Archive for the 'Science and Medicine' Category

Jun 04 2019

New Information on the CRISPR Babies

Last year a Chinese researcher, Dr. He Jiankui, announced that he had altered the germ line DNA of two babies using the relatively new and powerful gene-editing technique known as CRISPR. Dr. He is back in the news because of a new study looking at the effect of a mutation similar to the one Dr. He created on the life expectancy of those with the natural variant. The study finds that those who are homozygous for the gene variant (the delta 32 mutation of the CCR5 gene) have a 21% greater all cause mortality than those without the variant. What this means for the two children is unclear, but does raise concern.

Dr. He took it upon himself, without proper oversight or approval, to use CRISPR to alter the CCR5 (C-C chemokine receptor type 5) gene of embryos he then used for IVF (in-vitro fertilization) on his patient. The father who donated the sperm for fertilization (the patient’s husband) is HIV positive, so He sought to make a genetic change to the eggs to prevent HIV infection from the father. CCR5 is a protein on white blood cells that is used by HIV as an important gateway into the cell. Without it HIV infection becomes much less likely. There are other gateways, so it is not perfect immunity, but those with the naturally-occurring delta 32 mutation of CCR5 seem to be immune to HIV as a result.

He’s plan was to alter the CCR5 gene in the embryos in a way similar to, but not identical to, the delta 32 mutation. This was apparently successful in preventing HIV infection in the resulting babies. He announced what he had done after their live and apparently healthy birth.

He received widespread criticism for what he did for several legitimate reasons. First and foremost is his unsanctioned use of CRISPR on humans. He essentially conducted illegal human research. Human research is carefully regulated, with international standards, in order to protect the rights of people from harm and exploitation. He bypassed these regulations and was acting as a rogue researcher. That in and of itself is a career-ender.

Further, the specific application that He chose was not necessary. There are already effective proven treatments to minimize the chance of HIV infection from infected sperm used in IVF. Using an experimental treatment instead of a proven standard treatment is also considered unethical.

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Jun 03 2019

Should You Nap?

Some cultures routinely have a siesta after lunch. Is napping in the middle of the day good for you or bad? The short answer is – it depends. However a new study adds further evidence for a possible benefit to the mid-day nap, at least for elementary school children.

Let’s start with the concerns about napping, which has to do with “sleep hygiene.” Sleep hygiene refers to behaviors that optimize sleep quality, such as avoiding bright light late at night, going to bed with an empty stomach and bladder, and keeping a consistent schedule. One item on the good sleep hygiene list has been to avoid napping during the day. The problem with napping is that it makes it more difficult to fall asleep at night, which can result in a net loss of total sleep and sleep quality.

But it turns out the real answer is more nuanced. Some studies, such as this Spanish study in favor of siestas, show that a 30 minute light nap in the early afternoon is actually a net benefit, including improved memory, performance, and a reduction in stress. In 1995 NASA conducted a study and found that 26 minutes was the optimal time for their pilots to nap in order to optimize performance.

The features of a beneficial nap, therefore, include a limit on time to around half an hour. They also include (and this is probably a linked feature) lightly napping only – not falling into a deep sleep. The deep sleep is more likely to interfere with sleep onset at night. Also, the nap needs to be early in the afternoon, at least four hours prior to when you want to sleep at night. It should also be part of your routine schedule.

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May 21 2019

The Inherent Contradiction of Marketing Homeopathy

The Center for Inquiry (CFI) is suing Walmart for their marketing of homeopathic products, similar to a prior lawsuit against CVS. Their claim is that Walmart is using deceptive practices to sell homeopathy, implying that such products are equivalent to science-based remedies. While I applaud their effort, you can tell by reading the reporting that it is ultimately an exercise in futility.

First let me clearly state my underlying premise – homeopathy is pure 100% nonsense. It is a 200+ year old pre-scientific system of potions with no basis in reality. It is simply witchcraft. And if that is not enough for you, it has been tested in clinical trials (despite being utter nonsense) and has been convincingly, and unsurprisingly, shown to have no effect.

The inherent contradiction this undeniable fact creates is, how do you market homeopathic products without deception and harm? The answer is – you can’t. The only way to actually sell the product is to deceive the customer on some level.

The FDA and FTC have tried to strike a balance between freedom and consumer protection when it comes to homeopathy, but this is a hopeless endeavor. There is no balance. So they each have their guidelines for the industry to promote transparency, honesty in labeling, and to minimize deception. Of course these regulations don’t go far enough. They just mean the industry has to be a little more clever and coy in their marketing.

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May 10 2019

Apparently Medicine is Sorcery

According to Texas House Representative Jonathan Stickland, Texas pediatricians should mind their own business when it comes to vaccines, which, by the way, are sorcery.

