Archive for the 'Science and Medicine' Category

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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Feb 14 2019

FDA Wants Better Supplement Regulation

It has been 25 years since the 1994 Dietary Supplement Health and Education Act (DSHEA), which reduced the FDA’s power to regulate supplements. Since DSHEA supplements have been regulated like food, not drugs, with no preapproval process. The FDA can only take action after a product is on the market, and they have the burden of proof of either harm or adulteration (for example, by containing actual drugs).

Unsurprisingly:

Since the law was enacted, the industry has grown from 4,000 products and $4 billion a year in sales to as many as 80,000 products and $50 billion in sales, according to the FDA.

There is no evidence that those additional 76,000 products and $46 billion per year have provided any health benefits to the public, and in fact are probably a net health negative. Anything genuinely useful, like prenatal vitamins, or supplements for actual deficiencies, were already available. The new products are mostly snake oil.

The situation is almost comically ridiculous. Herbal supplements are rampant with substitutions, contaminations, and adulterations. But even if the label is accurate, most herbs do not do what is claimed for them. They are simply not medical useful.

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Feb 12 2019

Kidney Organoid Breakthrough

We are on the cusp of several technologies that promise to transform medicine – genetic manipulation, brain-machine interface, and stem cell therapies among them. One of the hopes for stem cells is that we will be able to grow from them entire replacement organs. Imagine that you have kidney failure, and face years of dialysis with the hope of finding a kidney donor, so you can exchange that dialysis for a regimen of anti-rejection drugs. You may wait years on the list because we simply don’t have enough organs to go around.

Now imagine that even before your kidneys completely fail doctor take a skin or mucous membrane sample from you, and then over the next few month they grow a new kidney from your own cells. The kidney is your own tissue, and so there is no rejection at all. Eventually the new kidney is surgically implanted and you are good to go.

It doesn’t take much imagination to see how awesome this could be. If we could grow new hearts, lungs, livers, pancreases or kidneys from one’s own tissue that would transform medicine. The threshold for doing transplants could go way down, because we no longer need donors, we can grow them. The risk would go down because there is no longer the possibility of rejection and therefore the need for powerful anti-rejection drugs, so we could do transplants in more situations. We wouldn’t have to wait for organs to completely fail. Also, if you have cancer we don’t have to try to preserve as much of the organ as possible – just take the whole thing out, making sure you get all the cancer, and replace it with a new one.

This would be a truly transformative medical advance that would bring us into a new age of medicine. I don’t think we are close (meaning <10 years) to such applications, but we are close enough to say that researchers are working on it, and to see a path to get there. It’s enticing.

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Feb 08 2019

Oral Insulin

Insulin is a protein. Like all protein (or peptide) drugs it needs to be injected, you can’t take it in pill form. This is because proteins are digested in the GI tract, are generally large and difficult to absorb intact, and if they make it that far they then have to deal with the liver before they can get to their intended target. So protein or peptide drugs are simply not able to be delivered orally.

The need to give daily injections is literally a pain, however. There has therefore been extensive research in the pharmaceutical industry into methods to allow for oral, transdermal, or mucous membrane administration of so-called biologicals. As this review states:

These problems can be overcome by adopting techniques such as chemical transformation of protein structures, enzyme inhibitors, mucoadhesive polymers and permeation enhancers.

A new study which is getting some media attention takes a completely different approach – they have created an autoinjector that you swallow, which then injects insulin into the stomach from the inside. The research is the result of collaboration between academics and industry:

Giovanni Traverso, an assistant professor at Brigham and Women’s Hospital, Harvard Medical School, and a visiting scientist in MIT’s Department of Mechanical Engineering, where he is starting as a faculty member in 2019, is also a senior author of the study. The first author of the paper, which appears in the Feb. 7 issue of Science, is MIT graduate student Alex Abramson. The research team also includes scientists from the pharmaceutical company Novo Nordisk.

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