Mar 09 2015

Basic Science Should Inform Clinical Science

Last year David Gorski and I published an article in which we argue that it is a waste of resources and ultimately counterproductive to conduct clinical trials of a treatment that is so scientifically implausible it might as well be “magic.” Homeopathy, for example, fits squarely into this category. The alternative medicine (CAM) community did not respond favorably to our arguments.

A recent article by Sunita Vohra and Heather Boon directly critiques our article. Vohra and Boon are both involved in homeopathy research, so this is no surprise. In their brief article they essentially repeat the standard CAM talking points about scientific research, without really countering the position that David and I have described. In their article, in my opinion, they demonstrate the utter intellectual bankruptcy of the CAM position. They repeat points that have been deconstructed years ago, without ever addressing the counterpoints.

The core of the disagreement is about the relative role of various kinds of scientific research in evaluating medical therapies. The position of science-based medicine (SBM) is that rigorous efficacy trials are required to truly know if a treatment is safe and effective (that aspect of our position we share with standard evidence-based medicine or EBM). Further, this clinical evidence must be put into the context of all the rest of science, right down to basic laws of physics, summarized as an overall scientific judgement about the plausibility of the treatment. This basic science plausibility should also be used to guide the expenditure of our limited resources in conducting expensive and resource-draining clinical trials. At the same time, solid evidence from clinical trials can inform basic science by suggesting possible biological mechanisms.

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Mar 03 2015

The Problem with Astroturfing

In a recent TEDx talk, Sharyl Attkisson nicely demonstrates the deep problem with astroturfing, although part of her demonstration was inadvertent. The problem is actually deeper than she stated, because she herself has fallen victim to part of the deception.

Astroturfing is essentially fake grassroots activism. Companies and special interests create non-profits, Facebook pages, social media persona, write letters to the editor, and essentially exploit social and traditional media to create the false impression that there is a grassroots movement supporting some issue. The key to astroturfing is that they conceal who is truly behind these fronts.

Attkisson, a journalist for CBS news, points to several examples in which pharmaceutical companies, for example, secretly promote their drug and marginalize criticism. She correctly points out how campaigns of doubt and confusion can work, by generating so much controversy that the public loses confidence in the science (and in fact science itself) and throws the baby out with the bath water.

This is all part of the same phenomenon I discussed in yesterday’s post about Google ranking websites by their factual accuracy. There is power in information, and there is essentially a war going on over control of information, which increasingly is fought on the battleground of the internet and social media.

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Mar 02 2015

Google Wants to Rank Websites for Trustworthiness

I like this idea, but it is certainly bold and needs some careful thought. Google wants to rank websites according to how trustworthy their factual statements are.

Google undoubtedly is a cornerstone of the internet, which itself is now a cornerstone of our civilization. We are rapidly evolving to having a worldwide network of shared human knowledge and communication. The internet is now the dominant medium of human ideas.

Google is not just a search engine – it is the dominant portal to this information. This makes Google rank a vital statistic for any website. In fact, there is an entire industry, search engine optimization (SEO), dedicated to improving one’s Google ranking.

Google’s big innovation, and the one that launched them to the top of the heap, was to rank websites according to the number and quality of incoming links. This turned out to be a useful proxy, and serves to reward users with a helpful ranking of the websites they are searching for. Specifically, it is not easy to game the system. You can’t boost your Google rank simply by repeating search terms in the coding. In fact, I have a couple friends at Google and they tell me that Google is constantly tweaking their algorithm specifically to make SEO ineffective. SEO is an attempt to game Google’s ranking algorithm, and Google doesn’t want that. They want the truly most valuable and appropriate sites to float to the top.

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Feb 27 2015

What Color Is This Dress? It’s An Optical Illusion

This is pretty amazing – almost as much for how quickly this has gone viral as for the effect itself. There is now an intense debate going on in the intertubes over whether this dress is black and blue or white and gold. Take a look and decide for yourself. Buzzfeed has a poll which currently puts it at 72% white and gold, and 28% black and blue. Right now there are about 2 million votes, so that is probably statistically significant.

