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Archive for October, 2008

51 “Facts” About Homeopathy

Get your facts first, and then you can distort them as much as you please.

—- Mark Twain

I use a Mac, so I know I think different. I also coexist on an alternative parallel world where people live on the same planet as me, but have such a radically different way of thinking that I wonder if we have the same ability to evaluate reality (1).

The best example of different ways of seeing the same thing is homeopathy. Homeopathy is utterly and completely ridiculous with zero plausibility or efficacy. Only therapeutic touch is its rival. Yet homeopath Louise Mclean can suggest there are 50 facts that validate homeopathy (2). These facts were presented as an attempt to counter criticism that homeopathy is only water with no therapeutic effects.

Lets evaluate each fact. There are two parts to the evaluations: whether the fact is true and what, if any, logical fallacy is being used. Deciding on which logical fallacy is being used is not my strong point, feel free to correct me in the comments, and I will add to the text later.
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Posted in: Health Fraud, Homeopathy

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When Further Research Is NOT Warranted: The “Wisdom of Crowds” Fallacy

Most scientific research studies have at least one thing in common: the conclusion section ends with, “further research is warranted.” I’d say it’s about as common as the “talk to your doctor” disclaimer in TV ads for pharmaceutical products. And in a way, they both serve the same purpose. They’re a “CYA” move.

What does “further research is warranted” mean in plain English? I think it can be roughly translated: “My research study is not of the size or scope to fully explain all the phenomena described in this article. Therefore, draw conclusions beyond the data and study methods at your own risk. And yeah, my work is important and cool – so people should study it further.”

Of course, the first two sentences are reasonable – we should always remember not to draw conclusions beyond the information provided by the data we’ve collected (even though that’s about as challenging as getting a beagle not to eat a table scrap in an empty room). The real problem is the third sentence. Is the research promising enough to require further investment? How are we to know if further research is indeed warranted? I would argue that it should not be based solely on the subjective opinions of the researchers nor the popularity of the research topic to the general public. (more…)

Posted in: Clinical Trials, General, Science and Medicine

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Interpreting the Medical Literature

The science in science-based medicine includes all of science, but relies most heavily on the biomedical literature – published studies that collectively represent our scientific medical knowledge. The scientific basis of medicine is only as good as this body of knowledge and the manner in which it is interpreted and put into practice.

We often discuss on this blog how to evaluate individual studies- the need for blinding, randomization, the importance of study size to meaningful statistical analysis, and other features that distinguish a reliable study from a worthless one. This is important, but only half of the equation. We also at times discuss the medical literature as it relates to a specific medical question or set of related questions – does homeopathy work or are statins beneficial for cholesterol reduction, for example. This requires not only the ability to judge individual studies, but a higher order analysis of the overall pattern of evidence among all relevant studies. Failure to do this, by focusing only on individual studies, results in the failure to see the forest for the trees.

It is this higher order analysis that I wish to discuss in this entry.

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Posted in: Clinical Trials, Science and Medicine

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Puncturing the Acupuncture Myth

Note: This is slightly revised from an article I originally wrote as a “SkepDoc” column for Skeptic magazine. It was pre-released online in eSkeptic and it has already generated a lot of comments, including “a truly amazing piece of peurile pseudo-intellectualism,” “an ad hominem attack on one form of alternative medicine so beset by poor thinking that one must come to the conclusion this woman might just be paid to write such propaganda,” and “twaddle wrapped in swaddling rhetoric.” (I treasure comments like those as evidence that my critics are so bankrupt of real arguments that they have to dip into the insult pouch for ammunition.)  I thought it would be interesting to post it here on the blog and see how much controversy it would stir up among my co-bloggers and readers.  Please keep in mind that it was written for a popular audience and excuse the lack of scholarly citations. You may recognize some of the studies I refer to from previous blog entries.

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“Alternative” medicine is by definition medicine that has not been scientifically proven and has not been accepted into mainstream scientific medicine. The question I keep hearing is, “But what about acupuncture? It’s been proven to work, it’s supported by lots of good research, more and more doctors are using it, and insurance companies even pay for it.”

It’s time the acupuncture myth was punctured – preferably with an acupuncture needle. Almost everything you’ve heard about acupuncture is wrong. (more…)

Posted in: Acupuncture

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When compassion is outshined by ignorance

In a media-saturated society, public figures have a disproportionate influence on people’s understanding of science and medicine. Most patients see their doctor no more than a couple of times a year, but they watch TV, go online, or read a paper daily. In our newspapers and in our news rooms, dedicated science reporters are becoming vanishingly rare.   A wide range of news sources seep into this gap, but perhaps one of the most unfortunate is the “celebrity health expert”.

