The College of Physicians and Surgeons of Ontario (CPSO) has a proposed guideline for physicians that has caused some controversy. The proposed policy addresses the issue of so-called complementary and alternative medicine (CAM) and has drawn serious criticism from Canadian physicians (at least those who are paying attention and have the slightest clue about what is going on). The backlash is good to see, but it is not nearly vigorous enough.

The original proposed policy contained several recommendations that are right in line with CAM proponents – who keep trying to achieve through legislation and intimidation what they cannot achieve through science and evidence, namely acceptance and access. The proposed policy is a good example of this, as well as demonstrating how CAM proponents wish to carve out a double standard for themselves, so that they can be free to practice whatever nonsense they wish without being held to all that pesky science and evidence.

The first clue that CAM proponents had their hands all over this policy is the fact that it referred to science-based medicine as “allopathic” and CAM and “non-allopathic.” Modern scientific medicine is not “allopathic” – that is a derogatory term invented by Hahnemann to refer to the standard medicine of his time (which was both ineffective and toxic) and to distinguish it from homeopathy. CAM proponents are very adept at playing semantic games to frame CAM in as positive a light as possible. The truth is that there is science-based medicine and there is everything else. All therapies and modalities lie someone along the spectrum of safety and efficacy, and are backed by various amounts of evidence, and may even have evidence for lack of efficacy.

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Here we go again. Over the past few years there have been a number of cases in which a crank, quack, or charlatan has attempted to silence legitimate criticism of their claims and behavior by threatening legal action, either shutting down their site through the ISP or suing for libel. I guess they feel that a lone blogger would be easy to intimidate. They are not part of a large media outlet with lawyers on the payroll to defend them. Defending against even a frivolous suit can be ruinous to a lone blogger.

The goal, however, is not to really sue but to threaten the blogger into silence. It is intellectual thuggery, meant to defend a charlatan who cannot defend themselves with science and evidence.

However, it is not accurate to describe bloggers who expose charlatans as “lone” – they are part of an informal web of science and skeptical bloggers who are all trying to expose fraud and pseudoscience. When one of us is threatened we have banded together to create what is knows as the Streisand effect – try to silence one blogger and a hundred voices will rise up, having the exact opposite effect that you intend.

Recently a person calling himself Marc Stephens wrote a very threatening letter to Andy Lewis who wrote a critical post about the cancer clinic of Stanislaw Burzynski called The False Hope of the Burzynki Clinic. Stephens tried to make the letter sound legal and official, even though he does not appear to be a lawyer. The letter says, in part:

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From Emil Håkansson, a listener of my podcast, the SGU, comes this e-mail, with a translation of a story in Swedish:

“Electric allergy could render Mora without mobile- and tv-signal
Masts could be re-angled

A zone without mobile- and tv-coverage could become a reality in Mora.
The enviromental office want to force the mobile- and tv-operators to re-angle the masts, in consideration of Dan Bengtsson, 62 – who claims to be allergic to electricity.
– I get dizzy, nauseated and headaches, he says to Aftonbladet.

The joint enviromental office of Mora and Orsa counties want to take to drastic measures. Mobile operators and radio- and TV-distributor Teracom (owned by state, translators note) is according to the suggestion forced to re-angle the position of their masts to create a radiation free zone.

Protective suit in silver

According to Dan Bengtsson himself the headaches, back-problems and heart tinglings is due to his allergy against electricity and that the mobile net has been expanded. Against the radiation he wears a protective suit, in a special silver fabric, from time to time.
– It looks a bit like a space suit and is sown in protective fabric. It cushions somewhat, but not completely.
[…]”

It is a long part about his daily problems, same problems that you always hear about this kind of thing, amongst other things he states that he thinks he caught it from working as an electrical engineer at an electric company in 1992. But it continues with this:

”
In 2006 he sent in a citizen suggestion to the county, to achieve a radiation-free zone in Venjan (the village where he lives, translators comment).

