunita Vorha, who also is the director of their CARE program for integrative health and healing.

The debate has not changed, and it gets to the core foundation of modern health care. The SBM position is quite straightforward – as a profession, health care providers owe it to the public to base their advice and interventions on the best available science and evidence. It is our duty to establish and enforce a standard of care that includes adequate due diligence in determining the safety and effectiveness of interventions. The standard of care also includes giving patients proper informed consent and ethical standards of professionalism. There is also a well-established standard for conducting research on humans.

Essentially, we need to be reasonably sure that our interventions have more benefit than harm, and we need to tell our patients what they need to know so they can make informed decisions about their own health care. Continue Reading »

8 responses so far

May 30 2016

Underwhelming Cell Phone Rat Study

cell-phone-rat-studyMother Jones headline declares: “Game-Changing” Study Links Cellphone Radiation to Cancer.” NBCNews was similar: A Possible Cellphone Link to Cancer? A Rat Study Launches New Debate.

Any evidence that might link cell phone use to cancer is of legitimate concern, but this is a classic situation in which such evidence needs to put into proper context. I will start with some reassuring clinical context – human epidemiology data has failed to show any consistent association between cell phones and cancer. Further, brain cancer rates have not been increasing overall in the last 20 years when cell phone use skyrocketed. Therefore, any real world effect of cell phones on humans must be tiny to nonexistent.

Toxicology science, however, looks at questions several ways. The most definitive evidence would be placebo-controlled trials, but we almost never have this because it is unethical to expose a subject to a possible toxin just to see if it has a negative effect. (You can do this as part of a therapeutic trial where there is a greater chance of benefit to the subject, but not just to test toxicity.)

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12 responses so far

May 24 2016

Naturopaths Are Not Doctors

Herbal Medicine

This is the title of a change.org petition started by former naturopath, Britt Hermes. Please take some time to read and hopefully sign it.

Hermes has a significant insight into the state of naturopathic practice and education, since she was trained as a naturopath. She came to the conclusion that she was duped into a scam of a profession and now she tries to raise awareness of naturopathy to protect others from this scam.

Pseudosciences often depend upon ignorance of what they actually are in order to promote themselves and gain public approval. In the case of naturopaths they also depend upon the ignorance of politicians as they seek licensure, and then to expand their practice privileges and to force insurance companies to pay for their services.

In short, naturopaths desire all the status and privileges of medical doctors, but without the training, experience, or science-based standard of care.

You may think I am being hard on naturopaths, but that is likely because they have been successful in selling their narrative and confusing the public about what they actually do.

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8 responses so far

May 23 2016

Who Owns Your Genetic information?

genetic codeA genetic testing company, Myriad, is embroiled in a controversy over who owns genetic information. The company performs genetic testing, such as for BRCA1 and BRCA2 genes with variants that are associated with higher risk of breast cancer.

It has been the company’s policy to release information to their clients on any pathological gene variants, those known or suspected of being associated with higher breast cancer risk. If, however, the client has what is currently believed to be a benign variant, that is all they are told. They aren’t given the specific information about the gene sequence, just a note that it is benign.

Further, the company has declined to share its vast database of information with open source databases being used for research. The company cited patient privacy as their reason for not sharing data.

Now, several clients have sued Myriad to have their full genetic information released to them. It turns out a new rule under HIPPA (the Health Insurance Portability and Accountability Act) requires that companies release full genetic information to patients. Faced with this the company has decided to release the information to those who request it, but insist that it is voluntary and will still not release such information routinely (only to individuals who request it).

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5 responses so far

May 16 2016

Review of Probiotics

probioticsThe idea behind probiotics superficially sounds reasonable – friendly bacteria are important to the functioning of our gastrointestinal (GI) system and immune system. Probiotic products are supposed to supplement those friendly bacteria with live bacteria from certain foods, such as yogurt, or even in capsules.

A recent paper, however, reviews studies looking at probiotics in healthy subjects, finding no evidence for benefit. Let’s take a close look at this study and the science of probiotics.

The systematic review focused on studies looking at the change in the composition of bacteria in feces in healthy adults taking probiotics compared to placebo. They found:

Seven RCTs investigating the effect of probiotic supplementation on fecal microbiota in healthy adults were identified and included in the present systematic review. The quality of the studies was assessed as medium to high. Still, no effects were observed on the fecal microbiota composition in terms of α-diversity, richness, or evenness in any of the included studies when compared to placebo. Only one study found that probiotic supplementation significantly modified the overall structure of the fecal bacterial community in terms of β-diversity when compared to placebo.

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240 responses so far

May 09 2016

Still No Association of Cell Phones and Brain Cancer

cell.phone.giI have been following the scientific research looking into any possible association between cell phones and brain cancer. A new study coming out of Australia adds to this literature and argues against any association.

The question is obviously an important one, and has drawn some public attention. However, scientists argue about whether or not a causal relationship between cell phones and cancer is impossible or just really low. I fall into the really low camp, but the distinction is minor.

Plausibility

The key fact to understand about cell phones is that they produce non-ionizing radiation. By definition, ionizing radiation is powerful enough to break chemical bonds. This is a health concern because breaking such bonds could cause mutations in DNA, and some of those mutations may turn a healthy cell into a cancerous cell. This is the primary reason that radiation causes cancer.

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7 responses so far

May 06 2016

Acupuncture for Tension-Type Headache

acupuncture2A newly updated Cochrane systematic review of 12 studies looking at acupuncture for the treatment of tension-type headaches (TTH) concluded:

The available evidence suggests that a course of acupuncture consisting of at least six treatment sessions can be a valuable option for people with frequent tension-type headache.

This has led to another round of headlines that, “Acupuncture works but no one knows how.”

A closer look at the data, however, does not back up that conclusion, in my opinion. Cochrane is generally considered to be the gold standard for evidence-based systematic reviews, but their history is dodgy when it comes to unconventional treatments. For example, they famously had to withdraw their review of homeopathic occillococcinum for the flu because they concluded, although the evidence was insufficient to recommend, it was “promising” and deserved further research.

Their updated review is not much better, however:

There is insufficient good evidence to enable robust conclusions to be made about Oscillococcinum® in the prevention or treatment of influenza and influenza-like illness. Our findings do not rule out the possibility that Oscillococcinum® could have a clinically useful treatment effect but, given the low quality of the eligible studies, the evidence is not compelling.

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26 responses so far

Apr 28 2016

What Is Biohacking?

bulletproof-butter-coffeeAfter reading up on biohacking and listening to its proponents, I have come to the conclusion that biohacking is not a real thing. It doesn’t really exist.

Here is how one biohacking site describes what they think it is:

Biohacking is a crazy-sounding name for something not crazy at all—the desire to be the absolute best version of ourselves.

The main thing that separates a biohacker from the rest of the self-improvement world is a systems-thinking approach to our own biology.

You know how coffee feels like a shot of energy to your brain?

Pre-coffee you is sleepy….zzzzzz…

Post-coffee you is WIDE AWAKE!!

The only difference is the coffee in your stomach.

The lesson is this: What you put into your body has an ENORMOUS impact on how you feel.

See what I mean? So, drinking coffee is “biohacking?” If you look at what is considered biohacking it essentially amounts to living a healthy lifestyle through diet and exercise, with the addition of the usual assortment of pseudoscientific nonsense. This is nothing but a rebranding of standard self-help quackery.

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22 responses so far

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