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Archive for April, 2011

Cochrane is Starting to ‘Get’ SBM!

This essay is the latest in the series indexed at the bottom.* It follows several (nos. 10-14) that responded to a critique by statistician Stephen Simon, who had taken issue with our asserting an important distinction between Science-Based Medicine (SBM) and Evidence-Based Medicine (EBM). (Dr. Gorski also posted a response to Dr. Simon’s critique). A quick-if-incomplete Review can be found here.

One of Dr. Simon’s points was this:

I am as harshly critical of the hierarchy of evidence as anyone. I see this as something that will self-correct over time, and I see people within EBM working both formally and informally to replace the rigid hierarchy with something that places each research study in context. I’m staying with EBM because I believe that people who practice EBM thoughtfully do consider mechanisms carefully. That includes the Cochrane Collaboration.

To which I responded:

We don’t see much evidence that people at the highest levels of EBM, eg, Sackett’s Center for EBM or Cochrane, are “working both formally and informally to replace the rigid hierarchy with something that places each research study in context.”

Hallafrickin’loo-ya

Well, perhaps I shouldn’t have been so quick to quip—or perhaps that was exactly what the doctor ordered, as will become clear—because on March 5th, nearly four months after writing those words, I received this email from Karianne Hammerstrøm, the Trials Search Coordinator and Managing Editor for The Campbell Collaboration, which lists Cochrane as one of its partners and which, together with the Norwegian Knowledge Centre for the Health Services, is a source of systematic reviews:

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Posted in: Clinical Trials, Energy Medicine, Medical Academia, Science and Medicine

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Do calcium supplements cause heart attacks?

Calcium is good for us, right? Milk products are great sources of calcium, and we’re told to emphasize milk products in our diets. Don’t (or can’t) eat enough dairy? Calcium supplements are very popular, especially among women seeking to minimize their risk of osteoporosis. Osteoporosis prevention and treatment guidelines recommend calcium and vitamin D as an important measure in preserving bone density and reducing the risk of fractures. For those who don’t like dairy products, even products like orange juice and Vitamin Water are fortified with calcium. The general perception seemed to be that calcium consumption was a good thing – the more, the better. Until recently. (more…)

Posted in: Herbs & Supplements, Science and Medicine

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Dr. Oz on alternative medicine: Bread and circuses

NOTE: Dr. Novella has written up a detailed description of his experiences on The Dr. Oz Show. Please read it. Also note that the online video for Dr. Novella’s appearance is now available:

  1. Controversial Medicine: Alternative Health, Part 1
  2. Controversial Medicine: Alternative Health, Part 2
  3. Controversial Medicine: Alternative Health, Part 3

When I first learned that our fearless leader and partner in crime for this blog, Dr. Steve Novella, Yale neurologist, blogger, and host of the popular skeptical podcast the Skeptics’ Guide to the Universe was going to be on The Dr. Oz Show, I was concerned. After all, this is the same physician who had in essence given up science-based medicine in favor of media stardom based on the promotion of alternative medicine. Of late Dr. Oz has been getting worse, too, promoting pseudoscience and what can only be described, in my opinion, as quackery. The snake oil that Dr. Oz has promoted over the last several months includes Dr. Joe Mercola, one of the biggest promoters of “alternative” health, whom Dr. Oz first had on his show about a year ago and then defiantly defended in a return appearance in early 2011, to be followed by a rapid one-two punch in which Dr. Oz had an ayurvedic yogi named Cameron Alborzian, who promoted highly dubious medicine, including “tongue diagnosis,” to be followed a few days later by something I would never, even in my most cynical assessment of Dr. Oz, expected, namely the appearance of faith healer Issam Nemeh on his show. ext Dr. Oz endorsed a diet that he once eschewed as quackery and then, to top it all off, invited psychic John Edward onto his show, asking Is talking to the dead a new kind of therapy? All of these offenses contributed to the reasons why in 2011 the James Randi Educational Foundation awarded him the The Media Pigasus Award for the second year in a row.

