Jun 17 2009

Comment Roundup

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Comments: 14

My primary blog entry for today can be found at Science-Based Medicine – it covers the recent FDA warnings regarding Zicam and anosmia.

A couple of recent comments are worth a direct response. In response to my Heuristics entry from yesterday Zelocka wrote:

“You may be able to conclude, therefore, that people who walk more tend to have lower BMI”

But this would be an incorrect assessment based on perception of BMI. BMI is nothing more than weight / height. It would be perfectly reasonable for someone that walks to have more muscle mass then someone that does not. Since muscle weighs more, someone that walks could have a higher BMI then someone that does not for at least a certain period of time and maybe longer depending on the calories the muscle / exercise uses compared to the conversion of the excess on the person that does not walk. If you would have used body fat rather than then you would have removed this loophole.

Zelocka is technically correct – BMI is just height to weight, and a very muscular person can have a high BMI without being fat. This is a widely recognized limitation of BMI. Fat measurements are therefore better. However, BMI is still used in many epidemiological studies because the information is readily available.

Also, BMI is still very useful becuase with large numbers of people, body types and muscle mass will tend to average out, and therefore BMI gives a pretty good estimate of excess fat.

While I agree that walking will increase muscle mass, this effect is likely to be much less of a factor on weight than the loss of excess fat is. And, in fact, studies do show a correlation between higher BMI and less walking.

Plus – I would point out, this was just a hypothetical example to illustrate my point.

Dana Ullman has made a splash defending homeopathy. He is incoherent as usual. I will pick on a couple of points here.

He wrote:

His assertion that “Hahnemann based this rule on a single observation” is either based on extremely limited knowledge of Hahnemann and homeopathy, or you are purposefully providing mis-information. You’re seeming a smart guy. I assume that you’re doing the latter.

Nice ad hominem – I don’t think anyone would miss the fact that you accuse me of deliberately lying. Ullman does not actually follow with any evidence to contradict my statement, just some anecdotes about how people thought Hahnemann was a nice guy – a point not in dispute.

But primarily I think Ullman misunderstood my point. I did not say that Hahnman made only a single observation, but he came up with the idea of like cures like based upon a single observation. He then followed with a very large series of observations – so-called “provings” to see what substances has what symptomatic effects. But these “provings” were not designed to test the premise of like cures like – they were based upon the assumption of like cures like.

There is no research in basic or clinical science that established the notion of like cures like – it remains nothing but a principle of sympathetic magic.

Ullman follows with this:

“Why is it, as homeopaths claim, that and extract of onion should treat colds, which are caused by a viral infection, simply because onions irritate mucous membranes and cause tearing and secretions similar to the common cold.”
The answer: A homeopath may use Allium cepa (onion) for those symptoms that it is known to cause in overdose. By using a drug that mimics the symptoms of the body’s efforts to fight infection, Allium cepa helps resolve the viral infection faster. Homeopathy gained its greatest popularity in the 19th century in the US and Europe due to its impressive success in treating infectious disease epidemics of that era, including cholera, scarlet fever, typhoid, pneumonia, and influenza.

Did everyone notice that Ullman simply restated his premise, and then followed with a separate assertion. He did not answer the question at all. What physiological or biological principle would lead us to conclude that like should cure like – what is the mechanism? Is Ullman going to take the vaccine gambit? I don’t recommend it.

Other commenters have address Ullman’s other points, soI will let that conversation continue.

Commenter killbill then comes in with some solid anti-medicine propaganda.

While I am not personally an advocate of any particular form of medicine, it should be noted that the number one cause of death in the United States today is medical malpractice.

Modern western medicine kills people.

This has already been dealt with numerous times – such statistics only consider risk, not risk vs benefit, and is therefore useless.  Also, the sicker people are the more invasive and risky the treatments to help them, and therefore the higher the risk of unintended consequences. Harriet Hall deals nicely with this “medicine kills” fallacy.

Killbill then takes up the propaganda a notch.

Another thing to consider is this… when was the last time modern western medicine cured any sort of disease. Pretty much never.

Why?

Modern western medicine is driven by two things. Dollars and greed. There just is no money in a cure, but there sure is a lot of money in providing some drug that you need to take indefinitely.

Unless, of course, you count small pox, or any of the acute problems that can be corrected with surgery, or any potentially fatal infection that can be cured by antibiotics. Modern medicine cures diseases when we can. For many diseases the underlying cause is not yet curable, but the effects can be manage. Sure, we cannot turn a Type I diabetic into a non-diabetic(yet), but with medication they can lead a normal life. That’s pretty close to a cure.

There is a bias, however, in public perception that only “cures” are valuable. But this is simply not true. If the consequences of a disease can be significantly mitigated – life span increased, quality of life improved, functionality improved – that is highly valuable also. If you don’t think so – talk to any diabetic and see if they are grateful for their insulin, or any patient with severe seizures for their anti-seizure medication, or any patient with severe migraines for their migraine treatment.

Killbill plays the conspiracy card without any evidence – just naked propaganda. There is no big dark conspiracy (based on dollars and greed) to keep people sick. That is simply absurd – on many levels. First of all, doctors are actual real people, not comic-book villains. Second – there is a high degree of transparency in medical research and practice. No dark cabal can control medical information across multiple nations around the world. Further, the academics who conduct most of the research and set the standard of care are generally salaried, and make their money and reputation by improving the effectiveness of medicine – not treating patients.

Further – as a profession, doctors gain respect and patients by being successful. The more effective we are in treating illness the more money and respect we get – not less. Keep in mind overall there tends to be a shortage of doctors and an excess of demand. We are not hurting for business. Until we find the cure for everything, people will always get sick.

It would be hugely to our advantage to reduce the burden and cost of health care by curing chronic illness. That would free up resources for others who need it, and the demand would easily fill the vacancy. It would also take the stress off the health care system – and everybody would be better off, especially health care professionals – who are the worse hit financially from the rising cost of health care.

So, basically, every way you look at it, killbill’s assertion is absurd and at odds with the facts. It really is just made-up propaganda – but it is very common.

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