Archive for the 'Science and Medicine' Category

Dec 07 2017

Alternative Medicine Kills

If the best available evidence is used to determine which treatment strategy for a serious illness has the best survival, than any “alternative” to this evidence-based treatment should, by definition, have a lower survival.

That is a simple and straightforward fact. You have to believe in some twisted conspiracy theory to avoid the obvious conclusion.

But good scientists like to dot all their “i”s and cross all their “t”s. In August Yale researchers published a study in which they looked carefully at the outcomes of cancer patients treated with conventional treatments vs those who opted for so-called alternative treatments. They only considered patient who used alternative treatments instead of proven treatments.

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Dec 01 2017

Liberation Procedure for Multiple Sclerosis – The Final Chapter?

In 2009 an Italian neurosurgeon, Paolo Zamboni, published a controversial article in which he claimed that patients with multiple sclerosis (MS) suffered from blockage in the veins that drain blood from the brain, that this correlation was strong and the pattern suggested a causal relationship. He called his newly identified condition Chronic Cerebrospinal Venous Insufficiency (CCSVI). His article concluded:

CDMS is strongly associated with CCSVI, a scenario that has not previously been described, characterised by abnormal venous haemodynamics determined by extracranial multiple venous strictures of unknown origin. The location of venous obstructions plays a key role in determining the clinical course of the disease.

I first wrote about the resulting controversy in 2010. At the time I concluded that there was good reason to be skeptical, that there were many “red flags for crankery”, but that further research should be done to put the question to bed. There were many reasons to be skeptical, not the least of which is that an entirely vascular cause of MS went against decades of research showing that MS is an autoimmune disease. In that first article I also wrote:

Then one of two things will happen: either the new idea or treatment will fade, becoming little more than a footnote in the history of science, or a subculture will persist in believing in the treatment and will dismiss contrary evidence and mainstream rejection as a conspiracy. Which course the new idea will take seems to depend largely on the original scientist – if they accept the new evidence and abandon their claims, it will likely fade. If they refuse to give up in the face of new evidence, then a new pseudoscience will likely be born.

Well, here we are 8 years after Zamboni’s original publication. How has this drama played out?

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Nov 17 2017

The Ethics of Head Transplants

sergio-canaveroNewsweek, who has been following the story of Italian Neurosurgeon, Sergio Canavero, now reports: “Human Head Transplants Are About to Happen in China: But Where Are the Bodies Coming From?”

I have already discussed the scientific aspects of this claim. They are highly implausible and I doubt that such a transplant is about to happen at all. If it does I predict it will be a dismal failure, and ethically dubious. First, I have to reiterate, that it is far more accurate to call such a procedure a body transplant. The head donor will wake up with a new body. The body donor is, I suspect, dead.

There are three basic hurdles that need to be overcome in order to have a successful body transplant – the surgical attachment, suppression of rejection, and regeneration of the attached neurological tissue. Given that Canavero is a surgeon, I suspect he is excited about the first issue. He may think he has made some advances because he improved his technique for making the attachment. This was never, however, the primary hurdle.

We are already making great advances with organ transplantation and controlling rejection. However, this is still a huge issue. Donor and recipient have to be closely matched, and lifelong drugs are required. Still, the amount of tissue being transplanted here will be a challenge. It opens up, for the first time, the possible effects of tissue rejection on an entire brain. While this is a significant hurdle, our current treatments mean it is not necessarily a deal breaker (it might be, but research would be needed to see).

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Nov 07 2017

Science-Based Veterinary Medicine

chiropractic_HorseThe Royal College of Veterinary Surgeons (RCVS) is a UK-based professional organization for veterinary surgeons and nurses. They describe their mission as:

We aim to enhance society through improved animal health and welfare. We do this by setting, upholding and advancing the educational, ethical and clinical standards of veterinary surgeons and veterinary nurses.

