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Archive for October, 2010

High Dose Flu Vaccine for the Elderly

Dr. Novella  has recently written about this year’s seasonal flu vaccine and Dr. Crislip has reviewed the evidence for flu vaccine efficacy.

There’s one little wrinkle that they didn’t address — one that I’m more attuned to because I’m older than they are.  I got my Medicare card last summer, so I am now officially one of the elderly. A recent review by Goodwin et al. showed that the antibody response to flu vaccines is significantly lower in the elderly.  They called for a more immunogenic vaccine formulation for that age group. My age group.

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Posted in: Vaccines

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Joe Mercola and Barbara Loe Fisher declare November 1-6, 2010 “Vaccine Awareness Week”? Not so fast!

As I pointed out earlier, a rare thing happened this week, namely I don’t have a full post ready for Science-Based Medicine because I’m at the Lorne Trottier Symposium. Not only have the organizers have packed my day with skeptical and science goodness, but I only have Internet access when I’m back at the hotel, which isn’t very often. I suppose I could pay outrageous international roaming charges by activating international roaming on my iPhone, but why on earth would I do that except in urgent circumstances? Fortunately, David Ramey stepped in with his usual excellent work.

The trials and tribulations of actually trying to do more than be at home, work, and blog aside, I couldn’t let this one pass. The ever-observant Mark Crislip sent his fellow SBM bloggers this little tidbit from the website of that well-known promoter of quackery Joe Mercola. Buried near the bottom of Mercola’s “newsletter” is an announcement of this intriguing (from a blog fodder perspective) initiative:

Mercola.com & NVIC Dedicating November 1-6 Vaccine Awareness Week

In a long-scheduled joint effort to raise public awareness about important vaccination issues during the week of November 1-6, 2010, Mercola.com and NVIC will publish a series of articles and interviews on vaccine topics of interest to Mercola.com newsletter subscribers and NVIC Vaccine E-newsletter readers.

The week-long public awareness program will also raise funds for NVIC, a non-profit charity that has been working for more than two decades to prevent vaccine injuries and deaths through public education and protecting informed consent to vaccination.

The November 1-6 Vaccine Awareness Week hosted by Mercola.com and NVIC will follow a month-long vaccine awareness effort in October that was recently announced on Facebook by parents highlighting Gardasil vaccine risks.

The six-week-long focus this fall on vaccine issues will help raise the consciousness of many more Americans, who may be unaware that they can take an active role in helping to prevent vaccine injuries and deaths and defend the legal right to make voluntary vaccination choices.

And remember, you can always visit Vaccines.Mercola.com and NVIC.org for the latest vaccine news updates and other important vaccine information.

“Six week” focus? Methinks Dr. Mercola meant “six days.”
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Posted in: Vaccines

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Acupuncture and history: The “ancient” therapy that’s been around for several decades

Make the lie big, make it simple, keep saying it, and eventually they will believe it

– A. Hitler

It seems that just about every article about acupuncture makes some reference to it having been used in China for thousands of years. The obvious reason for such a statement is to make the implication that since it’s been around for so long, it must therefore also be effective. Of course, longevity doesn’t argue for efficacy, otherwise everyone would likely agree that astrology is the way to chart one’s life; astrology has been practiced for many more years than acupuncture.

What’s maddening about the acupuncture longevity myth is that it isn’t true, and demonstrably so. In human medicine, “needling” was illustrated in the 17th century by western observers: no points, no “meridians,” just a big awl-like “needle,” driven in with an ivory-handled circular hammer. In addition, the rationale for hammering these little spikes into various spots (of the practitioner’s choosing) was said to be “exactly the same” as Greek humoral medicine (see, Carruba, RW, Bowers, JZ. The Western World’s First Detailed Treatise on Acupuncture: Willem ten Rhijne’s De Acupunctura. J Hist Med Allied Sci (1974) XXIX (4): 371-398).
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Posted in: Acupuncture, History

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At the Lorne Trottier Symposium…

I have to apologize. There won’t be one of my usual epic posts this week. Fear not, however. I did get another SBM blogger to pinch hit for me in a post that will appear later today. I also had time to write a quick post announcing an initiative we here at SBM are planning for early November.

