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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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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Feb 06 2015

Did Williams Lie?

Memory is a slippery thing. We know from countless psychological studies that memories can easily be fabricated, they will alter over time, and details will shift to enhance the emotional theme of the story. Further, we tend to personalize stories – over time we remember events that happened to our friends as happening to us.

Recently NBC host Brian Williams was caught telling a version of an event that happened 12 years ago that differs from the version others recall, and the version that he himself told at the time. He and his cameraman were in a helicopter group during the Iraqi war in 2003. The leading three helicopters, which were 30-60 minutes ahead, were forced to land upon taking small arms fire, with one copter being hit by an RPG. Williams’ copter also landed when they arrived at the lead group in order to avoid being fired on. The group had to be rescued by ground troops and tanks.

The problem is that Williams’ retelling of this story has shifted a bit over the years, until in the last couple of years he puts himself in the helicopter that was hit by fire. Stars and Stripes gives the timeline of this shifting story. So what’s going on here.

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Feb 05 2015

A Better Steel

Material science seems to me to be an underappreciated discipline. Perhaps because its benefits are not seen directly by the consumer, but only indirectly. Material scientists don’t make a better gadget, but they make a better gadget possible. Sometimes a breakthrough can even be a complete game-changer for certain technologies.

Humans have been using an alloy of carbon and iron for over three thousand years. Iron is a very common element, making up about 5% of the Earth’s crust. Steel is iron with 0.2-1.5% carbon alloy. Carbon makes steel hard but brittle, and so carefully controlling the amount of carbon to optimize hardness but keep it malleable enough not to be brittle is what makes steel.

Steel is still on the cutting edge (pun intended) of material science. Researchers are still discovering ways to make steel lighter, stronger, and better suited to specific purposes. A recent paper, for example, presented a new technique for making blended steel that results in light, strong, and ductile steel – perfect for making more fuel efficient cars, for example.

A brief sidenote on terminology: “hardness” is the resistance to deformation by a force. There are different kinds of hardness, such as scratch hardness and compression hardness. “Strength” is the measure of a substances elastic range. “Toughness” is a measure of how much total energy a material can absorb before it breaks.

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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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Feb 02 2015

Gravity Waves and Science Self-Correction

In 2011 scientists tentatively reported that they may have detected neutrinos traveling faster than the speed of light in apparent contradiction to the theory of relativity. By early 2012 the technical error that led to the apparent discovery was revealed.

Also in 2012 scientists reported that, using the Large Hadron Collider, they probably found the Higgs boson, the particle responsible for mass. However they were still not completely sure so they kept testing, and then last year they announced that indeed they did identify the Higgs as predicted by the standard model of particle physics.

In March of 2014, in what was definitely the biggest science news story of the year scientists reported detected gravity waves from the Big Bang, confirming the theory called the “inflationary universe.” The discovery was hailed as a “smoking gun.” Space.com at the time wrote:

If it holds up, the landmark discovery — which also confirms the existence of hypothesized ripples in space-time known as gravitational waves — would give researchers a much better understanding of the Big Bang and its immediate aftermath.

In those four little words, “if it holds up,” lies the essence of science. This is just a sample of recent big science news stories that reveal the process of science – skeptical questioning of all claims and testing those claims against objective evidence.

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Jan 30 2015

The Gap Between Public and Scientific Opinion

A recently published poll from the Pew Research center finds that there is a huge gap between public opinion and the opinion of scientists on many important scientific issues of the day. This is disappointing, but not surprising, for a variety of reasons.

Generally speaking, if the majority of scientists have the same opinion about a scientific question (especially relevant experts), then it is a good idea to take that majority opinion seriously. It does not have to be correct, but if you were playing the odds I would go with the experts. If public opinion differs from the opinion of scientists on a scientific question, it is a safe bet that the public is wrong, probably because of interfering cultural, social, political, ideological, psychological, or religious beliefs. (Scientists have those too, which may explain the minority opinion in some cases.)

This attitude is often portrayed as elitism – usually by those who disagree with the scientific majority. Those relatively new to concepts of critical thinking, or trying to sound as if they are critical thinkers, might also dismiss such sentiments as an “argument from authority,” and then declare themselves the victor because they were able to point to a logical fallacy.  They miss the fact that informal logical fallacies are context dependent, and it is not a fallacy to respect (within reasonable limits) the consensus of expert opinion.

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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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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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Jan 26 2015

The Brains of Lucid Dreamers

Lucid dreaming is a very interesting phenomenon that perhaps gives us a peek into the inner workings of the human brain. I have had about a dozen lucid dreams in my life that I can remember. Normally while dreaming we are not aware of the fact that we are dreaming. Our dreaming selves accept the reality of the dream. During a lucid dream we become aware that we are dreaming, but we do not wake up. This state is inherently unstable and often results in actually waking up or dreaming that we wake up, which ends the lucidity.

The phenomenon of lucid dreaming was originally known from self report, but was first verified in a 1981 study in which subjects consciously gave a signal while lucid dreaming – they carried out predetermined actions in their dreams that resulted in “observable concomitants.”

One of the goals of lucid dreaming research is to determine what exactly is happening in the brains of those who are lucid while dreaming. One hypothesis is that part of the frontal lobes may be more active, allowing for greater self-reflection and reality-testing while dreaming. Preliminary studies, for example using EEG to look at brain activity during wakefullness, normal REM sleep, and lucid dreaming, suggested that lucid dreaming is a hybrid state between fully awake and REM sleep.  The frontal lobes are more active in lucid states than normal REM, but not as active as fully awake.

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