They recently came out with a statement regarding complementary and alternative medicine, essentially setting the standard for their profession in the UK. There are some good parts to the statement, but also some dramatic weaknesses which are representative, in my opinion, of the broader issues of how academia is dealing with the CAM phenomenon.

The Case for Science-Based Medicine

Before we get to the statement, let me review my position on the matter. As many readers will likely know, I am a strong advocate for what I call science-based medicine. The SBM approach, at its core, is simple – we advocate for one science-based standard for the health-care profession. This means that treatments which are safe and effective are preferred over those that are either unsafe or ineffective. Effectiveness and safety, of course, occur on a continuum and so individual decisions need to be made based on an overall assessment of risk vs benefit.

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Oct 16 2017

Clean Eating Antiscience

Eating “clean” is the latest fad diet pseudoscience. A recent article in The Guardian goes over the many aspects of this movement in great detail, and is worth a read. My only complaint is that the author, Bee Wilson, buys into misinformation about the medical profession and nutrition.

Wilson claims that the medical profession was unhelpful when it came to nutrition. I disagree – the medical profession was at the forefront of nutritional research and advice. The problem was that the science-based answers were not what everyone wanted to hear.

There are many aspects to the clean-eating movement, which Wilson does do an excellent job discussing. It is mostly marketing, a way for self-proclaimed “gurus” to make millions selling cookbooks, diet plans, and detox programs with outrageous claims that it will transform you health and cure whatever ails you.

The movement is also partly a reaction to the realities of modern Western culture. There is an obesity epidemic in our culture, and while the exact causes are debated it seems clear that the food industry is partly to blame. Market forces also favor tasty food, which tends to be calorie dense, and supersized portions.

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Oct 12 2017

Another Antivaccine Retraction

Retracted-950x633Science only works when it works.

In other words – science itself does not lead to an understanding of the universe unless that science is done correctly, rigorously, and honestly. This is a lot harder than I think is generally appreciated. In order to really reach firm scientific conclusions about any complex question we need to follow the arch of the research as it matures. We need to see what overall patterns emerge in the evidence. Eventually a tentative but reliable scientific consensus can be achieved.

There are many ways in which this process can go off the rails, however. With ESP we see researchers chasing the noise – trying to find tiny signals but only chasing their tails. With acupuncture we see proponents choosing to ignore, misinterpret, and then abandon well-controlled clinical trials in favor of “pragmatic” studies that will show them what they want. There is “cargo cult” science that goes through the superficial motions but lacks true scientific methodology. There is “Tooth Fairy” science that nibbles around the edges but never addresses the core premise – is the phenomenon actually real?

There is a huge positive bias in science – researchers have a tendency to tweak their methods to get the results they want, publishers have a tendency to publish positive exciting research, and other scientists have a bias toward citing positive interesting research. Funding sources affect research outcome. When pharmaceutical companies fund research the results are much more likely to be favorable to their drug than independent research. Scientists make mistakes, take shortcuts, and often have blinders on. And then there is outright fraud, which is uncommon but still crops up on a regular basis.

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Oct 06 2017

Unnecessary Medical Interventions

clinical-decision-making-46-638A recent JAMA article is an update on a systematic review of overused interventions in medicine. They list the top ten overused tests and treatments, meant to highlight this problem in medicine. They conclude:

The body of empirical work continues to expand related to medical services that are provided for inappropriate or uncertain indications. Engaging patients in conversations aimed at shared decision making and giving practitioners feedback about their performance relative to peers appear to be useful in reducing overuse.

You can read a summary of the ten overused interventions here.  The one you are likely already familiar with is antibiotic overuse. The others are very specific tests or interventions in specific situations, like Computed Tomography Pulmonary Angiography to help diagnose acute pulmonary embolism.

Reviewing each of these interventions in the top ten list would require a deep dive into the literature and detailed discussion, which is not my intent here. If you want that level of detail, read the original article. What I want to discuss is, in general terms, why this is a problem in the first place.

