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Archive for 2012

Closing out 2012 with a bit of fun: Do you want some quantum with that pseudoscience?

today is the last day of 2012. As I contemplated what I’d write for my last post of 2012, I wondered what to do. Should I do a “year in review” sort of post? Naahh. Too trite and too much work. Should I just do what I normally do? There are, after all, many topics that are out there, some of them still holdovers from before the holiday season. I can’t get to them all, even between this blog and my not-so-super-secret other blog. I thought about it a minute, but then rejected that possibility. So I decided just to cover one of them. After all, when years begin and end are human constructs, and there’s nothing special about today other than that society has decided that it is the last day of the year, and tradition mandates that a significant proportion of the population will gather before midnight to get drunk and stupid. I’m boring that way, rarely doing anything on New Years Eve other than sitting in front of the TV with my wife and watching the ball drop in Times Square. Then I thought: Oh, what the heck? Why not take on something a bit…different for a change? Maybe even get a bit silly? At least I can finish off the year with a bit of fun. Who knows? I might even be able to be far more concise than usual? (Actually, that might be asking too much.) Besides, the topics I tend to take on here are almost always serious; so a little amusement would be good before diving into the science and pseudoscience that will certainly pop up in 2013.

If there’s one thing about “alternative” medicine, “complementary and alternative medicine” (CAM), or “integrative medicine” that’s always puzzled me, it’s just how gullible some practitioners must think their clients are. In some cases, they might know their customers every bit as well as a car salesman knows his clients or an author knows his readers, but in actuality most people who fall for alt-med are no more gullible than average. However, some words seem to impress more than ever, as promoters of alt-med scramble to appropriate impressive-sounding science terms into their woo. I’ve seen a lot of them. So has Mark Crislip.

Among the favorite real science term that quacks love to appropriate is “quantum.” I blame Deepak Chopra. Although I highly doubt he was the first promoter of alternative medicine and various New Age thought to use and abuse the term “quantum” as a seemingly scientific justification of what in reality is nothing more than ancient mystical thinking gussied up with a quantum overcoat to hide its lack of science, Chopra has arguably done the most to popularize the term among the science-challenged set. In Chopra’s world, the word “quantum” functions like a magical talisman that explains ™everything because in the quantum world anything can happen. Actually, I should clarify. While it’s true that many bizarre and wondrous things can be explained through quantum theory (such as quantum entanglement), it is not, as Chopra and his many imitators would have you believe, a “get out of jail free” card for any magical thinking you can imagine, and quantum effects do not work the way people like Chopra (say, Lionel Milgrom, who seems to think that homeopathy works through quantum entanglement between practitioner, remedy, and patient) would like you to think.
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Posted in: Basic Science, Health Fraud, Humor

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780.6

You can tell what a doctor does for a living by the ICD-9 codes they have memorized. There is an ICD-9 code for nearly every medical condition. Weightlessness is 994.9. Must be there for NASA, I have yet to see a weightless patient. Decapitation by guillotine is E978. There, I suppose, in case Marat returns from the dead. There is an ICD-9 code for the initial visit after being sucked into jet engine (V9733XA) and one for subsequent visits (V9733XD). Why do I suspect V9733XD has yet to be used?

780.6 is my personal favorite. Fever. All my patients have fever and 780.6 was certainly the first ICD-9 code I committed to memory. I have an endless interest in fever and after last Fridays post I thought I would toss in my two cents worth. I will remind my readers that I am an adult ID doctor (who I treat, not necessarily how I behave) and unless specifically mentioned, all that follows applies to those who can legally drink, vote and serve in the military.

98.6 F. It is not normal body temperature. Well it is. But it is not. 98.6 F as average body temperature is an enduring medical myth. (more…)

Posted in: Basic Science, Evolution, History, Science and Medicine

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Naturopathy Embraces the Four Humors

The ancient Greeks posited a system of health and disease based on the four humors: blood, phlegm, black bile and yellow bile. According to this system, health is defined as a harmony of these four humors and disease is caused by an imbalance among them. Restore the balance, and health is restored. Bleeding is a familiar example of humoral medical treatment based on a diagnosis of an “excess” of blood. Fortunately, the humoral system of diagnosis and treatment died out with the advent of modern scientific medicine.

