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Archive for April, 2010

Chemotherapy versus death from cancer

Editor’s Note: Having pivoted immediately (and dizzyingly) from attending NECSS and participating with John Snyder, Kimball Atwood, and Steve Novella in a panel on the infiltration of quackery into academia to heading down to Washington, DC for the AACR meeting, I’ve neglected my SBM duties a bit this week. After a packed day of talks at the AACR meeting followed by spending an evening with a friend whom I haven’t seen for a long time (complete with a trip to The Brickskeller), there’s–gasp!–no new material today. Because for some reason a decision was apparently made to cut our panel very short in order to get the conference back on schedule, we were unable to answer anywhere near as many questions from the audience as we had originally hoped, I was thinking of doing a post trying to answer a couple of the questions asked by audience members who came up to me after the panel terminated prematurely, because one of them was a particularly dicey situation. Maybe later this week. In the meantime, here’s something that I wrote about a year ago, which I tweaked a bit. It’s a very serious topic, but I think it appropriate because it discusses exactly what science-based medicine tries to prevent using evidence and what “alternative medicine” claims it can prevent based on no evidence.

I’ve written before about the Daniel Hauser case, a 13 year old boy who last year refused chemotherapy for his Hodgkin’s lymphoma, necessitating the involvement of the legal system. Cases like that of Daniel Hauser reprsent supreme “teachable” moments that–fortunately–don’t come along that often. The antivaccine movement, for instance, will be with us always (or at least, I fear, as long as I still walk this earth and beyond), but cases like that of Daniel Hauser tend to pop up only once every couple of years or even less. As tragic as they are, they always bring up so many issues that I have a hard time leaving them alone.

This time around, I wanted to touch on an issue that has come up frequently in the discussions of this case, and that’s the issue of chemotherapy. Specifically, it’s the issue of how horrible chemotherapy can be. Again, make no mistake about it, chemotherapy can be rough. Very rough. But what is often forgotten is that it can also be life-saving, particularly in the case of hematologic malignancies, where it is the primary therapy. What is also often forgotten or intentionally ignored by promoters of unscientific medicine is that doctors don’t use chemotherapy because they have some perverted love of “torturing” patients, because they’re in the pockets of big pharma and looking for cash, or because they are too lazy to find another way. They do it because, at least right now, it’s the best therapy science-based medicine has to offer, and in the case of Hodgkin’s lymphoma, for example, it’s life-saving. You can be sure that if a less harsh way were found to achieve the same results, physicians would jump all over it. Indeed, a major focuse of oncology research these days is to find less brutal regimens and improve the quality of life of cancer patients while still giving them the best shot at survival.
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Posted in: Cancer, Pharmaceuticals

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Homeopathy – Failing Randomized Controlled Trials Since 1835

I’m sad to say that this is the last day of World Homeopathy Awareness Week.  We’ve tried to give homeopathy its due honor, providing it the attention its practitioners clearly desire, while continuing to cover pertinent news in the world of homeopathy and providing a somewhat more sober, rational discussion of it on our homeopathy reference page.

Of course, most of this has not been news in the literal sense of the word.  There hasn’t been anything truly new in homeopathy since its invention (no, not discovery; discovery implies that something actually exists to be found) by Hahnemann in 1796.

Well, perhaps that’s not quite fair.  As our knowledge of reality (medicine, pharmacology, chemistry, physics, etc) has steadily improved, homeopathy’s plausibility has dwindled to the point of being indistinguishable from the roundest of numbers (0).  And I suppose the recent contortions of logic, abuses of legitimate science, and pure magical thinking put forth to protect homeopathy from the relentless assault of science are far more impressive than that laid out by Hahnemann.  So that’s news of a sort.

There’s also homeopathy’s long and rich tradition of abject failure in randomized controlled trials to consider.  The overwhelming mountain of evidence showing homeopathy to have no effect beyond placebo is impressive and definitive.  That’s data Hahnemann didn’t have, so that’s news too.

Each of these properly conducted studies and analyses demonstrates the scientific method’s utility to help us understand reality and protect us from our own delusions, but frankly, at this point they are about as exciting and useful as proving that the sun will rise in the east tomorrow morning.  News?  Not so much. (more…)

Posted in: Homeopathy

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The dangers of opponents of science-based medicine

Michael Specter, author of Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives, on the danger of science denial:

Given that more than half of the video is devoted to discussing vaccine denialism, supplements, and HIV/AIDS denialism, I think Spector’s talk is quite appropriate for this blog. Perhaps the best quote in Specter’s entire speech is this: “When you start down the road where belief in magic replaces evidence and science, you end up in a place where you don’t want to be.”