Uninformed statements from celebrities are nothing new, but when the queen of the antivaccination movement gets to call someone else stupid, that’s news.

Comedian Dennis Leary did little to advance the cause of humor or medical knowledge when he wrote this:

“There is a huge boom in autism right now because inattentive mothers and competitive dads want an explanation for why their dumb-ass kids can’t compete academically, so they throw money into the happy laps of shrinks . . . to get back diagnoses that help explain away the deficiencies of their junior morons. I don’t give a [bleep] what these crackerjack whack jobs tell you – yer kid is NOT autistic. He’s just stupid. Or lazy. Or both.”

There is no “autism epidemic” as such, but there sure is a lot of ink spilled in ignorance, and Leary certainly seems to have a surfeit of that.  But never fear, Jenny McCarthy will come to the rescue of autistic folks everywhere.

“My fight isn’t with Denis Leary, my fight is with the government — a bigger fish to fry. So I’m still gonna work on the vaccines and I’m still working on pediatricians and Denis Leary can go hopefully be more educated by every mother that stops him from this day forward to give him a piece of their mind,” she said.

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Posted in: Science and the Media, Vaccines

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Dr. Jay Gordon and me: Random encounters with an apologist for the antivaccine movement

27452983Although he doesn’t detest me nearly as much as antivaccine honcho and founder of Generation Rescue J. B. Handley does, Santa Monica celebrity pediatrician Dr. Jay Gordon doesn’t like me very much at all.

Actually, I’m not sure whether that’s entirely true or not, but Dr. Gordon sure doesn’t like it when I criticize him for his antivaccine rhetoric. He affects an oh-so-wounded posture and self-righteously assures me that he is not “anti-vaccine” and that it is “beneath me” to use such rhetoric against him. Whether such rhetoric is “beneath me” or not, however, I’ve never quite understood why Dr. Gordon gets so upset at when I describe him as “anti-vaccine.” After all, his words are frequently apologetics for the anti-vaccine movement, and his actions frequently give it aid and comfort. After all, he is Jenny McCarthy‘s son Evan’s pediatrician, and as a result of that connection he has been giving speeches to antivaccine rallies, such as the “Green Our Vaccines” rally in Washington, D.C. in June. (He is the man in the sunglasses behind Jim Carrey in the picture at the top of this post by me.) After all, he has been palling around with luminaries of the antivaccine movement, such as Jenny McCarthy and her boyfriend Jim Carrey, the aforementioned J. B. Handley, Robert F. Kennedy, Jr., Boyd Haley, and numerous others at events like the “Green Our Vaccines” rally.

But, above all, over the last three or four years, Dr. Gordon has become the go-to pediatrician that the media seemingly always wants to interview when a vaccine “skeptic” with an MD after his name is required to provide the “balance” that journalists worship above all else, even when that “balance” gives undue credence to pseudoscientific nonsense. He clearly relishes that role, too, most infamously on his appearance with Jenny McCarthy on Larry King Live!, in which McCarthy shouted down pro-vaccine physicians and yelled “Bullshit!” (as if she who yells the loudest and is the most foul-mouthed wins the debate) and as evidenced by his appearances on certain antivaccination mailing lists, from which messages are occasionally forwarded to me.

What else am I supposed to think, except that Dr. Jay is at the very least an apologist for the antivaccine fringe, if not a card-carrying member himself?

Unfortunately, Dr. Gordon strikes me as being mostly a nice guy. I say “unfortunately” because it would be much easier to be as harsh on him as his promotion of antivaccine pseudoscience deserves if he were not. He also clearly believes that he is right based on the evidence. Based on science and clinical evidence, he most definitely is not. Recently, I had decided more or less to lay off him for a while, so as to avoid the wounded cries that invariably accompany valid charges that he is an apologist for the antivaccine fringe. Also, I felt kind of bad beating up on him so regularly and thought that perhaps a respite was in order. Then I found out that Dr. Gordon wrote the foreword to Jenny McCarthy’s new antivaccine and pro-autism quackery book, Mother Warriors: A Nation of Parents Healing Autism Against All Odds. Then, one of my readers actually took the time to transcribe Dr. Gordon’s foreword and e-mail it to me.

I read it, and I was appalled.
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Posted in: Neuroscience/Mental Health, Public Health, Science and the Media, Vaccines

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A New Twist for Autism: A Bogus “Biomedical” Board

Here’s a short addition to the topic of Pseudomedical Pseudoprofessional Organizations (PPOs).† New pseudo-board-certification schemes pop up like mushrooms after a spring rain, but just last week there was an announcement of one with a difference:

The American Medical Autism Board

AMAB offers the first of its kind board/diplomate certification program for medical doctors specializing in biomedical treatment of autism and related disorders. These disorders are known collectively as the Autism Spectrum Disorders (ASD). Thus, medical doctors who become certified by the American Medical Autism Board show that they specialize in biomedical treatment of ASD, and will have met the Board’s high levels of criteria for training and experience, and will have passed its rigorous certification examination.