So right from the start I wasn’t very optimistic about how this whole thing would turn out. Fortunately, however, I was pleasantly surprised. Steve managed to hold his own in a completely hostile environment with only minor stumbles, while Dr. Oz peppered him with “Have you stopped beating your wife?”-style questions. At one point, Steve even managed to hand Dr. Oz his posterior. Alas, I doubt it will make any difference to Dr. Oz’s viewers, but we can always hope to change a few minds. I also realize that, however a big deal being on Dr. Oz’s show was to Steve and many members of the skeptical movement (especially supporters of SBM), to Dr. Oz it was just one segment in one episode of one season of a daily talk show made up of 150 episodes, each containing four or so segments. Not to detract from Steve’s achievement at all (it’s truly amazing that he managed to get on the show and do as well as he did, given how badly the deck was stacked against him), but to us this is big; to Dr. Oz it’s just another segment of another episode. It’s entertainment. As giddy and anxious as we at SBM have been the last two weeks, we have to keep things in perspective.

So what happened?
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Posted in: Acupuncture, Herbs & Supplements, Science and the Media

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Conflicts of Interest

When an article is published in a medical journal, the authors must disclose any conflicts of interest. This is important, because even if they think owning stock in the drug company won’t influence their scientific judgment, we know that subtle biases can creep in to somehow affect the findings of studies. It has been shown that studies funded by drug companies are more likely to get positive results for their drug than studies funded by independent sources. Andrew Wakefield, author of the infamous retracted Lancet study suggesting a relationship between MMR vaccine and autism, was severely chastised for not disclosing that he received money from autism litigators and expected to earn a fortune from his own patented products if the MMR vaccine could be discredited.

I was recently contacted by an acupuncturist who plans to critique an article I wrote. It was a commentary in the journal Pain that accompanied a systematic review of systematic reviews of acupuncture by Ernst et al. For details of Ernst’s and my articles, see my previous post. He challenged my statement that I had no conflicts of interest to report. He apparently thinks I should have said I have a conflict of interest in that I am anti-CAM and anti-acupuncture. When he writes about my article, he plans to attack me for not declaring this alleged conflict of interest and he plans to set a good example with a conflict of interest statement of his own, divulging that he makes his living practicing acupuncture, has financial investments in it and many personal relationships, that his self-identity and prestige are dependent on his belief in acupuncture’s efficacy, and that he is biased towards constructivism and away from positivism. (I think this is a fancy way of saying he favors experience over the scientific method.) I agree that he has conflicts of interest, but was I wrong to say I had no conflicts of interest? I don’t think so. (more…)

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A Skeptic In Oz

UPDATE 4/27/2011: Here’s the online video of Dr. Novella’s appearance on The Dr. Oz Show:

  1. Controversial Medicine: Alternative Health, Part 1
  2. Controversial Medicine: Alternative Health, Part 2
  3. Controversial Medicine: Alternative Health, Part 3

I must say I was a bit shocked two weeks ago when I was contacted by a producer for The Dr. Oz Show inviting me on to discuss alternative medicine. We have been quite critical of Dr. Mehmet Oz over his promotion of dubious medical treatments and practitioners, and I wondered if they were aware of the extent of our criticism (they were, it turns out).

Despite the many cautions I received from friends and colleagues (along with support as well) – I am always willing to engage those with whom I disagree. I knew it was a risk going into a forum completely controlled by someone who does not appear to look kindly upon my point of view, but a risk worth taking. I could only hope I was given the opportunity to make my case (and that it would survive the editing process).

The Process

Of course, everyone was extremely friendly throughout the entire process, including Dr. Oz himself (of that I never had any doubt). The taping itself went reasonably well. I was given what seemed a good opportunity to make my points. However, Dr. Oz did reserve for himself the privilege of getting in the last word—including a rather long finale, to which I had no opportunity to respond. Fine—it’s his show, and I knew what I was getting into. It would have been classy for him to give an adversarial guest the last word, or at least an opportunity to respond, but I can’t say I expected it.
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Posted in: Acupuncture, Herbs & Supplements, Homeopathy, Science and the Media

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The trouble with Dr. Oz

UPDATE 4/27/2011: Here’s the online video of Dr. Novella’s appearance on The Dr. Oz Show:

  1. Controversial Medicine: Alternative Health, Part 1
  2. Controversial Medicine: Alternative Health, Part 2
  3. Controversial Medicine: Alternative Health, Part 3

Welcome, Dr. Oz viewers!