But as David Gorski asked (sarcastically, of course) in his presentation on quackademic medicine at CSICon in October, if supposedly ancient philosophies of diagnosis and treatment such as Traditional Chinese Medicine and Ayurveda are so beloved by CAM proponents, despite their implausibility and lack of evidence of effectiveness, why not the humoral model of health and disease? Why not include humorism in the CAM practitioner armamentarium?

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Posted in: Faith Healing & Spirituality, History, Naturopathy, Politics and Regulation, Religion, Traditional Chinese Medicine

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Why Do People turn to Alternative Medicine

Any sociological question is likely going to have a complex answer with many variables that are not easy to tease apart. We should therefore resist the temptation to make simplistic statements about X being the cause of Y. We can still, however, identify correlations that will at least inform our thinking. Sometimes correlations can be triangulated to fairly reliable conclusions.

When the data is complex and difficult to interpret, however, evidence tends to be overwhelmed by narrative. The recent Sandy Hook tragedy is an excellent example. No one knows exactly why the shooter did what he did, so it is easy to insert your own preferred narrative as the explanation.

Another example is the phenomenon of so-called complementary and alternative medicine (CAM). Why has it been increasing in popularity (and is it, really?). Is it slick marketing, relaxed regulations, scientific illiteracy, a gullible media,  or the failures of mainstream medicine? You can probably guess I think it’s all of these things to some degree. The most common narrative I hear by far, however, is the latter – if people are turning to CAM it must be because mainstream medicine has failed them. This version of reality is often promoted by CAM marketing.

The evidence that we have, however, simply does not support this narrative. Studies show that satisfaction with mainstream medicine is not an important factor in deciding to use CAM, that CAM users are generally satisfied with their mainstream care, and they use CAM because it aligns with their philosophy, and they simply want to expand their options.

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Posted in: Science and Medicine

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An Alternative “Truth” About Flu Shots

Vaccines, and flu shots in particular, have been covered ad nauseum on this blog; but the anti-vaccine propaganda never stops, so forgive me for bringing it up again. A correspondent inquired about a podcast by Steve Wright on Revolution Health Radio entitled “The Truth About Flu Shots (and What to do Instead).” You can either listen or read the transcript. It’s just too funny to pass up. That is, it would be funny if it weren’t endangering our public health by spreading misinformation.   (more…)

Posted in: Herbs & Supplements, Vaccines

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Anti-psychiatry and anti-vaccine activists shamelessly taking advantage of the Sandy Hook Elementary School shootings

Quacks detest science-based medicine (SBM) in general, but there are certain specialties that they detest more than others. For instance, you won’t find too many quacks attacking trauma surgery because even they know that when a person’s body has been on the losing end of a confrontation with a bullet or a car, no amount of laying on of hands, homeopathic nostrums, “energy healing,” or herbal remedies are going to stop the hemorrhage, mend broken bones, or repair holes in various internal organs. That’s why even homeopaths will concede that “allopathic medicine” is good for emergencies. It’s also why sketches like this one resonate:

However, from there the distrust of promoters of unscientific and pseudoscientific medical systems and treatment modalities for SBM appears to increase in direct proportion to the urgency and need for direct physical repair of damaged organs, with the possible exception of cancer, for which the standard physical treatment (surgery) is attacked nearly as much as chemotherapy.

Be that as it may, arguably the specialty most attacked by quacks is psychiatry. Many are the reasons, some legitimate, many not. For example, the Church of Scientology in particular despises psychiatry, even going so far as to maintain through its anti-psychiatry front group the Citizens’ Commission on Human Rights (CCHR) a risibly nonsensical “museum” in Hollywood dedicated to psychiatry that they charmingly call Psychiatry: An Industry of Death. It’s so ridiculously, painfully over-the-top, a veritable self-parody of anti-psychiatry hyperbole, that it inadvertently undermines the very attacks on psychiatry frequently leveled by Scientologists and quacks that it’s meant to reinforce. Indeed, not having visited its website for several years, I notice that the CCHR has totally revamped it, now including a virtual 3D tour of the museum, along with video clips from its many “exhibits” available online. I’ll have to file that away for later blog fodder, because the misinformation, cherry picking, and pseudoscience flow freely, as one would expect from a Scientology propaganda project. In the meantime, suffice to say that it’s not just the Church of Scientology that despises psychiatry. It’s founder L. Ron Hubbard and his disciples merely represent the most ridiculously over-the-top and vociferous anti-psychiatry group that I’m currently aware of.