That some state representative is completely clueless should come as no surprise, nor that he exposes his cluelessness on Twitter. Here is the now infamous exchange:

Prof Peter Hotez MD PhD@PeterHotez
Jonathan Stickland@RepStickland
You are bought and paid for by the biggest special interest in politics. Do our state a favor and mind your own business. Parental rights mean more to us than your self enriching “science.”
Prof Peter Hotez MD PhD@PeterHotez
Jonathan Stickland@RepStickland
Make the case for your sorcery to consumers on your own dime. Like every other business. Quit using the heavy hand of government to make your business profitable through mandates and immunity. It’s disgusting.

In his first tweet Stickland starts with the shill gambit, which is a lazy personal attack used to casually dismiss the concerns of others. In this case Stickland is assuming, and publicly asserting, that the only reason a pediatrician might advocate for children getting vaccinated is because they are “bought and paid for.” He then basically tells the doctor to shut up, as if a medical doctor does not have a legitimate professional and even ethical responsibility toward the health of their patients. Finally he dismisses “science” as a conspiracy and asserts the rights of parents to be free from science.

That is a lot of nonsense to pack into one tweet.

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May 07 2019

Why Prior Probability Matters

Back in the early days of my skeptical career I attended a skeptical conference hosted by CSI (then CSICOP). One panel stuck out, and I still remember some details more than two decades later. This was a panel on extrasensory perception (ESP). The proponent on the panel argued that the research showing that ESP is real shows as much of an effect as the research showing that aspirin prevents strokes. Therefore if we accept one, we should accept the other. Even my nascent skepticism was able to detect that this argument did not hold water, but now I understand why in far greater detail. There are many problems with the claim (such as the quality of the research and the overall pattern of results) but I want to focus on one – the role of prior probability.

This is often a sticking point, even among mainstream scientists and clinicians, I think because of the inherent human lack of intuition for statistics. Most scientists are not statisticians, and are prone to making subtle but important statistical mistakes if they don’t have proper consultation when doing their research. In fact, there is an entire movement within mainstream medicine that, in my opinion, is the result of large scale naivete regarding statistics – evidence-based medicine (EBM).

EBM focuses on clinical research to answer questions about whether or not a treatment works. Conceptually EBM explicitly does not consider prior probability – it only looks at the results of clinical trials directly asking the question of whether or not the treatment is effective. While this may seem to make sense, it really doesn’t.

Let me explain.

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Apr 11 2019

Herbals Potentially Unsafe in Pregnancy

I know this blog is a metaphorical finger in the dike of a massive corporate advertising and misinformation campaign, but I need to say it as often as possible that herbal products are drugs. They are consumed or applied for the pharmacological effects of the chemicals they contain. But they are advertised as “natural” which is somehow magically supposed to alter that reality.

Many people, I suppose, don’t contemplate the fact that arsenic, hemlock, curare, strychnine, and countless other chemicals are all natural powerful poisons. The natural world is full of toxins, poisons, and powerful drugs. To a first approximation the natural world is trying to kill you. I would not, for example, recommend eating any part of a plant you cannot identify. Those are not dice you want to throw.

Literally centuries of snake oil marketing, however, has created a health halo around the vague concept of something being “natural”. The herbal supplement industry makes billions off this misconception, and of course does everything it can to promote it. Even the term “herbal supplement” is a misnomer – the result of the industry lobbying the government to treat these unpurified dirty drugs as if they were food.

As a result we have a drug industry that is largely unregulated and sells their products directly to the consumer, without prescription or any medical oversight, and are allowed to make or imply all sorts of health claims. Their products are rife with contamination, substitution, mislabeling, and adulteration. Even when the label is accurate, we often don’t know what the active ingredients are, their doses, or their interactions.

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Apr 09 2019

Quantum Acupuncture

In 2017 Chinese scientists published a paper in the journal Chinese Acupuncture & Moxibustion titled, “Discussion on quantum entanglement theory and acupuncture.” There are several layers to the erosion of science that this paper represents. Fortunately the paper was recently retracted, for reasons the editors do not make clear. I suspect they were just embarrassed.

The first layer I would like to peal away is the use of quantum mechanics to essentially explain magic. The authors write (originally in Chinese – this is the bad translation):

After learning the quantum entanglement, the authors have found that many characteristics of quantum are reflected in TCM, acupuncture theory and clinical practice. For example, the quantum entanglement phenomenon is mutually verified with the holism, yinyang doctrine, the theory of primary, secondary, root and knot in TCM, etc. It can be applied to interpret the clinical situations which is difficult to be explained in clinical practice, such as the instant effect of acupuncture, multi-point stimulation in one disorder and the points with specific effects.

Let me parse that a bit for you. What they are essentially admitting is that there are several aspects to acupuncture that cannot be explained with actual science, by appealing to evidence, logic, or what has been established about how the human body actually works. One of those aspects is the “instant effect” that acupuncture often seems to have on patient.

