Archive for the 'Science and Medicine' Category

Apr 23 2020

Hydroxychloroquine Not Looking Good for Covid-19

We have been tracking the story of the hype surrounding hydroxychloroquine over at Science-Based Medicine, but there is a brief follow up I wanted to comment on. The short version of the story so far is that one very bad French study claimed to show dramatic reduction in detected virus in those treated. This study, however, was not only preliminary, it was a horrible study, so much so that the results are uninterpretable. The big problem was that it did not count patients who became too sick or died. That is a classic way to make a treatment look better than it is. The author is also a climate change denier who initially mocked China for taking steps to mitigate Covid-19. He does not exactly have street cred within the scientific community.

But that one horrible study from a sketchy researcher was enough to spark media hype, at least in certain circles, and capture the attention of a president apparently desperate to make this problem go away. Amid the fear of a pandemic, that was a toxic combination. The notion that hydroxychloroquine (with our without the antibiotic, azythromycin) might fight the SARS-Cov2 virus is not implausible. But most things in medicine that are “not implausible” don’t work out. We need high quality clinical science to ultimately tell.

The big question always is – what is the risk vs benefit? Hydroxychloroquine and Azythromycin both have the same potentially deadly side effect, prolonging the QT interval of the heart, which increases the risk for sudden cardiac death. This is a manageable side effect in the right setting, but is potentially serious. This is not a good drug or combination to be taking just on the chance it might help.

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Apr 17 2020

Mixed Feelings About the WHO

The World Health Organization (WHO) is one of those entities that are so essential if it didn’t exist it would need to be invented. But at the same time, it is a frustratingly flawed institution.  Some of those flaws are being highlighted during the Covid-19 pandemic. But the WHO is not alone in this – Covid-19 is an extreme stress on the system, and it is revealing multiple weaknesses. The big lesson I hope at least a majority of people take from this entire episode is that we actually need continuity of competent government.

The WHO is essential for establishing international standards of medical care, and helping deliver modern medicine to the developing world. They are a critical source of information on epidemiology, and often the first source I go to when researching a medical topic. They have become a critical trust of medical, public health, and epidemiological expertise. They are also critical in dealing with things like pandemics. Here is their list of their primary goals, but in short:

Our goal is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and well-being.

The WHO is a creature of the UN and came into existence in 1948 (just three years after the UN itself). They have 7,000 employees in offices in 150 countries. Ideally, an organization dedicated to health would be apolitical, nonpartisan, and heavily science-based. In a way the WHO represents the highest ideals of the UN – many nations getting together to cooperate for mutual benefit. But predictably it’s difficult to get so many different cultures and perspectives to collaborate seamlessly, and this has lead to what I consider some major problems with the WHO.

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Apr 06 2020

COVID-19 Is Not Due to 5G

What do the following things have in common? A train engineer deliberately derails his train trying to crash it into a hospital ship in port to relieve overstressed hospital. In 2016 a man entered a pizza parlor and began shooting his assault rifle. And in the last few days several cell towers in the UK were the victims of apparent arson. These strange acts were all apparently motivated by bizarre conspiracy theories. Conspiracy thinking can be dangerous on many levels. It creates an alternate view of realty, one insulated from facts and refutation. Grand conspiracy theories also commonly create a narrative in which the enlightened few are struggling against a powerful and dark secretive cabal. It can motivate people to think they must do something – something desperate, dramatic, and heroic. The train conductor sums up this mind set:

“You only get this chance once. The whole world is watching. … I had to. People don’t know what’s going on here. Now they will.”

But let’s get back to this notion that 5G networks are somehow responsible for the coronavirus pandemic, or at least making it worse. This claim occurs in the context of general fear of the health effects of 5G. As I discussed at length in this SBM article, these concerns are not valid and are confusing the implications of the science. Here’s the quick version – 5G is operating at a relatively low frequency and low energy level, too low to cause direct harm to tissue. This is what is called non-ionizing radiation, because it is too low power to break chemical bonds. 5G critics make much of the fact that 5G is at a higher frequency than 4G or 3G , operating in the 28 and 39 gigahertz range. But as I and others point out, as you go higher still in EM frequency you get to visible light. Visible light has a frequency rage of 430–770 THz – that’s terahertz, which is 1,000 gigahertz – so visible light is at a frequency about 12,000 times higher than 5G. 5G networks are also low power, in the tens or at most hundreds of watts. In other words, that computer screen you are looking at right now is bathing you is much more powerful and higher frequency EM radiation than any 5G network.

