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Archive for October, 2010

Pat Schroeder’s endorsement of Rage Reduction Therapy: The Cult of the Celebrity Strikes Again

We all know that misguided celebrities, such as Jenny McCarthy, Oprah, Prince Charles, and Arianna Huffington, pose considerable public health threats. Few know that arguably the most vile form of quackery has been getting the thumbs up from a celebrity hailing from the most rarified heights of power and influence — Representative Patricia Schroeder (D-CO, 1973-1997).

The practice I’m referring to is “Rage Reduction.” This practice, popular for decades in adoption and foster care circles, claims to help children develop the capacity to love and become attached to their new caregivers. Practitioners believe these children suffer from “Attachment Disorder” because of early abuse and neglect. Typical of quackery, this unrecognized diagnosis consists of an absurdly long catch-all list of signs used to ensnare any child. (Even good behavior is interpreted as sneaky manipulation of parents.)

In a Rage Reduction therapy session, a child is restrained by a therapist – usually a licensed psychologist or social worker – plus one or more assistants. The therapist “activates” a child by yelling, belittling, threatening, relentlessly tickling, bouncing the child’s head, covering his mouth, and painfully knuckling the child’s rib cage and sternum. Such sessions typically go on for two or more hours, until the child is exhausted from struggling and becomes, as one psychologist observed, “a whimpering little puddle.” Children, even teenagers, are then swaddled and given a baby bottle by their adopted mother for “bonding time.”
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Posted in: Science and Medicine

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Do you have low T?

If you google “low testosterone” you’ll see lots of ads for testosterone replacement.  Some are from pharmaceutical companies that sell testosterone, others from obvious snake-oil salesmen.

Both types of ads list vague sets of symptoms, encourage you to believe that they are pathologic, and want to sell you something to make you better.  For example, the pharmaceutical company Solvay gives you a handy guide for speaking to your doctor, and a quiz to see if you have “low T”.  The quiz asks some questions that may be useful, but also asks very general questions about your sense of well being, and includes this gem:

I don’t feel sick, I just don’t feel like myself anymore. Could I have Low T?

The ad then gives this advice:

Because Low T signs and symptoms may not be clear and apparent, they may seem to be a normal part of aging or assumed to be caused by other health conditions. But talk to your doctor if you have symptoms of Low T. And ask to get tested. All it takes is a simple blood test that can be done during a routine checkup. If you do have Low T, your doctor may recommend treatments that can help bring testosterone up to normal levels and keep them there.

If you have diabetes, you should ask your doctor for a Low T test. The Endocrine Society recommends that all men with type 2 diabetes have their testosterone levels checked. Patients who have been diagnosed with diabetes have an increased chance of also having Low T.

Let’s step back for a moment.  What is being claimed is that low testosterone levels in males is a common cause of certain symptoms, and that testosterone replacement therapy can alleviate these symptoms.  To evaluate this claim from the perspective of science-based medicine, we need to ask specific questions. (more…)

Posted in: Science and Medicine

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Some Flu Vaccine Updates

It is always flu season somewhere in the world. As Australia’s flu season comes to a close, we are getting ready for ours in the Northern Hemisphere. This is a good time to start thinking about getting the flu vaccine, and as always there is a lot of flu vaccine news to sort through.

Mark Crislip has already reviewed the evidence for the efficacy of the seasonal flu vaccine. Like most questions in medicine, the evidence is deceptively complex, and Mark does an excellent job of sorting through it, so I won’t repeat it here.

This year the H1N1 pandemic flu virus will be incorporated into the seasonal flu vaccine, so there will not be two separate vaccines as there was last year. H1N1 remains the dominant strain of seasonal flu, and as predicted the pandemic has simply been incorporated into the seasonal flu pattern.

Here are some updates on flu vaccine news – first the good news:

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Posted in: Science and Medicine, Vaccines

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Skepticamp: Invading the Great White North on October 23

skepticamp

Are you frustrated by the prevalence of pseudoscience in medicine? Are you interested in critical thinking and science? Is SBM your rational refuge?  Want to meet like-minded science advocates? On October 23, 2010 four Skepticamps will take place across Canada. If you enjoy reading this blog, you’ll probably enjoy Skepticamp.

Happily, Skepticamp involves no actual camping. It’s a flexibly organized, collaborative conference on science and critical thinking. Skepticamp is not your typical medical conference with high fees, bad PowerPoint, long talks and little interaction with speakers. Skepticamps are open, collaborative, interactive, and FREE.

Here are the four events, and a few of the SBM-related highlights.