Unfortunately, for more and more of the population, it seems, when it comes to vaccines and “alternative” medicine that’s exactly where they’re going. They don’t want to be there, but unfortunately they won’t realize it until there there. They might not even realize it even then.

Unfortunately, society will.

Posted in: Herbs & Supplements, Science and Medicine, Vaccines

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Randi on World Homeopathy Awareness Week

World Homeopathy Awareness Week is fast coming to an end, unfortunately. And what would any sort of “homeopathy awareness” be without a commentary from James Randi? After all, Steve, Kimball, and I will be seeing Randi on Saturday as we participate in the SBM panel for NECSS:

We at SBM share with Randi his desire that people be aware of the true nature of homeopathy.

Posted in: Homeopathy

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Social Factors in Autism Diagnosis

There is no question that the incidence and prevalence of autism are on the rise. Starting in the early 1990s and continuing to today, there has been a steady rise in the number of children diagnosed with autism. Prior to 1990 the estimates of autism prevalence were about 3 per 10,000. The most recent estimates from the CDC and elsewhere now have the number at about 100 per 10,000, or 1%.

The burning question is – why are the rates increasing steadily? There are those, particularly in the anti-vaccine community, who conclude that the increase in prevalence is a real biological effect – an epidemic – and is evidence for an environmental cause (which they believe is vaccines, even though the scientific evidence does not support this position). However, the evidence strongly suggests that the rising prevalence of autism is largely an artifact of broadening the diagnosis and increased surveillance.

It should be noted that the data cannot rule out a small true increase in autism prevalence. Some hypothesize that increasing maternal and paternal age are contributing to the incidence of autism, but I will leave that question for another post.

A new study now adds significant support to the surveillance hypothesis – Ka‐Yuet Liu, Marissa King, and Peter S. Bearman from Columbia University, publishing in the American Journal of Sociology, report that the risk of being diagnosed with an autism spectrum disorder (ASD) correlates with social proximity to another family with a child with an ASD diagnosis. For those interested in this topic, the full paper is worth a read. While it gets technical at times, the authors do an excellent job of reviewing this topic in detail.

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Posted in: Neuroscience/Mental Health, Vaccines

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Breastfeeding Is Good but Maybe Not THAT Good

An article entitled “The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis,” by Bartick and Reinhold, was published in Pediatrics 2010 April 5. According to this news report, it showed that 900 babies’ lives and billions of dollars could be saved every year in the U.S. if we could get 90% of mothers to breastfeed for at least 6 months. It says breastfeeding has been shown to reduce the risk of stomach viruses, ear infections, asthma, juvenile diabetes, Sudden Infant Death Syndrome and even childhood leukemia.

This new study did not provide any new evidence. It simply took risk ratios from a three year old government report, extrapolated, and estimated the costs.
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Posted in: Nutrition

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A homeopathy supporter notices our visit with the director of NCCAM

On April 2, Steve Novella, Kimball Atwood, and I visited the National Center for Complementary and Alternative Medicine (NCCAM) to meet with its director, Dr. Josephine Briggs. I’m not going to rehash what was said because we agreed that Steve would handle that task, and he did so admirably last week. I agree with Steve that it was encouraging that Dr. Briggs apparently reads this blog and shares many of our concerns about NCCAM, the poor science that it has funded, and its use by promoters of unscientific medicine to promote their quackery. Most heartening of all was that she appeared to recognize how much CAM is infused with anti-vaccine beliefs and, worse, the promotion of these beliefs to the detriment of public health.

Those positive reactions to what was a friendly but frank exchange of views notwithstanding, as we were sitting in a conference room next to Dr. Briggs’ office, I couldn’t help but wonder what the reaction of CAM promoters would be when they found out about this meeting. Now I know. John Weeks over at The Integrator Blog is not happy:

Novella’s posting reads like a Fox News interview: 95% his team’s point, then a brief NCCAM response. That Briggs asked for the meeting likely grew out of an early March conference at Yale at which Novella and she both participated. For this, she deserves the Barack Obama Big Tent award for her proven interest in sitting down with everyone, no matter which party affiliation or belief. (Some have said this was proven in early 2008 when Briggs met with me.) Arguably, Briggs takes her openness to dialogue further than the President. While Obama has kept arms length from leaders who call for the demise of the United States, Briggs has now met with those who have been lobbing bombs at her professional home for years, calling steadily for NCCAM’s destruction.