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Apr 03 2020

A Stupidity Pandemic

As a skeptical science communicator I am constantly walking the line between hope and cynicism. On the one hand, I very much take to heart Carl Sagan’s approach to science – focusing on the absolute wonder of the universe, and celebrating the curiosity and ingenuity of humanity. We have peered into the past, walked on the moon, and decoded many of the secrets of life. Science is a powerful tool that has transformed the world more in the last few centuries than in tens of thousands of years beforehand. And yet, humanity still struggles with the demons of our evolutionary history. We are tribal, superstitious, and capable of surrendering our critical thinking to a charismatic leader.

What this all means is that when we are faced with a challenge, even a crisis, we are capable of meeting it. We can bring the tools of science, philosophy, and politics to bear to solve almost any problem. And yet the extent to which we will fail to do so is a consequence of our own stupidity and lack of critical thinking. There is nothing like a pandemic to reveal all of this – the good and the bad.

On the bright side, there have already been thousands of studies of the novel coronavirus (SARS-COV-2) and the disease it produces, COVID-19. Researchers are already exploring possible treatments and developing a vaccine. Meanwhile, we have solid mechanisms everyone can use to protect themselves and slow the spread of disease. Where implemented properly and in time, these strategies work. Compare this to just 100 years ago, during the 1918 flu pandemic. That pandemic killed at least 50 million people worldwide – and that magnitude was created largely by the world’s collective failure to properly understand and deal with the virus. They had no treatment, no vaccine, and utterly failed to enact adequate public health measures (for sure, this was partly due to the fact that they were fighting a world war and many politicians prioritized the war effort over mitigating the pandemic). Go back a bit further to the black death, which killed a third of Europe, and they did not even understand the nature of the pandemic. Their ignorance made them all but helpful before it.

Today, through science we understand exactly what is going on, down to the molecular level. And we have the methods to quickly (relatively speaking) figure our how best to address it. It is still a challenge, because the pandemic is moving quickly, but all we really have to do collectively is not panic and listen to our own experts. But of course, it’s never that simple. Some people will find a way to screw it up, because humanity is a complex mixture of motivations, biases, and emotions.

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Mar 26 2020

Boosting Your Immune System During a Pandemic

The short answer to the question – how do you boost your immune system – is that you can’t. The very concept of “boosting” the immune system is not scientific and does not exist within mainstream medicine. That’s because it is based on a fundamental misunderstanding of immunity, and of biological systems. Having said that there are legitimate things you can do to optimize immune function, which all are simply ways of avoiding things that inhibit immune function. But first let’s cover some basic principles.

Basic Principles

Biological organisms are complex, dynamic, homeostatic systems. This may seem obvious when you think about it, but many dubious health claims violate this basic understanding of biology. The immune system itself is a highly complex system – so complex that even though we have a vast amount of knowledge about the immune system, we have a hard time predicting the net effect of specific changes to the system. We have studied drugs in auto immune diseases, for example, that have had the opposite of the predicted net effect. This means we need to be very wary of any study that purports to show a change in some measure of immune function, and then concludes that this is a good thing, a “boosting” of immunity.

But perhaps even more important is the homeostatic bit. Immunity is a delicate balance, and evolution has tinkered with this system for hundreds of millions of year. If there were a simple way to make this system function better, we would have evolved it already. Put another way, there is no simple way to hack this system with a supplement or other measure. Immunity is also a double-edged sword – it fights off invaders and damaged cells, while trying to minimize harm to our own tissue. Think of inflammation – this is a good thing when it is killing bacteria, but also causes a lot of harm. When this delicate balance is disturbed, the result can be an auto-immune disease.