As managing editor of the Science-Based Medicine (SBM) blog, I am writing this post because our founder and exective editor Dr. Steven Novella was invited to be on The Doctor Oz Show. Later today, the episode in which he will appear will air in most of your local markets, and we wanted to make sure that any Dr. Oz viewer who sees the segment and as a result is intrigued (or angered) enough to wonder what it is that we are all about will have a convenient “primer,” so to speak, on the problem with Dr. Oz from a science-based perspective. In other words, who are these obnoxious upstart bloggers who are so critical of Dr. Oz are and, far more importantly, exactly why are we so critical? What is science-based medicine, anyway?

On to some of the answers!
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Posted in: Science and the Media

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The curious case of Poul Thorsen, fraud and embezzlement, and the Danish vaccine-autism studies

If there’s one thing about the anti-vaccine movement, it’s all about the ad hominem attack. Failing to win on science, clinical trials, epidemiology, and other objective evidence, with few exceptions, anti-vaccine propagandists fall back on attacking the person instead of the evidence. For example, as I’ve noted numerous times, Paul Offit has been the subject of unrelenting attacks from Generation Rescue and other anti-vaccine groups, having been dubbed “Dr. Proffit” and accused of being so in the pocket of big pharma that he’ll do and say anything for it. I personally have been accused by Jake Crosby of a conflict of interest that isn’t, based on conspiracy mongering and an utterly brain dead argument (which is much like every other argument Jake likes to make on this issue). Steve Novella, Paul Offit, Amy Wallace, Trine Tsouderos, and others were portrayed as cannibals sitting down to a Thanksgiving feast of baby. Meanwhile, anti-vaccine luminaries invoke the pharma shill gambit with abandon and try their best to smear journalists who write about how anti-vaccine views are endangering herd immunity, journalists such as Trine Tsouderos, Amy Wallace, Chris Mooney, and Seth Mnookin, to name a few.

Sometimes, however, for whatever reason karma, fate, God, or whatever you want to call it smiles on anti-vaccine activists, dropping a story into their laps that allow them to indulge the worst of their tendencies towards ad hominem attacks and seem superficially credible. So it was about a year ago when an financial fraud investigation was being undertaken in the case of Poul Thorsen, a Danish investigator who had contributed to two large Danish studies, one of which failed to find an association between the MMR and autism in the immediate wake of Andrew Wakefield’s falsified data suggesting such an assocation and one of which failed to find an association between mercury in the thimerosal preservative in vaccines and an increased incidence of autism. At the time longstanding anti-vaccine propagandist Robert F. Kennedy, Jr. tore into Thorsen with abandon before he was even indicted or charged (he was only under investigation at the time) as though, even if he actually did commit fraud, such fraud invalidated the two large studies regarding MMR and autism and thimerosal and autism with which he had been involved. Did it?

To find out, let’s hop into our SBM TARDIS and go back in time about a year, in order to see the genesis of this manufactorversy that AoA is currently flogging. Let’s look at the case of Danish investigator Poul Thorsen as it developed.
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Posted in: Science and the Media, Vaccines

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Watch Steve Novella on The Dr. Oz Show on Tuesday!

UPDATE 4/27/2011: Here’s the online video of Dr. Novella’s appearance on The Dr. Oz Show:

  1. Controversial Medicine: Alternative Health, Part 1
  2. Controversial Medicine: Alternative Health, Part 2
  3. Controversial Medicine: Alternative Health, Part 3

I can’t believe I’m saying this, but I want you all to tune in to The Dr. Oz Show on Tuesday, April 26. Either that, or DVR it. Why am I asking you to do this? Have I lost my mind? Have I suddenly gone woo? Of course not. The reason is that, an episode I’ve been waiting for since I learned it was in the works last week will air on that date.

That’s right. Our fearless leader Steve Novella will be on The Doctor Oz Show this Tuesday to do battle in the belly of the beast.

Unfortunately, I fear for the results. I know Steve acquitted himself quite well, at least as well or better than any skeptic and booster of SBM could hope to do in such a hostile environment, but get a load of the title of the segment, Controversial Medicine: Why your doctor is afraid of alternative health?

Afraid?

Afraid?

