Jun 17 2009
Comment Roundup
My primary blog entry for today can be found at Science-Based Medicine – it covers the recent FDA warnings regarding Zicam and anosmia.
A couple of recent comments are worth a direct response. In response to my Heuristics entry from yesterday Zelocka wrote:
“You may be able to conclude, therefore, that people who walk more tend to have lower BMI”
But this would be an incorrect assessment based on perception of BMI. BMI is nothing more than weight / height. It would be perfectly reasonable for someone that walks to have more muscle mass then someone that does not. Since muscle weighs more, someone that walks could have a higher BMI then someone that does not for at least a certain period of time and maybe longer depending on the calories the muscle / exercise uses compared to the conversion of the excess on the person that does not walk. If you would have used body fat rather than then you would have removed this loophole.
Zelocka is technically correct – BMI is just height to weight, and a very muscular person can have a high BMI without being fat. This is a widely recognized limitation of BMI. Fat measurements are therefore better. However, BMI is still used in many epidemiological studies because the information is readily available.
Also, BMI is still very useful becuase with large numbers of people, body types and muscle mass will tend to average out, and therefore BMI gives a pretty good estimate of excess fat.
While I agree that walking will increase muscle mass, this effect is likely to be much less of a factor on weight than the loss of excess fat is. And, in fact, studies do show a correlation between higher BMI and less walking.
Plus – I would point out, this was just a hypothetical example to illustrate my point.
Dana Ullman has made a splash defending homeopathy. He is incoherent as usual. I will pick on a couple of points here.
He wrote:
His assertion that “Hahnemann based this rule on a single observation” is either based on extremely limited knowledge of Hahnemann and homeopathy, or you are purposefully providing mis-information. You’re seeming a smart guy. I assume that you’re doing the latter.
Nice ad hominem – I don’t think anyone would miss the fact that you accuse me of deliberately lying. Ullman does not actually follow with any evidence to contradict my statement, just some anecdotes about how people thought Hahnemann was a nice guy – a point not in dispute.
But primarily I think Ullman misunderstood my point. I did not say that Hahnman made only a single observation, but he came up with the idea of like cures like based upon a single observation. He then followed with a very large series of observations – so-called “provings” to see what substances has what symptomatic effects. But these “provings” were not designed to test the premise of like cures like – they were based upon the assumption of like cures like.
There is no research in basic or clinical science that established the notion of like cures like – it remains nothing but a principle of sympathetic magic.
Ullman follows with this:
“Why is it, as homeopaths claim, that and extract of onion should treat colds, which are caused by a viral infection, simply because onions irritate mucous membranes and cause tearing and secretions similar to the common cold.”
The answer: A homeopath may use Allium cepa (onion) for those symptoms that it is known to cause in overdose. By using a drug that mimics the symptoms of the body’s efforts to fight infection, Allium cepa helps resolve the viral infection faster. Homeopathy gained its greatest popularity in the 19th century in the US and Europe due to its impressive success in treating infectious disease epidemics of that era, including cholera, scarlet fever, typhoid, pneumonia, and influenza.
Did everyone notice that Ullman simply restated his premise, and then followed with a separate assertion. He did not answer the question at all. What physiological or biological principle would lead us to conclude that like should cure like – what is the mechanism? Is Ullman going to take the vaccine gambit? I don’t recommend it.
Other commenters have address Ullman’s other points, soI will let that conversation continue.
Commenter killbill then comes in with some solid anti-medicine propaganda.
While I am not personally an advocate of any particular form of medicine, it should be noted that the number one cause of death in the United States today is medical malpractice.
Modern western medicine kills people.
This has already been dealt with numerous times – such statistics only consider risk, not risk vs benefit, and is therefore useless. Also, the sicker people are the more invasive and risky the treatments to help them, and therefore the higher the risk of unintended consequences. Harriet Hall deals nicely with this “medicine kills” fallacy.
Killbill then takes up the propaganda a notch.
Another thing to consider is this… when was the last time modern western medicine cured any sort of disease. Pretty much never.
Why?
Modern western medicine is driven by two things. Dollars and greed. There just is no money in a cure, but there sure is a lot of money in providing some drug that you need to take indefinitely.