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Posted in: Health Fraud, Politics and Regulation, Science and Medicine

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The Pseudomedical Pseudoprofessional Organization (PPO*)

(*Not to be confused with “Preferred Provider Organization,” which shares the acronym)

This is part of an ongoing series† discussing pitfalls of regulating physicians, but I’ve decided, in the interest of flexibility, to vary the title. A couple of weeks ago I gave some examples of how individual physicians practicing substandard, implausible medicine manage to avoid or delay being disciplined by state medical boards. I observed that the boards themselves seem reluctant or slow to act against such practices, even those that are illegal, and that this stands in contrast to their prompt actions against other types of malfeasance: those of the “low-hanging fruit” variety. In a comment, David Gorski reminded me that he had previously offered a few reasons for that discrepancy, with which I agree. Nevertheless, it seems odd that state boards don’t do better.

In an attempt to find more explanations, this week we’ll look at another tactic of practitioners of pseudomedicine: banding together to create pseudomedical pseudoprofessional organizations (PPOs), complete with pseudo-legitimate names, pseudo-legitimate conferences, pseudo-legitimate appearing websites, pseudo-”board certifications,” protocols for pseudo-therapies, patient brochures hyping pseudo-therapies, pseudo-consent forms for pseudo-therapies, pseudo-Institutional Review Boards to approve pseudo-research, pseudo-journals to publish reports of pseudo-research, very real financial contributions from pseudoscientific corporations to help pay for very real advertising, very real lobbying, very real legal representation, and more.

There are many more PPOs than we’ll be able to examine, but they have common features. We’ll also look at how some Institutions That Should Know Better respond to PPOs, which can be frightening. (more…)

Posted in: Health Fraud, Politics and Regulation, Science and Medicine

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Getting It On with Homeopathy

I have more thoughts on the homeopathy matter than fit in follow-up notes, so here goes.

First, David Gorski recalls the 1994 Pediatrics report on childhood diarrhea treated with tailored homeopathic remedies for each patient. There is more to the story than has been written. I am certain much of this will get back to the authors, but others may benefit from knowing how this group of homeopaths operate.

I recall the paper well, because it was the first journal report that I deconstructed and published (Pediatrics, Oct 1995) as a regular article. I think it was the first time the journal had published a formal rebuttal outside the Letters section. The head of pediatric pharmacy at Valley Medical Center, San Jose, brought the paper to me and asked what I thought if it. Bill London of National Council against Health Fraud and I spent six months discussing it and working over the details.

The paper had so many flaws, that one letter could not contain them. It had five or six end points, several arithmetical errors, graphs with missing data, only one end point reached consensus signficance (barely.)

Each case received a remedy tailored to the age, condition, duration of symptoms, appearance and odor of the stool, the recall of the parent or relative about stool frequency (which depended on how often the child’s diapers were changed, and a number of other qualities, typical of a homeopathic approach to diagnosis. The remedies given were not based on etiology, but based on personal observations, We saw that the remedy was chosen at a snapshot in time, depending on all those factors which varied from hour to hour. So the remedies depended on the time at which the child was brought in for examination and were unchanged throughout the duration of illness. That made no sense at all. Besides, the specific remedies had no data behind them for proof of efficacy, and were chosen on basis of charts and computer references.

One could hardly find anything about the paper that would lend credibility to its conclusion that suggested homeopathy “worked“ better than placebo. The results in our opinion demonstrated nothing more than the variations in the clinical trial system (noise.)
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Posted in: Clinical Trials, Homeopathy, Science and Medicine

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Disintegrating Integrative Medicine: Lessons From Baking

Suppose I were to bake you a cake and my ingredient list included the following:

  • Eggs
  • Milk
  • Butter
  • Sand
  • Flour
  • Baking Powder
  • Vanilla
  • Melamine
  • Sugar
  • Chocolate icing

What is the problem with the ingredient list? It has integrated inedible and poisonous items into the very fine basic ingredients that make a good cake. This is the exact same problem that the medical profession faces with the “integrative medicine” movement. Insofar as it espouses and promotes well-vetted, healthy ingredients, it is a boon to patients. But when inordinate emphasis is placed on placebos (“sand”) or when dangerous practices (“melamine”) are inserted into the prescription for our patients’ “health and wellness,” that attractive-appearing cake becomes a recipe for disaster.

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Posted in: General, Science and Medicine

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