Archive for the 'Science and Medicine' Category

Jul 01 2016

TIME Gets It Wrong on Acupuncture

AcupunctureA recent Time Magazine article tries to answer the question: Does Acupunture Work? Their answer:

For certain conditions—particularly pain—there’s evidence it works. Exactly how it works is an open question.

This answer is wrong. Granted, this is a deceptively complex question and there is a tremendous amount of authoritative misinformation out there, so it is hard to blame a journalist for getting this one wrong.

Perhaps the biggest pitfall in science journalism is the problem of outlier or non-representative experts. A journalist talks to someone who has appropriate credentials, but whose opinion on a topic is either a minority opinion, or just one side of a legitimate controversy. The journalist then mistakes this one person’s opinion for the consensus scientific opinion.

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19 responses so far

Jun 30 2016

Mummies and Cancer

egyptian-mummy-3Often there are several layers to my skeptical articles – there is the science story itself, and then there is the reporting of the science and the underlying neuropsychological factors that led to the disconnect between the two.

Here we have another classic example, surrounding the claim that cancer (and sometimes extended to other “modern” diseases) were rare in pre-industrial societies based on evidence from mummies.

The Narrative

The psychological and media story here is that people tend to organize their knowledge around thematic narratives (which I am doing right here – so meta). We like stories, especially stories that have meaning, and especially when that meaning is emotionally satisfying or surprising in some way.

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5 responses so far

Jun 28 2016

Caffeine and Sleep

caffeine-chemical-structureCaffeine is a drug. I think most people know that, but perhaps they don’t really think about it. Caffeine is essentially a legal unregulated drug (much like alcohol and nicotine, but with no age restriction).

Coffee, tea, cola, and chocolate are all common sources of caffeine. Many people use this drug on a regular basis, often daily. They become addicted to this drug, and suffer withdrawal symptoms when they don’t take their regular dose. If caffeine were not readily available in commonly consumed food and drink, and say it were being introduced as a new drug, I wonder how it would be viewed and regulated.

A new study looks at the effects of caffeine on mental performance in those who are sleep deprived (a common application). Caffeine is a stimulant, it therefore does increase alertness and mental function. However, like all stimulants, its effects are a double-edged sword.

The study looked involved only 48 subjects, and had them restricted to 5 hours of sleep per night. Half were then given caffeine at 8 am and 12 noon while the other half were given placebos. For the first three days those taking caffeine performed better on mental tasks than those getting placebo. On days four and five, however, there was no difference.

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19 responses so far

Jun 23 2016

Update on Use of Alternative Medicine

cam-pageThe CDC conducts an ongoing National Health Interview Survey (NHIS) to track various aspects of American’s use of health care. Since 2002 they have been tracking use of so-called alternative medicine services as part of the survey. The most recent results of this survey are available, including data through 2012.

The headline is that Americans spent $30.2 billion (out of pocket) on “alternative medicine” in 2012. That figure is alarming to anyone who cares about having a science-based standard in health care, and about consumers being scammed, but it is also highly misleading.

The core problem is that the category “alternative” (whether you call in complementary, integrative, functional, or whatever) is vague, poorly defined, and nonsensical. It is nothing but a marketing term meant to give an impression of hip acceptability to what was previously known simply (and more accurately) as health fraud.

To increase the apparent popularity of the false category, proponents have always inflated the numbers by including things that are not, by any reasonable definition, alternative. This survey is not exception.

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7 responses so far

Jun 20 2016

Massachusetts Senate Passes Naturopathic Practice Act

quackOne of the biggest challenges with trying to hold the line against pseudoscience in medicine is that the proponents of pseudoscience are relentless. Since they have a large financial stake in the outcome, they dedicate the time and resources to lobbying state legislatures to get the laws they want.

They lobby for health care freedom laws to weaken the standard of care, to carve out exemptions for particular kinds of quackery (like chronic Lyme quackery), to mandate coverage of worthless treatments through insurance, they fight for licensure of dubious professions, and then to expand their scope of practice. If they fail, they are back the following year, and they have the money to support their efforts.

Often such laws are passed before we even know they exist. There are just too many legislatures to watch, and often the efforts are deliberately under the radar. Every time the side of science wins, the victory is temporary. Every time the side of pseudoscience wins, their victory is permanent, and they slowly ratchet up the laws favorable to quacks and erode the standard of care.

The organizations that should be dedicating time and resources to fighting the advance of pseudoscience in medicine (like the AMA and state professional organizations) usually don’t. They are either gun shy or ideologically soft on pseudoscience. They are being placated with propaganda about how such treatments are harmless, just the soft and fuzzy part of medicine. Nothing to worry about.  Continue Reading »

78 responses so far

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

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