In real life, it takes time for the body to respond to any intervention. There are some drugs that, when given intravenously, can have a very rapid effect. Otherwise it takes time for substances to get absorbed, be distributed to their targets, for cells to respond, to make proteins, to begin healing, etc. Depending on the effect and the mechanism of the intervention, an almost instant response to treatment may be physiologically impossible.

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Mar 25 2019

What Good Journalism Looks Like

It’s refreshing to encounter a well-researched piece of excellent journalism that is not afraid to communicate an accurate picture of the subject. The headline of this article reads, “Naturopaths are snake-oil salespeople masquerading as health professionals,” by Gary Nunn writing for the Guardian.

He begins:

When I began researching and conducting interviews for a feature about naturopaths, I was doggedly determined to keep an open mind. Journalism 101 dictates balance: a fair hearing to both sides. My commitment was to present the unbiased truth; I was about to embark on a learning journey, as journalists often do.

Here’s the thing – many journalists confuse the need to approach a topic with a fair and open mind with the piece itself being “balanced.” However, if the topic itself is asymmetrical, then this leads to a false balance. Rather, the piece should reflect reality, not an arbitrary conclusion that both sides are equal.

Another trap is to justify this false balance by saying – I’ll let the readers (or viewers) decide. This standard makes sense for a news piece, rather than an opinion piece, but is often misapplied. It’s OK to give information without drawing firm conclusions from that information, and let the reader draw their own conclusions. But this approach requires a lot of context. In science journalism, it’s better to let experts give their analysis. Further, this editorial approach is not a justification for false balance. These are independent variables.

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Mar 18 2019

Sugary Drinks Linked to Heart Disease

A new study adds confirmation to what we have already been seeing in the data – drinking a lot of sugar-sweetened drinks, like soda, is linked to an increased risk of heart disease and death in men and women. This may seem obvious, but it is worth repeating precisely because it is a pretty straightforward bit of health advice that tends to get lost in the noise of bad health advice.

For example, during my visit a few years ago to Google I noted that the company tries to offer a healthy environment for its workers, providing the space and time to exercise, and a freely available snack room filled with healthful snacks. However, their refrigerator was filled with drinks that were sweetened with “all natural cane sugar” and none with artificial sweetener. This is backwards, falling for recent health fads and the appeal-to-nature fallacy. It doesn’t matter if sugar comes from sugar canes, sugar beets, is raw, natural, non-GMO, organic, or whatever. In the end it is all crystalized sucrose. And it’s really no different than high fructose corn syrup.

What matters is how many calories you are consuming from concentrated simple sugars. We evolved to like the taste of sweetness because simple carbohydrates provide much needed calories and glucose. We evolved in a calorie-limited environment, and so seek out high-calorie food. But we then used technology to hack our love of sweet foods. It didn’t take modern technology either. Native Americans figured out how to get syrup from maple trees, and that innovation is linked to a spike in various diseases, such as tooth decay, obesity, diabetes, and heart disease. Honey is another low-tech source of concentrated sugar.

But nothing beats table sugar or similar sources of concentrated calories and sweetness. We have also become accustomed to certain foods being sweet, such as our beverages. Sugar-sweetened beverages are now a significant course of empty calories and excess carbohydrates. One 12 oz can of Coke or similar soda is 140 calories. If you drink 72 oz per day, which is a typical amount to drink, that’s 840 calories – every day. That’s massive. An average daily caloric need is about 2,000 calories, so you are already almost half way there. Even if you have just one can per day, that’s enough calories to equal 14.6 pounds in one year.

You could, of course, decrease your food consumption to compensate, but then you are decreasing food with actual nutritional benefit.

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Feb 26 2019

Self-Monitoring for Weight Loss

The most effective method for weight loss! Lose weight in less than 15 minutes per day.

These sound like typical weight-loss overhyped sales pitches, but they are reasonably supported by evidence. There is now good (but not great) evidence that frequent and consistent self-monitoring predict successful long-term weight management. In fact, a new study finds that those who successfully used online dietary intake self-monitoring eventually spent only 14.6 minutes per day on the activity.

There are three components to self-monitoring in weight management: dietary intake monitoring, self-weighing, and exercise self-monitoring. Self-weighing probably has the best evidence so far. The evidence supports weighing yourself from every day to every week consistently as a good predictor of successful long term weight management. The optimal frequency is still a matter of debate, but it should be at least weekly. Consistency also appears to be a key.

Dietary self-monitoring is essentially estimating or counting the calories you eat each day and recording them in some fashion. Why might this be helpful? The evidence shows that people generally underestimate the calories in food and that they consume (by as much as 50% in some studies).  These studies are limited often by self-reporting, but there is a consistent result.

In fact, people both over and underestimate the caloric content of different foods, but they tend to underestimate (when they do) by more than they overestimate. In one study they overestimated by 65 calories on average, while underestimating other foods by 165 calories.

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