Afraid?

No, no, no, no! A thousand times no!

I do worry a bit how the producers edited Steve’s segment, though. Look at the promo. In it Dr. Oz is doing what I was afraid of, trying to portray himself as the voice of reason and accusing Steve of being “dismissive.” I was afraid Dr. Oz would play the “don’t be close-minded” or “you’re too dismissive” card, and he appears to have done it. Then get a load of the advertised segment that follows, showing Dr. Oz dictating what’s true and not in medicine, as in “Dr. Oz approved.”

Truly, the man has no shame.

I’ll have to wait until Tuesday to see what the final results are. Whatever happens, we at SBM are all incredibly proud of Steve for going into the proverbial lions’ den. As managing editor, I’m also enormously proud of our stable of bloggers; after all, it is a collective effort that got us noticed by the producers of The Dr. Oz Show. Also, now that Dr. Oz and his producers have noticed us, however the segment turns out we promise to keep holding Dr. Oz’s feet to the fire when he starts promoting nonsense like faith healers, psychic mediums, dubious diabetes treatments, and über-quacks like Joe Mercola. This should be facilitated by our new partnership with the James Randi Educational Foundation that was announced earlier this week.

You can also rest assured that Steve will blog about his experience after the episode airs, and I hope our readers will dive into the discussion forums after the show.

Posted in: Announcements, Science and the Media

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Without Borders

Take up the White Man’s burden–
The savage wars of peace–
Fill full the mouth of Famine
And bid the sickness cease;
And when your goal is nearest
The end for others sought,
Watch CAM and woo Folly
Bring all your hopes to nought.

The White Man’s burden, a bit of racism from the 19th century:

The term “the white man’s burden” has been interpreted as racist, or taken as a metaphor for a condescending view of non-Western national culture and economic traditions, identified as a sense of European ascendancy which has been called “cultural imperialism.” An alternative interpretation is the philanthropic view, common in Kipling’s formative years, that the rich have a moral duty and obligation to help “the poor” “better” themselves whether the poor want the help or not. The term “the white man’s burden” has been interpreted as racist, or taken as a metaphor for a condescending view of non-Western national culture and economic traditions, identified as a sense of European ascendancy which has been called “cultural imperialism.” An alternative interpretation is the philanthropic view, common in Kipling’s formative years, that the rich have a moral duty and obligation to help “the poor” “better” themselves whether the poor want the help or not.

I will let the commentators debate the meaning of the poem. There are places in the world so devastated by poverty, disease and political corruption that it may be beyond the capacity of the local populations to overcome. They need outside help. Certainly, the impulse to help those less fortunate than yourselves is a noble tradition. Haiti, Central America and Uganda are parts of the world that need assistance in overcoming an incredible number of problems to reach even a basic level of material support for its population.
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Posted in: Acupuncture, Homeopathy, Naturopathy

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The Forefather of Acupuncture Energetics, a Charlatan?

Not only his name and his titles of nobility were forged, but parts of the teachings of the man who introduced acupuncture to Europe were also invented. Even today, treatments are provided based on his fantasies.

– Hanjo Lehmann1

Decades before President Nixon’s visit to communist China, and before the articles in the Western popular press on the use of acupuncture in surgery, a Frenchman by the name of George Soulié de Morant (1878-1955), published a series of colorful accounts of the use of acupuncture in early 20th-century China. His work led to the creation of a school of thought known as “French energetics,” which has become the theoretical foundation for many proponents of acupuncture in the West, including Joseph Helms, MD, the founder and former director of the American Academy of Medical Acupuncture (AAMA), and the founder of the acupuncture certification course for physicians.

But just as the medical community gradually learned that the reports of the use of acupuncture in surgery in communist China were inaccurate, exaggerated, or even fraudulent, we are now learning that the reports on the use and efficacy of acupuncture by Soulié de Morant were also fabricated.

According to a 2010 article published in Germany by Hanjo Lehmann in the Deutsches Ärzteblatt (a short version was published in Süddeutsche Zeitung), there is no real evidence that the Frenchman who is considered the father of Western acupuncture ever stuck a needle in anyone in China, and he probably never witnessed a needling.
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Posted in: Acupuncture, Energy Medicine, Health Fraud

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