Therefore, we should think twice or thrice before doing something meant to disturb this delicate balance. Chances are greater we will make things worse than better. We need carefully conducted clinical trials to determine the net effect of doing anything to immunity in specific clinical contexts. Also, there is nothing better than a healthy immune system – there is no “super” immunity you can get from your diet or taking a supplement.

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Feb 24 2020

AI Antibiotic Drug Discovery

The use of artificial intelligence in the drug discovery process is not new, but it is advancing in significant ways. Several weeks ago the BBC announced the first AI developed drug to be taken to human trials. Now they are announcing the discovery of a new antibiotic using AI. Let’s talk about drug development to see how advances in AI are impacting this process.

Finding a drug that is useful medically is tricky, because it has to have a lot of properties simultaneously, and any one property can be a deal-breaker. A useful drug needs to get into the body, get to the target tissue, survive long enough to have the desired effect, it needs to have a desired effect at a dose that is lower than doses that cause significant side effects, and it needs to lack significant toxicity, such as liver or kidney damage. Will the compound be stable on the shelf? The same needs to be true, at least in lack of side effects and toxicity, for all the metabolites of the drug that may be created before everything is eliminated. On top of that we have to worry about drug-drug interactions, and even interactions with certain foods.

For this reason there is no perfect drug. Every pharmaceutical is a trade-off. Being “natural” is also not a magic wand that bypasses all these concerns. Substances that occur in nature did not evolve for our benefit. They generally evolved to be poisons to creatures that might eat them, including us. Drugs derived from plants are basically poisons that we have purified, usually altered, and then discovered a dose range that can be safely exploited.

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Feb 20 2020

Herbals Don’t Work for Weight Loss

One of the frustrating things I encounter as a practicing physician is listening to patients describe how they are motivated to improve their health, and then list all the things they are doing, none of which will improve their health. I am eating organic, taking probiotics, taking supplements, and “eating clean.” They may go into detail about their “paleo” diet, some specific megavitamin or superfood, or list the herbal supplements they think will supercharge some aspect of their health.

This is not their fault. They are motivated and taking action and responsibility for their health, but they have been failed by society. The regulatory infrastructure in place to protect the public from false or misleading health claims, from outright fraud, charlatans and snake oil peddlers has clearly failed. Further, the public largely assumed they are protected from fraud, when clearly they are not. People must protect themselves with information, often having to find on their own the glimmers of reliable information hiding in a sea of misinformation and slick marketing. So let me add one bit of helpful information – herbal supplements, according to a recent systematic review, do not work for weight loss.

To be more technically precise – there is currently insufficient evidence to conclude that any herbal product reviewed is effective for weight loss. Historically the most common reason for insufficient evidence of efficacy for a treatment that has been studied is that it simply does not work, or has only a clinically insignificant effect (which is functionally the same thing). You can hold out for larger and better studies to show a statistically and clinically significant effect, but don’t hold your breath, and in the meantime the most reasonable approach is to consider such treatments as ineffective until proven otherwise.

The authors reviewed and did meta-analysis on 54 placebo controlled trials. The herbs tested fell into one of several categories. Some straight up did not work. Others has small effects considered not clinically significant. Still others has few studies of poor methodological design, but also with clinically insignificant effects. No single treatment was shown to have both statistically and clinically significant effects in well-designed trials.

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Feb 10 2020

Homeopathic X-rays

Homeopathy is pure pseudoscience. No reasonable review of the evidence can come to another conclusion. Most people who use homeopathic products don’t even know what it is – they generally think that the term refers to herbal or natural remedies. Nothing could be further from the truth. In fact, for most people, when I tell them what homeopathy actually is, their first reaction is disbelief. As silly as homeopathy is, it is good to give occasional reminders of how nonsensical the homeopathic industry is and how absurd their claims. This reminder is about homeopathic X-rays, which I will get to below.

The two core claims of homeopathy include the notion that like cures like – that a substance that causes symptoms will reduce those same symptoms in teeny tiny doses. There is no science to this claim, and no, it does not operate like allergy shots or vaccines. The substances and doses used generally do not provoke any immune response. They don’t provoke any response at all, because the doses are so tiny, they are usually non-existence. That is the second core foundation of homeopathy, extreme dilutions.