I see black and blue, no matter what screen or version of that picture I look at. It does not seem to be an issue with the monitor or viewing conditions.

The reason, in my opinion, this has gone so viral so quickly is that people are legitimately freaked out by the realization that how they see the world is ultimately a subjective construction of our brains. Taylor Swift tweeted about the debate:

“I don’t understand this odd dress debate and feel like it’s a trick somehow. I’m confused and scared. PS It’s OBVIOUSLY BLUE AND BLACK.”

That about sums it up. She thinks it must be a trick (it is – a trick of the brain), and is scared and confused. At the same time she is caps-lock-certain that her perception of the dress’s color is the objective truth.

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Feb 26 2015

Liberals and Conservatives Both Resist Science, But Differently

There have been a number of studies looking at how ideological belief influence attitudes toward science. It is no surprise that in general people, of whatever ideological bent, engage in motivated reasoning to deny science that appears to contradict their religious or political beliefs. There are different views, however, regarding whether or not the two main political ideologies in the US, liberal and conservative, are equal or substantially different in their resistance to science.

A series of articles in a special section of The Annals of the American Academy of Political and Social Science explore this question.  In a commentary summarizing the findings, Kraft et al write:

The studies presented in the preceding section of the volume consistently find evidence for hyperskepticism toward scientific evidence among ideologues, no matter the domain or context—and this skepticism seems to be stronger among conservatives than liberals. Here, we show that these patterns can be understood as part of a general tendency among individuals to defend their prior attitudes and actively challenge attitudinally incongruent arguments, a tendency that appears to be evident among liberals and conservatives alike.

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Feb 24 2015

Anti-GMO Propaganda

There is so much anti-science propaganda out there I often feel like I am emptying the ocean with a spoon. Just today I was faced with an array of choices for my post – should I take on anti-vaccine, anti-GMO, or anti-AGW propaganda? For today, anyway, anti-GMO won. I’ll get to the others eventually.

This was sent to me by a reader – 5 reasons to avoid GMOs.  The content is mostly tired anti-GMO tropes (lies, really) that have been thoroughly debunked, but it is good to address such propaganda in a concise way. Also, it is a useful demonstration of the intellectual dishonesty of the anti-GMO movement. I may not get through all of them today – each one is so densely packed with wrong, and it takes longer to correct a misconception than to create one. Here is point #1 – GMOs are not healthy:

GMOs are unhealthy: Since the introduction of GMOs in the mid-1990s, the number of food allergies has sky-rocketed, and health issues such as autism, digestive problems and reproductive disorders are on the rise. Animal testing with GMOs has resulted in cases of organ failure, digestive disorders, infertility and accelerated aging. Despite an announcement in 2012 by the American Medical Association stating they saw no reason for labeling genetically modified foods, the American Academy of Environmental Medicine has urged doctors to prescribe non-GMO diets for their patients.

The author begins with an assumption of causation from correlation. The increase in food allergies actually does not correlate well with the introduction of GMOs. The correlation between organic food and autism is much more impressive. In fact, the organic food industry has been rising steadily over this same time period, and so one could make the even stronger point that organic food causes all the listed ills.

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Feb 23 2015

ADHD Is Real

Attention Deficit Hyperactivity Disorder (ADHD) has long been a target of those who dislike the very concept of mental disorders. This is partly because the emotional stakes are high – the diagnosis often results in children being treated with stimulants. Opposition to the concept of ADHD also reflects fundamental misunderstandings about medicine.

A recent opinion piece in The Blaze by Matt Walsh reflects this deep misunderstanding and unease with the concept of mental illness.

Throughout the piece he uses the terms “disease” and “disorder” interchangeably, without defining either. The distinction is important, because it relates to how medicine defines diagnostic entities. Not all diagnoses are created equal. I spend a great deal of time teaching medical students to have a sophisticated and nuanced understanding of the labels they will be attaching to their patients.