Unless, of course, you count small pox, or any of the acute problems that can be corrected with surgery, or any potentially fatal infection that can be cured by antibiotics. Modern medicine cures diseases when we can. For many diseases the underlying cause is not yet curable, but the effects can be manage. Sure, we cannot turn a Type I diabetic into a non-diabetic(yet), but with medication they can lead a normal life. That’s pretty close to a cure.
There is a bias, however, in public perception that only “cures” are valuable. But this is simply not true. If the consequences of a disease can be significantly mitigated – life span increased, quality of life improved, functionality improved – that is highly valuable also. If you don’t think so – talk to any diabetic and see if they are grateful for their insulin, or any patient with severe seizures for their anti-seizure medication, or any patient with severe migraines for their migraine treatment.
Killbill plays the conspiracy card without any evidence – just naked propaganda. There is no big dark conspiracy (based on dollars and greed) to keep people sick. That is simply absurd – on many levels. First of all, doctors are actual real people, not comic-book villains. Second – there is a high degree of transparency in medical research and practice. No dark cabal can control medical information across multiple nations around the world. Further, the academics who conduct most of the research and set the standard of care are generally salaried, and make their money and reputation by improving the effectiveness of medicine – not treating patients.
Further – as a profession, doctors gain respect and patients by being successful. The more effective we are in treating illness the more money and respect we get – not less. Keep in mind overall there tends to be a shortage of doctors and an excess of demand. We are not hurting for business. Until we find the cure for everything, people will always get sick.
It would be hugely to our advantage to reduce the burden and cost of health care by curing chronic illness. That would free up resources for others who need it, and the demand would easily fill the vacancy. It would also take the stress off the health care system – and everybody would be better off, especially health care professionals – who are the worse hit financially from the rising cost of health care.
So, basically, every way you look at it, killbill’s assertion is absurd and at odds with the facts. It really is just made-up propaganda – but it is very common.
14 Responses to “Comment Roundup”
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Did you ever notice how when someone prefaces a comment by stating what they are not, or what they don’t believe, or what they’re not sure of, it tends (more often than not) to be followed by a statement that shows they have an underlying true belief and their preface was dishonest BS?
BMI is better than nothing but it still has large limitations even outside body composition. It’s very inaccurate for the short or the tall for example and doesn’t take into account body frame differences. I agree it is easy and that’s why it has been latched onto so much and I will also agree that on average is can be reasonably accurate as long as you’re dealing with a group of people that fit in the norm of each other. For scientific studies, I would like to see the method of measurement that has the least margin for error. That said, the article itself wasn’t using BMI it was just a example given but I still felt it needed addressing.
“health care professionals – who are the worse hit financially from the rising cost of health care.”
On face value this seems like a ridiculous statement. Could you expand on it?
I don’t claim to know everything about human psychology, but I tend to agree with Karl, above.
Mark – the rising cost of healthcare resulted in managed care, which kept costs down primarily by reducing payments to hospitals and physicians. Physicians lost income big time – directly as a result of rising healthcare costs. I suspect we are in for another round of this from the Obama plan.
On the other hands – doctors who are padding their profit by overperforming procedures will lose if their abuse is stopped, which of course I favor, but that is a separate issue.
Another separate issue I’d love to see Dr. Novella address is whether there are any indications as to how much (if any) ‘complementary’ or ‘alternative’ medicine will be involved in any governmental health care reform plans.
Can’t speak for others, but if you want me to climb a water tower with a rifle (j/k Homeland internet monitors), tell me no, I can’t get that life saving liver transplant, but we’ve got a lovely array of herbal supplements we’d like you to consider…..
Also, would a single-payer (read “government controlled”) medical system pretty much end the concept of obtaining a second opinion? My father nearly lost a leg to diabetes, but a second opinion saved it. I have this cynical vision of government doctors covering each others’ butts on this issue.
From what I have seen, specialists are doing well, but primary care (pediatricians, general practice, esc) are doing very poorly. They are the ones getting hit with all the problems and none of the benefits. They are the ones that the country is most in need of (volume wise) to drop prices.
As for pseudo care in any healthcare reform, people that make the money selling the crap are more than smart enough to lobby (bribe) officials to make sure they get covered with more cash. Obama may be pushing for results for money, but congress could care less.
” … would a single-payer (read “government controlled”) medical system pretty much end the concept of obtaining a second opinion?’