Let’s face it, psychiatry hasn’t always had the best history. It’s a very hard to study human behavior and disorders of human behavior in a rigorous fashion, but to my mind that didn’t excuse the the widespread acceptance for many decades of the ideas of Sigmund Freud, which were little removed from pseudoscience in many respects. Also, psychiatry has not always had the best history, particularly in the early part of this century. Too often, psychiatry has been used as a tool of control rather than a means of helping people who are suffering. Perhaps the worst example is the misuse of psychiatry by various totalitarian regimes, be it the Nazis using it as a primary tool of its T4 euthanasia program or the Soviet Union declaring enemies of the state to be mentally ill and shipping them off to Gulags.

Although there is a ways to go, however, psychiatry in 2012 is much better than psychiatry, say, 50 or 75 years ago. It wasn’t so long ago that, popularized by Walter Freeman, thousands of “ice pick lobotomies” were performed for all manner of indications, few of which had what we would consider to be compelling scientific support to back them up. Over the last half-century, better psychiatric drugs to treat different conditions have been developed, leading to their widespread use for a number of indications.
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Posted in: Neuroscience/Mental Health, Politics and Regulation, Public Health, Vaccines

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Another blow to the anti-vaccine movement as legislation change forces a name change

Earlier this year, Australia’s anti-vaccine lobby, the Australian Vaccination Network (AVN), took the NSW Government to the Supreme Court. In dispute was their license to fundraise which had been revoked and a public warning, issued because they refused to put a Quack Miranda on their website.

The public warning was posted after the NSW government investigated their website following two complaints, one from a concerned citizen and one from the parents of a 4 week old girl who had died of pertussis.

The complaints accused the AVN of peddling dangerous health misinformation including that vaccines were linked to autism and that pertussis was “nothing more than a bad cough”.

The AVN had always insisted that the HCCC did not have jurisdiction over them because they were not health care providers or educators in the “traditional sense”. It is true that health legislation in NSW is very much out of date in the Internet age. The rules say you can complain only if you can demonstrate direct harm as a result of taking someone’s dodgy advice. For example you had a stroke because of a chiropractor’s adjustments or a punctured lung from acupuncture. Just having a website full of woo-woo wasn’t really covered.

So the AVN challenged the HCCC on these grounds and, to the surprise of many of us, they won. Those who were present in the court that day recall the Judge urging the HCCC Barrister to present evidence for direct harm. And the worst thing was the HCCC apparently had this information, but for reasons unknown to us, did not present it. Those who were there said the HCCC Barrister dropped the ball big time that day. And they were right.

Within hours the public warning was expunged and shortly after that the authority to fundraise was returned. As if nothing ever happened.
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Posted in: Politics and Regulation, Public Health, Vaccines

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Fever Phobia

Fever is a mighty engine which Nature brings into the world for conquest of her enemies.”

— Thomas Sydenham

 

The occasional abnormal elevation in body temperature associated with infection is as much a part of the human condition as abstract thought or the desire to lose weight without exercise or cutting calories. Commonly known as fever, this powerful yet misunderstood physiologic response has been documented in a variety of animal species including fish, reptiles and of course humans. We have all had fever at least once in our lives, and probably several times. And many of us have undoubtedly spent a few anxious nights cradling febrile little ones, afraid more of the repercussions of the fever itself than the potential sequelae of the underlying cause.