Because our previous calls for the closing of a relatively small government institute because we view it as a poor use of taxpayer money is just like calling for the downfall of the United States government. Weeks clearly likes ridiculously overblown hyperbole. Interestingly enough, what appeared to upset Mr. Weeks the most was our discussion of homeopathy with Dr. Briggs. As Steve put it:
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Posted in: Clinical Trials, Homeopathy, Medical Academia

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Steven Higgs: Another antivaccine reporter like Dan Olmsted in the making?

April is National Autism Awareness Month, and as of today April is nearly half over. Do you notice anything different compared to the last couple of years? I do. Can you guess what it is?

The anti-vaccine movement’s usual suspects haven’t been all over the mainstream media, as they usually are this time every year, often as early as April 1 or even March 31. In fact, over the last couple of years I had come to dread April 1, not because it’s April Fools’ Day (although the things that made me dread that particular day were often indistinguishable from an April Fools’ Day prank, so full of idiocy were they), but rather the expected carpet bombing of the media by the likes of Jenny McCarthy, J. B. Handley, and their ilk, some or all of whom would show up on various talk shows to spread their propaganda that vaccines cause autism. For instance, last year Jenny McCarthy and her former boyfriend Jim Carrey showed up on Larry King Live! with Dr. Jerry Kartzinel (her co-author on her latest book of autism quackery) and J. B. Handley, the last of whom even contributed a guest post on Larry King’s blog, in which he touted an incredibly bad, pseudoscientific “study” commissioned by Generation Rescue. The “study” (and calling it a “study” is way too generous) was no more than cherry-picked random bits of data twisted together into a pretzel of nonsense, as I described. Around the same time, Jenny McCarthy was interviewed by TIME Magazine, an interview in which she uttered these infamous words:

I do believe sadly it’s going to take some diseases coming back to realize that we need to change and develop vaccines that are safe. If the vaccine companies are not listening to us, it’s their fucking fault that the diseases are coming back. They’re making a product that’s shit. If you give us a safe vaccine, we’ll use it. It shouldn’t be polio versus autism.

Soon after, Generation Rescue created a website called Fourteen Studies, which they promoted hither, thither, and yon. The idea of the website was to attack the main studies that failed to find a link between vaccines and autism and to promote the pseudoscientific studies that anti-vaccinationists like. In 2008, it was pretty much the same — well, worse, even. When she appeared on Larry King Live! with our old “friend,” anti-vaccine pediatrician to the stars, Dr. Jay Gordon, McCarthy shouted down real experts by yelling, “Bullshit!” (behavior trumpeted by Rachel Sklar of the Huffington Post).

This year? Oddly enough (and to me unexpectedly), there’s been almost nothing. J.B. Handley seems to be the man who wasn’t there. Well, not quite. It turns out that J. B. Handley has managed to get a little bit of fawning media attention, but just a little bit, in the form of an interview in The Bloomington Alternative entitled J. B. Handley: It’s unequivocal; vaccines hurt some kids. Apparently Mr. Handley has come down quite a bit in the world. Where’s his appearance with Jenny on Larry King Live! this year? Maybe it’s coming in the second half of the month. Or maybe the mainstream media, in the wake of the fall of Andrew Wakefield, have finally figured out how disreputable Generation Rescue is when it comes to vaccines. In the meantime Steven Higgs will have to do as a new mouthpiece for the anti-vaccine movement.

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Posted in: Neuroscience/Mental Health, Science and the Media, Vaccines

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In honor of World Homeopathy Awareness Week 2010, part 2

As I pointed out yesterday, World Homeopathy Awareness Week began yesterday. One common question that’s asked about homeopathy goes something like this: If homeopathy is just water, then what’s the harm?

Here’s the harm:

Part 1

Part 2

Homeopathy is magical thinking, far more religious or superstitious in nature than medical or scientific. And this form of magical thinking can lead people people to eschew effective medical therapy, with tragic results.

Posted in: Homeopathy

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In honor of World Homeopathy Awareness Week 2010

Today, April 10, is the first day of World Homeopathy Awareness Week (WHAW), or, as I like to call it, World Sympathetic Magic Awareness Week. This week long “celebration” runs from today until April 16. Now, given the dim view of homeopathy which, I daresay, each and every blogger here at SBM shares, you’d think I wouldn’t want people to pay attention to WHAW. Nothing could be further from the truth. It is because I view homeopathy as nothing more than quackery based on magical thinking that I actually want people to be aware of it, starting with some of the more amusing bits that homeopaths have published over the last year. Like this bit:

Which Steve discussed here, and Orac had some fun with here. (Steve’s deconstruction of Benneth’s nonsense brought responses calling him a hypocrite, a Nazi or a “slave breaker.”)

Or this bit:
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Posted in: Homeopathy, Humor

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