The reason for the rare occasion of my missing a week, of course, is that I’m participating in the 2010 Lorne Trottier Public Science Symposium in Montreal. Between all the travel, a two hour roundtable discussion featuring Michael Shermer, Ben Goldacre, and yours truly, among others, all organized by the McGill University’s Office for Science and Society. The event was videotaped, and a webcast of the event will be available, as will a webcast of our talks tomorrow. You can trust that I will certainly post links to them after they have been posted on the McGill website, in particular the symposium itself, so you can for yourselves see how much better speakers Michael Shermer and Ben Goldacre are when compared to me.

I’ll also be on the radio on CJAD AM 800 at 10 AM Monday morning with Michael Shermer and “Dr. Joe” Schwarcz to talk about pseudoscience in medicine and other areas.

Yes, I’m having a blast here, having had the opportunity at a leisurely dinner to discuss differences between the quackery situation in England compared to the U.S. and to meet Lorne Trottier. Now I have to fine tune my talk for tomorrow, and it’s late. Oh, well…

Posted in: Announcements, Science and Medicine, Science and the Media

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Uff Da! The Mayo Clinic Shills for Snake Oil

A couple of weeks ago, in a review of the Mayo Clinic Book of Home Remedies, Harriet Hall expressed relief that she hadn’t found any “questionable recommendations for complementary & alternative medicine (CAM) treatments” in that book:

Since “quackademic” medicine is infiltrating our best institutions and organizations, I wasn’t sure I could trust even the prestigious Mayo Clinic.

The Home Remedies book may be free of woo, but Dr. Hall was right to wonder if she could trust the Mayo Clinic. About a year ago I was asked to comment on an article in the American Journal of Hematology (AJH), in which investigators from the Mayo Clinic reported that among a cohort of lymphoma patients who were “CAM” users,

There was a general lack of knowledge about forms of CAM, and about potential risks associated with specific types of CAM…

This suggests the need to improve access to evidence-based information regarding CAM to all patients with lymphoma.

No surprise, that, but I couldn’t help calling attention to the paradox of one hand of the Mayo Clinic having issued that report even as the other was contributing to such ignorance:

The Mayo Clinic Book of Alternative Medicine details dozens of natural therapies that have worked safely for many patients in treating 20 top health issues. You may be surprised that Mayo Clinic now urges you and your doctor to consider yoga, garlic, acupuncture, dietary supplements and other natural therapies. Yet the record is clear. Many of these alternative therapies can help you achieve reduced arthritis pain, healthier coronary arteries, improved diabetes management, better memory function and more.

Mayo Clinic cover

Nor could such a paradox be explained by the right hand not having known what the left was doing: Brent Bauer, MD, the Director of the Mayo Clinic Complementary and Integrative Medicine Program, is both the medical editor of the Book of Alternative Medicine (MCBAM) and a co-author of the article in the AJH.

As chance would have it, I had picked up a copy of the latest (2011) edition of the MCBAM only a couple of days before Dr. Hall’s post. Does it live up to its promises? Do its “straight answers from the world’s leading medical experts” respond to “the need to improve access to evidence-based information regarding CAM?” Let’s find out. In some cases I’ll state the implied questions and provide the straight answers.