As with every branch of science, labels are used as placeholders of our understanding of phenomena, and also as a necessary contrivance to allow technical communication among experts, in the scientific literature, and also to the public. In medicine we need labels for certain practical applications, such as documentation, epidemiology, drug indications, reimbursement, and research. Labels are a scientific tool, and they need to be understood to be used properly.

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Feb 19 2015

Phantom Acupuncture

There are two basic schools of thought when it comes to acupuncture, which is the practice of placing thin needles into alleged acupuncture points in order to have a therapeutic or symptomatic effect. The “traditional” interpretation is that the needles are stimulating a physiological response of some kind at the acupuncture points. Within this school there is a range of opinions as to whether this response is due to a biochemical, neurological, or another known biological response or whether it is due to the still more traditional (but actually less than a century old) belief that the needles are manipulating the life force or Qi.

The other school holds that acupuncture is essentially an elaborate placebo. (Note – this article contains all the references necessary to support my statements below, so I will not repeat them.) Any apparent response is a non-specific response to the attention of the practitioner, expectation, distraction from pain, simple regression to the mean, and other illusory effects.

Each school makes different predictions about the various lines of evidence that can be brought to bear to resolve this question. There have been in total several thousand clinical studies looking at the apparent effects of acupuncture. These have failed to convincingly reject the null hypothesis, meaning that they have not demonstrated a clear biological response to acupuncture for any indication. The better controlled studies consistently show that needle location does not matter (sham acupuncture), and that needle insertion does not matter (placebo acupuncture). You can literally have a non-acupuncturist randomly poke someone with toothpicks and get the same response as the full acupuncture treatment.

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Feb 17 2015

Anderson Cooper Takes Down Dan Burton

I criticize bad, biased, and or just lazy science journalism frequently, and so it’s a pleasure to occasionally have the opportunity to praise good journalism. This recent interview of Dan Burton by Anderson Cooper could be a template for how to conduct an interview over a scientific issue.

Dan Burton is a former Republican Congressman who has a long history of being anti-vaccine. He likes to repeat anti-vaccine tropes, and does so with the clueless persistence of a seasoned politician with an agenda.

Anderson Cooper is one of the few American journalists who has demonstrated his ability to do a tough and probing interview – you know, actual journalism. He demonstrated his chops again here. Specifically:

He was clearly prepped for the interview. He did his research, understood the issues, and was able to challenge Burton on specific points. You can’t go into an interview like this cold, or with only a superficial understanding of the issue. You have to know what the other person is going to say and how to respond.

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Feb 16 2015

New Caveatus Emptora Superfood Medicinal Supplement

About once a week I get a question about a specific supplement, often new but sometimes a supplement that has been around for a while. The questioner wants to know if there is any value to the product. I suspect they often already know the answer, but it’s hard to resist the promises being made. I can give a generic answer, an emphatic, “No,” because the marketing of such products is just as generic. You literally can substitute the name of any new supplement you wish to market into the copy.

Snake oil purveyors are looking for the next exotic plant from a tropical location that they can sell as a supplement. It doesn’t matter what it is. Science and evidence do not even enter the equation. They want to know – can they get a supply of it, or even corner the market. If they cannot get enough of the plant it doesn’t matter. They will fill their bottles with wheat, alfalfa, or other fillers. Then they put it in a bottle, plug in the standard claims, do a little marketing, and rake in the millions. That’s it. Sometimes they deliberately adulterate their supplement with actual drugs, especially if they are for weight loss or erectile dysfunction.

Does the new exotic supplement from Gondwanaland, Caveatus Emptora, really work? No! It’s a scam. Save your money.

There are a few standard types of these scams. Here is the most recent miracle supplement about which I was asked, but I will swap out the name so as not to give it the slightest additional exposure.

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