“Red in the face”
The suggestion was well received. The county refers to the Enviromental Code.
– We work according to the precautionary principle and sees this as a good suggestion, says enviromental board director Hans Nalbom (S) (the (S) stands for his political party, social democrats, translators comment.)

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People notice patterns. Our brains evolved to be really good at pattern recognition. This strength can become a weakness, however, when we notice patterns that are not there, that are illusions or statistical flukes with no basis in reality. The answer, however, is not to ignore apparent patterns we think we see, but rather to treat them properly – as hypotheses rather than conclusions.

That simple rule can wipe away a lot of cognitive mischief. Anecdotes, testimonies, and our everyday experience can be valuable, as long as we treat that information as a way of generating hypothesis that may or may not be true. We then need to confirm the hypotheses with some sort of systematic and controlled way of looking at data (you might call that science).

For example, even as a medical student in my earliest days in a clinical setting, I noticed that many people who come into the ER or got admitted to the hospital with a heart attack were engaging is some strenuous activity at the time. Further, this activity was not something they do on a regular basis, but rather something they do only occasionally. In the summer this activity was often gardening or yard work. In the winter, this activity was often shoveling snow. I soon found out that this observation is common, in fact it is a pattern that is taken for granted  – yard work and snow shoveling provoke heart attacks.

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The news that Power Balance has filed for bankruptcy is both encouraging and disheartening at the same time. I’ll explain – but first for background: Power Balance is the company who made millions of dollars selling little plastic wrist bands embedded with a cheap hologram. It love it when people become millionaires selling pet rocks or hoola hoops. Come up with a unique idea that catches on and you deserve to rake it in. Power Balance, however, made their millions selling dubious claims.

They claimed that their little pieces of plastic could improve balance, energy, and athletic performance. Their marketing was very effective, with celebrity sports star endorsements and live demonstrations in malls. Their demonstrations were indistinguishable from old parlor tricks that have been recycled numerous times to sell many dubious products.  The SkepticBros even started selling (at their cost of about $1) Placebo Bands, which they believe are just as effective (i.e. nothing but the placebo effect) as Power Balance or any similar product.

The skeptical community has seen this all before. We targeted the claims of Power Balance, exposing the fact that they are highly implausible, the claims themselves are incomprehensible techno-babble, and there is no credible scientific to back them up. The Australian Skeptics lead the charge, resulting in the ACCC ruling against Power Balance, who then had to offer an apology, retraction of their claims, and refund to anyone who wanted it.

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Umm….Yes. Yes it does.

This is one of those stories that immediately makes me think that there must be a deeper issue that the press is missing. Recently the European Food Safety Authority was asked to evaluate and approve the following statement:

“Regular consumption of significant amounts of water can reduce the risk of development of dehydration and of concomitant decrease of performance.”

After three years of investigation the EFSA concluded:

The Panel considers that the proposed claim does not comply with the requirements for a disease risk reduction claim pursuant to Article 14 of Regulation (EC) No 1924/2006

This decision has been immediately and widely criticized as absurd – the EFSA is saying that water does not prevent dehydration. It’s surreal. It’s right out of Brazil (the movie), a dark comedic dystopian totalitarian nightmare. Or perhaps it’s just abject stupidity.

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There are a few items I have had in my list of interesting tidbits this week, but each one is too small a topic to make a full post – so I will throw them together for some Friday munchies.

Sundogs

The first is a YouTube video of the apparent sundog effect. This is a cool illusion, the technical name for which is parhelion. Bright spots occur near the sun due to atmospheric effects. The video shows this quite well – a bright splotch that jumps around. This is interesting to skeptics because sundog illusions are often the proposed explanation for apparent UFO sightings or miraculous sightings in the context of looking up in the direction of the sun in the daytime sky. Apparently this is the first time it has been clearly captured on video.

Poe

The next one comes from the RationalSkepticism.org blog. They link to another YouTube video in which a creationist who goes by the name Theologikus claims that he can disprove evolution. He argues that the reason different types of animals are found in different strata in the geological record is not because of evolution over time, but because during the flood animals climbs to higher altitudes to get away from the water. Faster smarter animals climbed higher, and so are found higher up in the geological record.