  • Vancouver: ear candling; dopamine as an explanatory model for superstition; and SBM copy editor Paul Ingraham speaking about his first year as an alternative medicine apostate.
  • Winnipeg: fad diets and detoxes; homeopathy; and the continued relevance of vaccinations
  • Ottawa: self-help cults; genes and inherited diseases; science denial; and forensic science
  • Toronto: I’ll be speaking about natural health product regulation. Other talks include a guide to the medical literature; the cognitive underpinnings of sympathetic magic; and naturopathy.

If there’s one near you, consider attending Skepticamp on October 23. Given it’s free, Skepticamp offers tremendous value-for-money. We invite our American colleagues to grab their passports, make a break for the border, and keep driving until there are Tim Hortons everywhere. And if you’re attending the Toronto Skepticamp, be sure to  say hello.

Posted in: Announcements

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Mayo Clinic on Home Remedies

I write a lot of critical articles. It’s nice to be able to write a positive one for a change. I received a prepublication proof of The Mayo Clinic Book of Home Remedies: What to Do for the Most Common Health Problems. It is due to be released on October 26 and can be pre-ordered from Amazon.com. Since “quackademic” medicine is infiltrating our best institutions and organizations, I wasn’t sure I could trust even the prestigious Mayo Clinic. I was expecting some questionable recommendations for complementary & alternative medicine (CAM) treatments, but I found nothing in the book that I could seriously object to.

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Posted in: Book & movie reviews

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I’m not worthy! I’m not worthy! (For the Lorne Trottier Public Science Symposium)

Trottier Symposium 2010

In two weeks, yours truly will be participating in the 2010 Lorne Trottier Public Science Symposium at McGill University in Montreal. This year, the theme is Confronting Pseudoscience: A Call to Action. I’ll be speaking with Ben Goldacre and Michael Shermer on Monday, October 18 from 5 to 7 PM on the Threat of Pseudoscience. On Tuesday, October 19, the ever-amazing Randi will speak on investigating paranormal claims. Unfortunately, the organizers couldn’t get Randi on the same stage with us because he couldn’t make it to Montreal from TAM London in time for Monday night; so this is the next best thing. Randi deserves the stage to himself anyway.

Obviously, I can’t wait, although I must admit that I’m rather nervous. To share the stage with Michael Shermer and Ben Goldacre and to get to hang out with them plus Randi, well, that’s more than I could have hoped for or imagined. It leaves me feeling like Wayne in this clip, with Shermer, Goldacre, and Randi as Alice Cooper (very appropriate, given Randi’s history of having done the effects for Alice Cooper’s stage show back in the 1970s):

So, if you happen to be in the Montreal area or can get there on October 18 and/or 19, come on over to McGill. It’ll be a rousing good skeptical time. I don’t yet know what Ben Goldacre and Michael Shermer will be discussing, but I’ll be speaking about cancer quackery (although I probably won’t be able to resist a brief commentary on quackademic medicine). I’ll also be on Dr. Joe’s radio show on CJAD 1010.

Posted in: Announcements, Science and Medicine

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The Guatemala syphilis experiment and medical ethics in science-based medicine

Several of the bloggers here at SBM have repeatedly criticized various clinical trials for so-called “complementary and alternative medicine” interventions for various conditions and diseases (or should I say dis-eases?) for being completely unethical. Examples include the misbegotten clinical trial for the Gonzalez protocol for pancreatic cancer, which — surprise, surprise! — ended up showing that patients undergoing Dr. Gonzalez’s combination of 150 supplements a day, dietary manipulations, and coffee enemas, actually did much worse than those undergoing standard of care, despite how depressingly poor the results of standard of care are; clinical trials of homeopathy in Honduras and other Third World countries, which both Wally Sampson and I lambasted; and ongoing clinical trial of chelation therapy for cardiovascular disease. I’ve also criticized the “autism biomed” movement, that amalgamation of parents who believe that vaccines cause autism and yet are willing to subject their children to all sorts of quackery to “cure” the “vaccine injury” of uncontrolled and unethical experimentation on autistic children. As valid as all these criticisms are, it is important to recognize that science-based medicine is not free of its own abuse of ethics.