Along those lines, fever is one of the most common reasons for parents to seek medical care for their children, with roughly a third of pediatric acute care visits related to it, as well as a frequent impetus for late night nursing calls to sleepy hospitalists. Actually only about half of after-hours calls are about fever but who’s counting. Unfortunately most medical professionals, including many pediatricians, have a poor understanding of the pathophysiology of fever, and their panicked approach to its management in many children involves unnecessary laboratory tests, imaging studies, and doses of broad spectrum antibiotics. It also adds to parental anxiety and helps to establish a vicious cycle as patients of over worried caregivers tend to undergo more aggressive evaluation and treatment.

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Posted in: Science and Medicine

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Bodytalk: Medical theater

If there were an icon of Science-Based Medicine, I think it should be Sisyphus: pushing a boulder uphill, only to watch it roll down again. Forever. Blogging about pseudoscience in medicine can feel that way at times. There is no end to the variations of nonsense, most health professionals are indifferent at best, and sometimes I wonder if blogging is just preaching to the converted. Compared to the media presence and web traffic of those that promote pseudoscence, I do wonder what to make of SBM. Does it have a bigger impact. Occasionally something comes along to give you some hope that the key concepts of SBM are having some resonance.

To effect meaningful change, we need to teach the concepts of SBM -  the process is the product, not the topics we blog about. This all came to mind as I was reading an open letter from TED organizers. TED talks are now iconic, but if you’re unfamiliar with them, the conferences started as a means of colliding speakers in the technology, entertainment and design fields to talk about big ideas. With a slogan of “ideas worth spreading,” perhaps it’s not surprising that TED talks can be provocative: that’s the point. TED talks are posted online and their success is remarkable: some talks get hundreds of thousands of views. The TED template has become so popular that it spawned TEDx, independent but licensed events that bring TED-like talks to smaller cities and venues. I’ve seen several TED talks and while many are compelling speakers, it’s clear the content is not always grounded in evidence. For all the talks by science advocates like Ben Goldacre, or James Randi, there’s the consciousnessbabble from Deepak Chopra. I’ve never seen TEDx presentations, but recently there’s been some very public criticism of its speaker standards. Anyone, it seems, can be a TEDx speaker including anti-GMO crusaders and naturopaths. Stung by recent criticism that the TED brand is losing credibility with its questionable presenters, TED HQ recently advised TEDx organizers to stop featuring pseudosicence:

It is your job, before any speaker is booked, to check them out, and to reject bad science, pseudoscience and health hoaxes.
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Posted in: Energy Medicine

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Brain-Machine Interface

We spend a great deal of time in the pages of Science-Based Medicine taking down every form of pseudoscience in medicine. Of course, what we see as pseudoscience, proponents often see as emerging or cutting edge science. They are taking advantage of the fact that there is a great deal of legitimate emerging science, and they hope they can sneak past the gates by cloaking themselves in the trappings of real science (jargon, studies, their own journals, etc.). Emerging science, however, no matter how plausible and earnest, still has yet to prove itself (by definition), and has to go through the rigorous process of scientific evaluation to slowly gain acceptance. That process – sorting out what works from what doesn’t, the real from the fake – is where all the action is in SBM.

It is refreshing sometimes to talk about an emerging field that, while still experimental, is legitimate and has the potential to usher in a genuinely revolutionary treatment.

I have been following the research into brain-machine interfaces for some years, and reporting on many of the significant “baby steps” in the advance of this new technology. A recent study published in The Lancet represents another incremental and encouraging advance. Researchers at the University of Pittsburgh implanted two strips of 96 electrodes into the motor cortex of a 52 year-old woman with tetraplegia. The electrodes are capable of detecting the firing of neurons in the motor cortex and transmitting those signals to an external processor that in turn controls a fairly sophisticated robotic arm. The arm is described as having seven degrees of freedom – three dimensions of translation, three dimensions of orientation, and one dimension of grasping.

After two days the subject was able to move the robotic arm with her thoughts alone. Over the course of the 13 week study she progressively gained control of the arm and eventually was able to feed herself with the arm. While this is still very far from a “cure” for paralysis or a restoration of full function, for someone who is tetraplegic (all four limbs are paralyzed) having any independent function is a huge improvement in quality of life.

So where are we with this technology?

Posted in: Neuroscience/Mental Health

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