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I recently received the following question, which contains some common misconceptions about vaccines so I thought I would answer here instead of just in a private e-mail. The e-mailer writes:

Hello, I’m a new listener to the show. A few times now I’ve heard the subject of vaccinations come up on the show and I’m not sure I understand.

I fully understand that the “anti-vac” folks are wrong, and that vaccinations are very helpful in eradicating disease. I also understand that a certain portion of the population needs to be immune to a disease in order to protect the rest of the population from it. But I don’t understand – why does everyone need to get them, every year, and isn’t it possible that doing so weakens our natural immune system? If my body can fight off the flu quite easily, then why get the shot? Won’t the net effect (my body killing the virus) be the same?

Is there something I’m missing?

The e-mailer refers initially to herd immunity – once a certain percentage of the population is immune to infection (for whatever reason) there will not be enough susceptible hosts for the bacteria or virus to spread, and therefore there will likely not be an outbreak. The exact percentage of the population that needs to be immune varies depending on the infecting agent, but around 90% is typical. This means that for most vaccine-preventable diseases we would need vaccine rates to be above 90% in order to achieve herd immunity (some people may be immune because of prior infection, but this number is low for diseases for which there has been a vaccine available for decades).

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Stem Cells have been one of the biggest science news stories of the decade, for many reasons. There is the controversy surrounding stem cell research, sparked by President Bush’s ban on federal funding for such research outside of existing cell lines. This controversy has quietly faded away as advances have rendered the core issue mostly obsolete – embryonic stem cells from aborted fetal tissue are still a great source of potent stem cells, but researchers have figured out several methods for deriving stem cells from adult tissue, and even tweaking them so that they have similar potential to embryonic-derived  cells.

There is also the scandal surrounding the creation of many stem cell clinics around the world, most notably in China, but they have cropped up anywhere where regulations are lax. These clinics are mostly peddling hype and false promises, preying on desperate patients with very premature offers of stem cell cures.

Meanwhile real research into stem cells continues, and has the potential to usher in a new age of medicine. Stem cell technology is potentially a game-changer for many serious illnesses, but this technology will take years to develop to the point that stem cell treatment will become routine. (I am not talking about old treatments like bone marrow transplant, which are technically stem cell treatments, but rather fixing or replacing tissue and organs with engineered stem cells.) We are on the brink of picking the lowest hanging fruit on the stem cell tree, and a new study published in the Lancet takes us one big step closer.

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The diagnosis of coma, specifically persistent vegetative state (PVS), is not as straightforward as it might seem. The current standard of care is to perform a thorough neurological exam in order to assess function. The limitation here, however, is that we are inferring brain functioning from what the patient can do. Some parts of the neurological exam are straightforward, like pupillary reflexes. Reflexes are a more direct way of interrogating the nervous system because the examiner is able to see the response, and therefore the integrity, of one specific pathway.  This is very useful in determining which parts of the nervous system are working and which are damaged.

Coma, however, is a condition of impaired consciousness – so we also need to determine, to the best of our ability, the exact level of consciousness of a patient. This is where it can get a little tricky. The parts of the exam that are most useful for determining level of consciousness are response to various types of stimuli and the ability to follow commands. If I say to a patient (without any non-verbal cues), “show me two fingers on your right hand,” and they then raise two fingers on their right hand, that tells me a lot about their function. They can hear, they can understand language sufficiently to understand the command, they are aware enough to make sense of the command and the context of the exam (they know I want them to do something), and they have the motor pathways necessary to move their fingers on the right hand.

The flip side of that, however, is that if the patient is unable to show me two fingers it could mean that they are deaf, aphasic (impaired language), delirious, or paralyzed in that hand. I cannot know for sure that their lack of response is due to impaired level of consciousness. We can compensate for this somewhat by giving various commands – using various body parts, language that is easiest to understand, and as loud as possible to be heard. But this is only a partial compensation. A patient who is locked-in, for example (conscious but paralyzed below the eyes), would give the same lack of response as someone who is in a PVS.

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