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Posted in: Acupuncture, Book & movie reviews, Chiropractic, Energy Medicine, Health Fraud, Homeopathy, Medical Academia, Medical Ethics, Naturopathy, Science and Medicine, Science and the Media

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The Cargo Cult of Acupuncture

Bloodletting, of course, was a major aim of early vessel therapy and is frequently described in the Su wen.1

Paul U Unschuld

“Cargo cult” is a metaphor that describes the act of imitating an activity or a practice without any insight into the underlying principles. In the literal sense, it refers to a magico-religious practice observed in tribal societies, where the members ritually imitate the activities of a technologically-advanced society they had contact with, so that they can magically draw their material wealth. For instance, after WWII, indigenous tribes in New Guinea who had come in close contact with cargo planes, started to build landing strips and populated them with plane-like effigies that were made of straw, bamboo, and coconuts, so that they can magically lure the passing planes.2 The term “cargo cult science” was introduced by Richard Feynman in a speech at Caltech in 1974 to describe pseudoscientific studies in which all the superficial aspects of a scientific inquiry are adhered to, but the underlying principles are not scientific. He classified many educational and psychological studies as such, for having the appearance of academic research but lacking the principles of a scientific inquiry.3

Another example of cargo cult science is the plethora of two-arm acupuncture studies that compare a needling regimen using the traditional concepts, and compare it with a non-interventional placebo. These studies might have the appearance of clinical research, but they are inherently flawed and inconclusive, because they do not rule out the possibility that the observed results are mainly due to the painful stimulus and injury caused by a needle, which can occur regardless of the insertion point. Indeed, an acute noxious stimulus from a prickle, heat, or any other painful stimulus – almost anywhere on the skin – can attenuate the perception of pain in another area of the body through a reflex called “counter-irritation,” also called the “pain-inhibiting-pain effect” or “diffuse noxious inhibitory control” (DNIC).4 DNIC was extensively studied by Fauve et al. in the 1980s, who showed in mice that it has an effect equivalent or superior to that of glucocorticoids.5,6
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Posted in: Acupuncture, Medical Academia, Science and Medicine

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What’s The Harm?

Any promoter of science-based medicine often faces the question – what’s the harm? What is the harm if people try treatment modalities that are not based upon good science, that are anecdotal, or provide only a placebo benefit? There are generally two premises to this question. The first is that most “alternative” placebo interventions are directly harmless. The second is that direct harm is the only type worth considering. Both of these premises are wrong.

The pages of SBM are filled with accounts of direct harm from unscientific treatments: argyria from colloidal silver, death from chelation therapy, infection or other complications from acupuncture, burns from ear candling, stroke from chiropractic neck manipulation – the list goes on. You can read anecdotal accounts of such harm on the website, whatstheharm.net. Of course, as we often point out, harm and risk is only one end of the equation – one must also consider benefit. It is the risk/benefit ratio of an intervention that is important. But generally we are talking about interventions that lack any evidence for benefit, and therefore any risk of harm is arguably unacceptable.

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Posted in: Public Health, Science and Medicine

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Science and Morality

I have frequently said that science can only provide data to inform our decisions but can’t tell us what we “should” do; that it can determine facts but not values. I stand corrected. A persuasive new book by Sam Harris, The Moral Landscape,  has convinced me that science can and should determine what is moral. In fact, it is a more reliable guide than any other option.

The Moral Landscape

Several recent books have looked at morality from a scientific viewpoint. Animals have been shown to exercise altruism and to appreciate fairness. Human cooperation has been shown to offer a survival advantage to individuals and groups. Game theory has demonstrated the success of the tit-for-tat strategy. In The Science of Good and Evil,  Michael Shermer argues that evolution has produced in us a moral sense that is not a reflection of some “absolute” morality but that constitutes a worthy human project that transcends individuals. He posits a pyramid of morality that becomes more advanced as it is applied to larger in-groups, from self to family to community to all living creatures. He amends the Golden Rule to specify that we should treat others not as we want to be treated but as others want to be treated.  (more…)

Posted in: Book & movie reviews, General

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Oprah’s buddy Dr. Christiane Northrup and breast thermography: The opportunistic promotion of quackery