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Sep 28 2017

Health Blogger Gibson Fined

BelleGibsonBelle Gibson is an Australian wellness blogger who made a lot of money selling her cookbooks and apps for healthy eating. What elevated her profile above the sea of competitors, however, was her claim to have cured herself of brain cancer with her diet. The problem with her story, however, is that she never had brain cancer.

Now an Australian court has fined Gibson $410,000 for  fraud.

Gibson doesn’t really tell a coherent story, and it is full of red flags, but here is what she says. She claims she was diagnosed with terminal brain cancer by a German alternative medicine practitioner. She believed the diagnosis, and was just “living her truth.” Therefore, she says, she never lied to her followers, she was lied to herself.

But her story of being a victim does not really hold together. In 2011 she was given a brain scan which found her to be perfectly healthy. So she knew at that time that she never had brain cancer. However, two years later she launched her wellness app in which she claimed her diet cured her of brain cancer. She also claims that she was about to come clean with her readers, but the media got to her first. Right.

Her claim of being a victim also doesn’t explain why the money that was apparently donated to charity via sales of her app never made it to the charity.

Those are a pretty damning set of facts, and her explanations don’t really cover them. I guess the Australian court agreed.

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Sep 25 2017

Lying About Vaccines

Robert F. Kennedy Jr. talks with reporters in the lobby of Trump Tower in New York, Tuesday, Jan. 10, 2017, after meeting with President-elect Donald Trump. (AP Photo/Evan Vucci) Robert F. Kennedy Jr. talks with reporters in the lobby of Trump Tower in New York, Tuesday, Jan. 10, 2017, after meeting with President-elect Donald Trump. (AP Photo/Evan Vucci)[/caption]

Robert F. Kennedy Jr. considers himself an environmentalist. While advocating for the environment, he has become particularly concerned about the effects of mercury on human health. This in itself is reasonable, and there is broad scientific agreement that we should make efforts to minimize human exposure to mercury.

But Kennedy goes beyond reasonable recommendations based upon scientific consensus. He has become part of what we call, “The Mercury Militia” who have become unmoored from reality in their zeal to combat the perceived evils of mercury. The mercury militia further became tied to the anti-vaccine movement when it was claimed that the mercury in some vaccines was causing harm (it doesn’t). He has become a visible example of how someone can cocoon themselves in their own reality.

In a recent interview for Stat News Kennedy tells a number of falsehoods about vaccines. In essence he is lying, although it is possible he believes the lies he tells. Kennedy has apparently dedicated a large portion of his life to this issue, publicly advocates for his position, and certainly has resources at his disposal. And yet he gets basic facts about vaccines hopelessly wrong. How does that happen?

Paul Offit has written an excellent take down of Kennedy’s interview, explaining many of his falsehoods. For example, in the interview Kennedy claims: Continue Reading »

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Sep 14 2017

India Opens Homeopathy Laboratory

homeopathy-803_250pxAs I continue my efforts to fight against pseudoscience in medicine, I often ask myself – how bad can it theoretically get? I have had this discussion with others as well, some of whom argue that we should not worry because science will win out in the long run. Science is self-corrective, and pseudoscience will become marginalized over time. I hope this optimistic view is correct, but I am not reassured by the evidence.

Let’s consider a recent article in the Hindustan Times, written completely without skepticism or irony, which details how the government of India has opened a state-of-the art laboratory to study homeopathy.

Howrah-based Centre of Excellence in Fundamental Research in Homoeopathy will also undertake fundamental research studies in homoeopathy with an interdisciplinary approach.

“This institute has undertaken several clinical research studies such as autism, psoriasis, vitiligo, breast cancer, hypertension, migraine etc. along with proving of new drugs in homoeopathy with their clinical validations,” said Naik.

The lab will support PhD students in homeopathy and focus on research into viral and other infectious diseases. This is all part of the Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH). In India, pseudoscience in medicine, including homeopathy, have been fully institutionalized and are explicitly endorsed by the government.

This is how bad it can get.

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