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 »

Comments: 8

Jun 06 2016

The Lost City

ZakynthosWe often don’t give nature enough credit. In many contexts, scientists or explorers find an anomaly and immediately the interest and speculation turns to intelligent agents at work. The ultimate expression of this, of course, is intelligent design creationism, where nature is denied credit for biology itself.

For example, snorklers discovered some odd shaped stones off the coast of the Greek island Zakynthos. The stones were surprisingly round, and so the immediate speculation was that these were the bases of pillars and are therefore the remains of an ancient Greek port, since lost to the sea.

I am not saying that this hypothesis is unreasonable, just that it seems to be the preferred hypothesis. This preference is also not unreasonable, because the remains of an ancient city are a lot more interesting than some oddly shapes stones (unless you’re a geologist).

Of course, there is always going to be someone taking such speculation too far, and prematurely concluding they have evidence for an intelligent artifact, even when further scientific investigation finds otherwise. It’s important to remember that in order to conclude that an anomaly is the product of deliberate artifice, we need further evidence. Greek ruins, for example, are lousy with pot shards. They are just everywhere. None have been found in the vicinity of the alleged pillars, however. This should give any ancient Greek port proponents extreme pause.

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Comments: 7

Jun 03 2016

Human Genome Project Write

Human-genome-001In 1990 the Human Genome Project (HGP) was launched, with a goal of sequences all the euchromatic DNA in the human genome within 15 years. The project was completed in 2003, two years ahead of schedule, at a cost of $3 billion. This was one of the great scientific achievements of our species – we set out to complete a huge goal, and we did, similar to going to the moon.

Over the course of the HGP the technology to sequence genes improved by orders of magnitude, becoming faster and cheaper. Not only did we gain a fantastic resource of knowledge that would fuel further science for decades, but the technological advances allowed us to sequence the genomes of many other organisms with still more scientific benefits.

Yesterday scientists announced HGP-Write, a plan to synthesize from scratch an entire human genome. Clearly they hope to replicate the success of the HGP. The plan is to organize an international effort to synthesize a human genome, advancing the technology to do so along the way. The proposed budget is $3 billion, the same as for the HGP.

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Comments: 6

Jun 02 2016

Theranos Exposed

Holmes-Summit-e1460127673162-1200x945I love a good cautionary tale. Perhaps my medical background predisposes me to “post mortem” analysis – what exactly went wrong and why? There is a risk of the cautionary tale, however, in that it is easy to impose a preexisting narrative onto events. The tale can be easily coopted, and then you are not learning a lesson but just reinforcing an existing belief.

I will try to avoid that trap while discussing the story of Theranos, but I am picking this story because it does support a cautionary tale skeptics like to tell.

Theranos was a hot tech startup based on a “disruptive” technology developed by its young maverick founder, Elizabeth Holmes. The story was perfect for the tech industry, who ate it up. It seemed a little dodgy to the medical industry, however, who viewed it with skepticism.

Here is a good overview of the story, with a list of tech news articles fawning over the new startup. Even some news sites who should have known better, like Smithsonian Magazine, were taken in. Read this article – it reads like a marketing brochure for the company. It overstates the limitations and problems with current technology, and overhypes how revolutionary the new technology will be. It asks, but does not answer, the key question – how is this new alleged technology supposed to work.

The claimed breakthrough of Theranos was a streamlined process for laboratory blood analysis that promised to perform 30 tests on a single drop of blood with same-day results. This would eliminate the need for drawing vials of blood and replace that with a simple finger prick.

For any scientist there are immediate red flags. Each blood test, in a way, is its own technology. You don’t measure sodium in the blood the same way you measure glucose, or test for the presence of antibodies to a virus. Yet Theranos claimed to have revolutionized dozens of standard laboratory tests. This would require a massive amount of research and development, or the introduction of an entirely new technology.

Such technology does not come out of nowhere. Research builds upon other research and then is translated into practical applications. The myth of the lone researcher making breakthroughs in their garage is largely just that, a myth. But that image clings tightly to the public consciousness. This makes it easier to sell the narrative of the lone genius making breakthrough technology.

Perhaps the tech industry is especially susceptible to this narrative. A team of coders with a great idea can create a disruptive app that will change the game. Investors are looking for disruptive startups, nerds with a great idea and the next billion dollar company. Medical technology is different, however. There needs to be a paper trail, years of research leading up to the application.

Now that the true story of Theranos is coming out, it seems obvious in retrospect that the whole thing was a scam. First, their labs were conducting 70% of their blood tests on conventional machines using conventional blood draws. They claim this is just while they were waiting for FDA approval of individual tests, but still they were not delivering on their promise.