Fibrocystic breasts

As many readers know, October is Breast Cancer Awareness Month. What that generally means at our cancer center and in the rest of the “real world” is that, during the month of October, extra effort is made to try to raise awareness of breast cancer, to raise money for research, and promote screening for cancer. Unfortunately, what Breast Cancer Awareness Month means around the Science-Based Medicine blog is that a lot of breast cancer-related pseudoscience and outright quackery will be coming at us fast and furious. There’s no way, of course, that I can deal with it all, but there’s one area of medical pseudoscience related to breast cancer that I just realized that none of us has written about on SBM yet. Actually, it’s not really pseudoscience. At least, the specific technology isn’t. What is pseudoscience is the way it’s applied to breast cancer and in particular the way so many “alternative” medicine and “complementary and alternative medicine” (CAM) practitioners market this technology to women. The technology is breast thermography, and the claim is that it’s far better than mammography for the early detection of breast cancer, that it detects cancer far earlier.

I’ve actually been meaning to write about thermography, the dubious claims made for it with regard to breast cancer, and the even more dubious ways that it’s marketed to women. In retrospect, I can’t believe that I haven’t done so yet. The impetus that finally prodded me to get off my posterior and take this on came from what at the time was an unexpected place but in retrospect shouldn’t have been. You’ve met her before quite recently when SBM partner in crime Peter Lipson took her apart for parroting anti-vaccine views and even citing as one of her sources anti-vaccine activist Sherri Tenpenny. I’m referring, unfortunately, to one of Oprah Winfrey’s stable of dubious doctors, Dr. Christiane Northrup. Sadly, Peter’s example of her promotion of vaccine pseudoscience is not the first time we at SBM have caught Dr. Northrup espousing anti-vaccine views. We’ve also harshly criticized her for her promotion of “bioidentical hormones” and various dubious thyroid treatments. However, Dr. Northrup is perhaps most (in)famous for her advocating on Oprah’s show the use of Qi Gong to direct qi to the vagina, there apparently to cure all manner of female ills and promote fantastic orgasms in the process. This little incident ought to tell you nearly all that you need to know about her. Even Oprah looked rather embarrassed in the video in which Dr. Northrup led her audience in directing all that qi goodness “down below.”

What brought Dr. Northrup to my attention again was my having joined her e-mail list. As you might imagine, I’m on a lot of e-mail lists, ranging from that of Mike Adams, to Generation Rescue, to Joe Mercola and beyond. I do it all for you, in order to have the blogging material come to me rather than my having to seek it out. True, the price is that my e-mail in box is frequently clogged with quackery, but it’s a small price to pay. This time around, Dr. Northrup’s e-mail brought my attention to a post of hers, Best Breast Test: The Promise of Thermography. It was truly painful to read, and I consider it inexcusable that someone who claims to be an advocate of “women’s health” could write something that reveals such ignorance. But, then, I suppose I shouldn’t be surprised after her recent flirtation with anti-vaccine views. If it isn’t already complete, Dr. Northrup’s journey to the Dark Side is damned close to complete. You’ll see what I mean right from her very introduction:
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Posted in: Cancer, Public Health

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Reflexology. Insert Nancy Sinatra Reference Here.

In the last post on acupuncture, I noted that the University of Maryland offered reflexology along with other supplements, and complementary and alternative medicine (SCAMs). I was uncertain as to the particulars of this SCAM, and this post is a result of those investigations.

Although messy in reality, science is a tool that gives us an idea as to how the real world functions. People will observe some aspect of nature, often for a lifetime, and from those observations discover a pattern in the data. Tycho Brahe spent a life carefully measuring the orbits of the planets; the data was used later by Kepler to determine that the planets orbit in an ellipse with the sun at one of the foci. If you have knowledge of the history of science, you realize what an amazing feat this represents, both in the measurement of the orbits and the analysis of the data. Careful observation, analysis of the data, then conclusions.

This is in contrast to SCAMs, where so many of the interventions are discovered by revelation, and then developed independently of data and observation. Palmer and chiropractic, von Peczely and iridology, Usui and reiki are examples. These geniuses discovered aspects of existence unseen by anyone before or after.

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Posted in: Energy Medicine, Science and Medicine

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