A couple of weeks ago, I wrote about the concept of clinical equipoise. Clinical equipoise is a critical concept in any clinical trial. Basically, a state of clinical equipoise exists when there is genuine scientific uncertainty over which of the options being tested in/on living, breathing human beings is better, and any clinical trial in which a state of clinical equipoise does not exist is at the very least ethically dodgy and probably downright unethical. For example, when the occasional anti-vaccine activist argues for a randomized controlled clinical trial comparing vaccinated children and unvaccinated children, it’s easy to shoot that idea down as unethical because there is no clinical equipoise. The children receiving placebo vaccines would be put at a much higher risk of suffering harm compared to the vaccinated children because they would be left unprotected against life-threatening diseases. In the realm of conventional medicine, the reason that few cancer clinical trials involve a placebo control group anymore but instead test a new therapy either against the standard of care or with the standard of care is because in many, if not nearly all, cases placebo use in a cancer patient is unethical when there exists effective therapy, even if the therapy is not all that effective. What all this boils down to is that science is only part of the basis of science-based medicine. Medical ethics must take precedence. After all, arguably the most efficacious way to test a new antibiotic would be to infect people with the bacteria the antibiotic treats and then divide these people up into a placebo control group and a group receiving the antibiotics to see how each group does. After all, this is the sort of thing that the Nazis and Japanese did during World War II, and the same sort of dehumanization and abuse of research subjects that every ethical precept regarding human subjects research that has been developed since then, such as the Helsinki Declaration of 1964, has been designed to prevent.

Unfortunately, medical scientists in the U.S. have not always lived up to these precepts. The most famous example is arguably the Tuskegee syphilis experiment, in which poor black men with syphilis were studied and the control group denied effective therapy for syphilis even after it was known that penicillin was an effective treatment for syphilis. This study spanned 40 years, from 1932 to 1972, and is justifiably held up as one of the worst examples of research misconduct in American history, if not the history of the world. The shock the revelation of this study to the American public in 1972, when it learned of men dying of syphilis, women contracting syphilis, and babies being born with congenital syphilis, all unnecessarily, led to Belmont Report and the establishment of the Office for Human Research Protections (OHRP).

It turns out that there was an even worse atrocity against medical science perpetrated by U.S. investigators in Guatemala over 60 years ago that only now has come to light in stories in the New York Times, MSNBC, and elsewhere. So bad was the offense that Secretary of State Hillary Clinton and Secretary of Health and Human Services Kathleen Sebelius have issued a formal apology to the Guatemalan government for the experiments in which Guatemalan prisoners were intentionally infected with syphilis and then treated with antibiotics, an apology that President Obama reiterated in a personal telephone call to Guatemalan President Alvaro Colom on Friday.
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Posted in: Clinical Trials, Medical Ethics

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Chiropractic Vertebral Subluxations: Science vs. Pseudoscience

A 1997 publication by the Foundation for Chiropractic Education and Research, supporting the vertebral subluxation theory, noted that “…we [chiropractors] have successfully distanced the concept of a chiropractic subluxation from that of an orthopedic subluxation.”1 When discussing “subluxations” or misaligned vertebrae, however, chiropractors often fail to point out the difference between an orthopedic subluxation and a chiropractic subluxation. Reference to subluxations in medical literature is often presented as support for the practice of chiropractic as a method of adjusting vertebral subluxations to “restore and maintain health.”

In the eyes of the public, the chiropractic vertebral subluxation theory has confused the definition of the word “subluxation,” a common medical term. Unlike the mysterious, undetectable and asymptomatic chiropractic “vertebral subluxation complex” alleged to be a cause of disease, a real vertebral subluxation, that is, an orthopedic subluxation, can be a cause of mechanical and neuromusculoskeletal symptoms but has never been associated with organic disease.

Subluxations: Real and Imaginary

An orthopedic subluxation, recognized and named as such since the days of Hippocrates, is a painful partial dislocation. Simple misalignment of a vertebra, also referred to as a “subluxation,” is commonly caused by disc degeneration, curvatures, spondylolysis, and structural abnormalities. Such a subluxation may or may not be mechanically symptomatic and can be seen on a plain x-ray image. In the absence of pathology such as disc herniation or osteophyte formation, these common vertebral subluxations or misalignments rarely affect spinal nerves and have never been associated with organic disease. Spinal nerves supply musculoskeletal structures. The body’s organs are supplied primarily by autonomic nerve ganglia and plexuses located outside the spinal column and by cranial and sacral nerves that pass through solid bony openings, providing overlapping nerve supply independent of any one spinal nerve that passes between two vertebrae.

An orthopedic subluxation, a true vertebral misalignment, or a mechanical joint dysfunction that affects mobility in the spine is not the same as a “chiropractic subluxation” that is alleged to cause disease by interfering with nerve supply to organs. Such a subluxation has never been proven to exist. There is no plausible theory and no credible evidence to support the contention that “nerve interference” originating in a single spinal segment can cause an organic disease.
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Posted in: Chiropractic

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