Archive for the 'Science and Medicine' Category

Aug 15 2019

Grain-Free Dog Food

This is a great example of the unintended consequences that can result from making decisions based on scientific conjecture and preliminary hypotheses. In this case, the hypothesis was never a good one. If you are a pet owner, you may have noticed the recent trend toward grain-free dog or cat food. The justification for this trend is the notion that since dogs are essentially wolves, and wolves are pure carnivores, then we should not be feeding our dogs grains. This is basically the paleo diet for dogs.

It should be noted, however, that many carnivores do need to get some plant matter in their diet. They may get this from the stomachs of the herbivores they eat. Wolves will also occasionally eat berries as a minor supplement to their diet. But sure, wolves don’t generally eat grains. But that is not the problematic premise here.

The problem with the grain-free diet claim is that while modern dogs are closely related to wolves, they are not wild wolves. They evolutionarily split from wild wolves 15-40,000 years ago. Over that time their diet has shifted significantly. They no longer hunt in packs, but live off the scraps of human civilization. And they have adapted.

So the grain-free theory is flawed, and we should not base dietary recommendations on theory alone anyway, but actually gather evidence to test those theories. Perhaps we already have, in an unintended ecological experiment. In 2018 the FDA noticed a spike in reported cases of dilated cardiomyopathy (DCM) in dogs. Previous years had 1-3 reported cases per year, in 2018 there were 320, and 2019 is on track to exceed this. This is still a small number compared to the millions of pet dogs in the US, but is likely massive underreporting. There is also likely some reporting bias here – one article on social media might explain the spike, rather than a true increase. But the FDA had to investigate the increase to see if it were real and what the cause might be.

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Jul 09 2019

More Bad News For Vitamin Pushers

Vitamins are, by actual definition, essential nutrients for humans. They are substances we need but cannot make ourselves from other nutrients, and therefore must consume. Each of the vitamins have a disease resulting from a deficiency of that vitamin. For some there may also be negative health effects from having an insufficiency (less than optimal levels, but not low enough to cause a deficiency state). This is why you should eat your vegetables, and have an overall well-rounded diet – to make sure you get enough of all the vitamins and other needed nutrients.

But of course if there is a way to exploit a fact to make money, someone will do it. In this case an entire industry has emerged to make money by convincing the public they need to take vitamin pills, the more the better. In 2017 the supplement industry in the US reached $36.1 billion a year. Unfortunately, the path to better health is not so simple, and the science simply does not support the vitamin industry hype.

Yet another meta-analysis was just published again demonstrating that routine supplementation is mostly worthless, and may even be harmful. This one is focusing on vascular outcomes, but since heart disease is the #1 killer, and stroke the #3 killer, vascular risk has a major impact on life expectancy. In 2018 I wrote about a meta-analysis published in the Journal of the American College of Cardiology. This study found:

  • Multivitamins, vitamins D, C, A, B6, E, calcium, β-carotene, zinc, iron, magnesium, and selenium had no benefit or harm for vascular disease or all-cause mortality.
  • Folic acid and B-complex (Folic acid, B6 and B12) reduced stroke risk
  • Antioxidants and niacin increased all-cause mortality.

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Jul 08 2019

Cancer Quackery on YouTube

Many outlets are covering the story of Mari Lopez, a YouTuber who claimed, along with her niece, Liz Johnson, that a raw vegan diet cured her breast cancer. Johnson recently updated the videos with a notice that Mari Lopez died of cancer in December 2017. She has refused, however, to take down the videos.

The story, unfortunately, is a common one. When people are diagnosed with cancer it is understandably a psychological shock. They face not only the grim possibility of their death, but also the prospect of surgery, chemotherapy, and/or radiation therapy – none of which are pleasant. It is a life-altering event. It also makes people vulnerable – in that situation, who wouldn’t want an escape hatch, a way to get back to their normal life? That is what cancer quackery offers – forget surgery and chemotherapy, just engage in this mild intervention, like a diet change, and your cancer will be gone.

Those who get lured in by this siren song experience one of several possibilities. First, many may still undergo some initial treatment, such as surgery, to treat the cancer, but then refuse adjunctive therapy like chemotherapy or radiation. Some of those patients may, in fact, be cured by the surgery. Often the purpose of the chemotherapy is to reduce the risk of recurrence. Others may forgo any science-based treatment.

Following the initial diagnosis, with or without some intervention, there is what we call the honeymoon period. In this phase the cancer may be relatively asymptomatic. This is especially true if it was discovered because of some screening test, like an X-ray or blood test, and not because it had already become symptomatic. This period can last for months and even years, depending on the stage and type of cancer. This is the phase where those who pursued some form of cancer quackery convince themselves that they are cured. They will also tend to credit the alternative treatment with their cure, even if they received surgery or some other standard treatment.

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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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