How extreme? A typical 30C dilution involves dissolving the starting ingredients 1:100 thirty times. That is a 10^60 dilution. There are about 10^50 atoms in the Earth, so you would need 10 billion Earths worth of homeopathic potion to have an even chance of getting a single molecule of “active” ingredient. But to the homeopath this is a feature not a bug, because they believe that the magical “essence” of the starting ingredient remains behind.

Homeopathy, in other words, is not medicine but magical potions, based on prescientific superstitions. That doesn’t stop corporations from pretending it is real medicine and selling it as such.

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Feb 06 2020

The Genetics of Cancer

More than a thousand scientists working for over a decade in 37 countries have just published the results of their comprehensive analysis of cancer genetics – Pan-cancer analysis of whole genomes. This was a massive effort, facilitated by modern computing allowing for international collaboration. It is a good example of the collaborative nature of science. There are some interesting take-aways from the results, but first let’s review the basics of cancer.

In healthy tissue there are multiple mechanisms to keep cells from reproducing and growing without limit. Cell proliferation is a carefully regulated process, and when that process goes awry one potential result is cancer. It has already been established for many cancers that they are caused by a combination of genetic mutations, which disable one or more of these regulatory mechanisms. The result are cells that will grow without limit, either in the blood or forming a solid tumor. Cancers can vary in terms of how aggressive they are – how fast do they grow, how much do they invade neighboring tissue, and how likely are they to metastasize (spread to remote areas).

Treating cancer involves removing tumors, and using drugs and radiation to kill rapidly dividing cells. Cancer cells are rapidly dividing, but so are some healthy tissues and this leads to significant side effects. Newer treatments block the formation of new blood cells to feed tumors, and also harness the immune system to attack cancer cells. Despite the fact that cancer is a horrifically complex set of diseases (not one disease), progress in our understanding and treatment of cancer has lead to a steady increase in survival.

The death rate from cancer in the US declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop ever recorded, according to annual statistics reporting from the American Cancer Society.

It is unlikely that there will ever be a “cure for cancer” but progress will lead to a steady slow improvement in survival, so that fewer and fewer people will actually die from their cancer, as opposed to living long enough to die from something else.

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Feb 04 2020

New York Times Goop Fail

This has to be the worst opinion piece I have read in a major news outlet in a long time. The authors, Elisa Albert and Jennifer Block, leave behind them a killing field of straw men and empty containers of metaphorical “Kool Aid.” Here is the short version – they are defending Gwyneth Paltrow’s Goop and the recent Netflix series Goop Lab with all the tropes of pseudoscience they can muster. They wrap them all up in a narrative of female empowerment, and dismiss out-of-hand all the legitimate criticism of the dangerous advice Goop sells as a conspiracy of the “patriarchy.”

Ironically, and sadly, I would argue that Paltrow, and by extension Albert and Block, are exploiting women, making them more vulnerable, and depriving them of true empowerment – which is knowledge. When you give someone misinformation, you are taking away their ability to have informed consent. This is what con artists do. Alternative medicine is frequently a double-con, in which those who promote it are themselves deceived and are just paying the deception forward.

All the talk about the “patriarchy” is also just another version of a conspiracy theory, in which all legitimate counter arguments and evidence are dismissed as part of the conspiracy (as I am sure some will do with this very blog post). Conspiracy theories work best if they contain a kernel of truth, or if they are built around a legitimate historical grievance, as in this case. All you have to do is wipe away all the nuance, and cherry pick the details that serve your narrative.

Let’s dig in to some of the details of the article. They start with a rather blatant straw man:

The show would surely promote “dangerous pseudoscience,” peddle “snake oil,” and be “undeniably awful for society.”

Six episodes of the show finally dropped late last month, and so far civilization seems to be more or less intact.

Right, so because civilization did not instantly collapse, none of the warnings about the dangers of pseudoscience are valid. But they were just getting started and this was a mere warm up. The next paragraph frames the discussion: Continue Reading »

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