I favor not only ‘second opinions’, but doing your own research on-line, something only possible in the last decade. But to get a second opinion by recruiting another physician is not easy. First, they’ll want your history. Unless you have a complete record, asking your primary or referral doc for those records won’t go over well, and for obvious reasons. Add to this the possibility of no reimbursement, considerable delay, and the reluctance of doc ‘B’ to contradict his buddy, doc ‘A’, well you get the point.
I favor single payer, but with crucial details worked out. Alternative medicine, (or a combination of alternative and alopathic) should be the patients choice, and if one chooses to self-diagnose, lab tests and other procedures should be available, but perhaps as self-pay.
Finally, outcomes need to be gleaned from databases, and with NO pharmaceuticals involved! Outcomes based not only on various treatments for properly diagnosed ailments, but tallied by providers (care centers at least) as well. These databases would be also available to self-providers, or to aid in making treatment decisions based on an a priori diagnosis. Medical databases of various ilks are sorely needed. Are you listening Google?
I also feel that the primary grades should focus more on human physiology courses, at least at the level of pre-med college courses. Or is cooking and car repair more important?
“My father nearly lost a leg to diabetes, but a second opinion saved it.” Or more self education, perhaps.
“I have this cynical vision of government doctors covering each others’ butts on this issue.”
Exactly.
“Obama may be pushing for results for money, but congress could care less.”
He can hardly say otherwise, and he’s a very recent congressman, so……
Indeed, Let me revise that
“Obama may be (publicly) pushing for results for money”
President Obama was Illinois’ U.S. Senator from 2004 – 2008. Prior to that time, he was a senator in the Illinois Legislature from 1996-2004. During those years, he was also a constitutional law professor at the University of Chicago. He taught constitutional law from 1992- 2004.
Steve wrote: “Further – as a profession, doctors gain respect and patients by being successful.
The first statement seems true as a matter of fact, but not a priori, *necessarily* true, so I don’t think you can draw logical conclusions about motivation from it. For instance, guys like Andrew Weil and even Kevin Trudeau gain respect by smearing their opponents, making grand claims, pretending to be defenders of their audience, and pretending to be selfless whistle-blowing heroes. Obviously, one does not need to be successful to get respect.
“The more effective we are in treating illness the more money and respect we get – not less.”
Again, CAM practitioners, and particularly chiropractors, string you along for many useless sessions, counting on the fact that you still feel bad to bring you back for another “treatment”. It is also a charge that they regularly level at symptom-masking, “allopathic” western medicine.
Devil’s advocate wrote: “…any indications as to how much (if any) ‘complementary’ or ‘alternative’ medicine will be involved in any governmental health care reform plans.”
Although Obama said “we need to … encourage broader use of evidence-based guidelines” in a speech to the AMA on June 15, 2009, he doesn’t have any scientific background, so he might not mean the same thing that we do by “evidence-based medicine”. A better way to gauge this might be to look at what happens in other countries: Mostly what we see is the state paying for real medicine, and alternative medicine being optionally covered by private supplemental insurance. For instance, the Canada Health Act says that “medically necessary” hospital and physician services must be provided to all eligible residents, but “additional benefits” could also be provided by regional or private insurance plans. An additional benefit could be something like a private hospital room, cosmetic surgery, or CAM.
There is also a logical reason for public health care to support science-based medicine. Private insurers are profit-driven, so they may support CAM as a cheaper alternative that keeps plan members away from effective medicine. Public systems are non-profit, with the goal of maximizing patient outcomes and minimizing cost. So, they should support only effective medicine. The flip side of public systems is that they are democratic, so the citizens get what they want even if it doesn’t make sense. Only last month in Alberta (Canada) was chiropractic coverage delisted. The conservative government also delisted sex-change operations, even though it only cost the province about $500K dollars a year, as a way of grandstanding to its right-wing base. So, the optional benefits that aren’t medically necessary tend to be used as a political football.
Well, yes, of course, but that’s the core of my concerns. Of all places, it is here in America that gov’t provided healthcare would be the most politicized. It won’t matter who’s in office. We simply don’t have a political party that is identified by its adherence to moral and ethical values, and how one builds a medical care delivery system without morals and ethics is beyond me.