Second, Theranos just voided the last two years of study results that were being conducted with their technology, what they called the Edison machine. In essence they just admitted that their technology does not work, and the lab test results they provided were not accurate. The company, essentially, has completely evaporated. The company now faces a class action lawsuit.

Last year Forbes estimated Holmes net worth at $4.5 billion. Yesterday they revised their estimate down a bit – to zero.

Conclusion

If this is a cautionary tale, what are the lessons? The obvious one, of course, is to be skeptical. Treat every new exciting claim as if it is a scam until proven otherwise. Don’t buy corporate marketing propaganda. Ask the hard questions, like exactly how does this work?

There are genuine breakthroughs, but most claimed breakthroughs aren’t. The market is currently being flooded with snake oil and medical pseudoscience, so again, it is a good default position that any new claimed medical breakthrough is probably a scam, or at least overhyped.

Also, be skeptical of nice neat narratives. If a story sounds ready made for movie plot, it probably is just that – a fiction. We love stories of underdogs rising from obscurity by challenging the big boys. We love the lone maverick narrative, the young genius, the rugged individual not afraid to break with convention.

The truth is often much less glamorous and exciting. Progress in science is more often made by various teams each contributing their incremental advance. Ideas rarely come out of nowhere. The big advancements are ones that we saw coming 1-2 decades before they became a reality.

Be aware of common red flags: A company selling a new technology should be able to describe, at least in general terms, how the technology works. You can do this without giving away technical secrets. If they refuse to give a satisfying answer for whatever reason, be suspicious.

If the relevant scientific community is skeptical, you should be too.

If they are using science-sounding jargon but do not really make sense (such as talking about frequencies, or quantum mechanics) it is almost certainly a scam.

Theranos is certainly not a rare case. Companies selling pure snake oil are out there in the thousands. Theranos was perhaps just the biggest one. I also doubt that the tech industry has learned its lesson. The allure of billion dollar  disruptive technology is just too great.

 

Comments: 17

May 31 2016

Postdictive Illusion of Choice

fmri brainDo we truly have free will? This is a vexing question, and as with the question of consciousness, there are complementary philosophical and neuroscientific approaches. Philosophy gives thoughtful possible answers given what we know, but neuroscience advances what we know.

As I have discussed many times before, the totality of neuroscientific evidence strongly supports the conclusion that consciousness is a phenomenon of brain function. Dualist philosophies, those that posit that consciousness is anything other than or in addition to brain function, are simply trumped by the scientific evidence.

Free will, however, is a thornier question and more entangled with the philosophy. There are those who maintain that free will is entirely an illusion, because our brains are machines so they must follow physical laws which determine their behavior, hence our behavior, therefore no true free will. While I do not think this can reasonably be refuted, some think the real question is whether or not we make choices. If we do, whether or not those choices are free from physics, then perhaps that can be considered a form of free will.

Putting aside the philosophical question here, the neuroscientific question is this – to what extent do we make conscious choices vs subconscious choices?

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Comments: 160

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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Comments: 12

May 27 2016

A Tale of Two Science News Reports

parviceps

One of the recurring themes of this blog, and of the skeptical movement itself, is that science news reporting is generally poor. It is highly variable – there are some excellent science news reporters out there, but most are mediocre and some are terrible. The problem is that the average quality is simply too low.

The problem is compounded by the fact that scientists sometimes overhype or overinterpret their results, but even more common, the press office for the university at which the scientists work often sensationalize the science. At every step there is an opportunity to add hype, misinterpret the actual results, sensationalize, focus on the speculative aspect of the study rather than the actual data, or simply get the story wrong.

The race for clicks seems to be driving the quality of science reporting down, favoring clickbait headlines. Reporters don’t seem to mind getting the story wrong and then being corrected by science bloggers, for then they just get another round of clicks correcting their own bad reporting as if it were someone else’s fault.

Sclerocormus parviceps Continue Reading »

Comments: 16

May 26 2016

What’s Killing the Bees

honeybeesYesterday I saw a bumper sticker that stated, “Save the Bees, Buy Organic.” Of course, a bumper sticker is not the place for a nuanced or thorough treatment of a complex topic. It is a venue suitable for simplistic slogans.

People like simple narratives, but reality rarely conforms to our desires. This has led to a frequent reminder, popularized by Ben Goldacre, that you will often find the situation (pretty much whatever situation you consider) is more complex than it might at first seem. That is a good rule of thumb – it is fair to assume as a default that any topic is more complex than your current understanding, or how it is being presented in the media, or how it is understood in the public consciousness.

Complex and ambiguous situations, like the fate of our pollinators, become a convenient Rorschach test for ideology. People tend to impose on this complex and not fully understood situation whatever simplistic narrative suits their beliefs and values, like the notion that organic farming will somehow save the bees. Continue Reading »

Comments: 14

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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Comments: 8

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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Comments: 5

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