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Archive for September, 2012

Frightening Breast Cancer Patients with Bad Science

No Time to Waste: Avoidant Coping Style Scrambles Circadian Rhythms in Breast Cancer Patients, warned the headline of an article in Clinical Psychiatry News. The article went on to claim

Even in the earliest days following a diagnosis of breast cancer, maladaptive coping styles are associated with a disruption in circadian rhythms –which are proven in metastatic disease to be a prognostic indicator of mortality. The surprising finding… holds potentially profound implications for the timing and tailoring of psychosocial interventions in newly diagnosed patients.

And it invoked psychoneuroimmunology for an authoritative sounding warning to breast cancer patients:

The fact that circadian disruption was significant in a subset of patients a mean 19 [sic] days after diagnosis suggests that there may be no time to waste in identifying and treating potentially maladaptive coping responses that could impact not only their adjustment, but also their prognosis.

Women who are diagnosed with breast cancer, enroll yourself immediately in a stress reduction program or support group, if you want to stem the progression of your disease and prolong your life! If you have metastatic disease, maybe you can blame your “maladaptive coping,” your inept handling of the days and weeks immediately after your diagnosis. Such frightening messages to women who are vulnerable because they have just received their diagnosis should require high standards before being released. This article reeks of hype and distortion, starting with its emotional title, No Time to Waste and “Scrambles Circadian Rhythms,” continuing with claims of “profound implications for the timing of psychosocial interventions,” and ending with an exhortation to breast cancer patients that “early breast cancer patients certainly warrant paying closer attention to coping from Day 1.”

The issue is not just skewered science, because  the article contains information that is easily misunderstood without a proper context. Breast cancer patients are urged to take get psychosocial intervention under the threat that if they do not, they are missing an opportunity to control the progression of their disease. This is an example of the irresponsible nonsense that I have been complaining in the past two blogs. There is simply no evidence that psychological interventions can slow progression of cancer or extend life. Claims to the contrary serve to burden cancer patients with an unrealistic responsibility for the outcome of their medical condition. Patients who experience progression to a terminal condition are provided with an irrational sense that they are to blame because they did not take the right steps, namely avail themselves of effective psychological interventions. This article implies that breast cancer patients with an unfavorable course have brought it on themselves by getting too stressed out.

It’s not clear whether journalist Betsy Bates Freed, PsyD. actually interviewed the authors of the study on which the story is based. Media coverage often offers direct quotes that appear to have been obtained directly from authors when they actually come from the scientific article.  In this particular case, Freed provides a highly speculative direct quote that “circadian cycles regulate tumor growth” as if it came directly from the mouth of the lead author of the study. For the record, there is some evidence of an association between circadian rhythms and progression of metastatic breast cancer, but it is not clear that it is causal or  affects”regulation” or in what direction any causal arrows run. Importantly, such findings have not been replicated with early breast cancer patients.

Clinical Psychiatry News is not some dubious CAM website, but an Elsevier published monthly newspaper with an advisory editorial board with recognizable scientist and clinician psychiatrists. It has largely free web access because of pharmaceutical company support. One has to question what editorial control over content is exerted before releasing articles like No Time to Waste.
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Posted in: Cancer, Neuroscience/Mental Health

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Iron supplements for fatigue

How are you feeling today? Tired? Is it your active lifestyle wearing you down? Or is it a sign of something more serious? Complaints about fatigue seem ubiquitous. Perhaps it’s a product of a culture with little downtime. Yet from a medical perspective, fatigue can’t be dismissed with a simple instruction to “get more sleep”. When approached in the pharmacy, I take the perspective that anyone actively seeking advice on treatment probably needs a medical assessment. That’s not something I can offer, but I try to impress upon patients the importance of finding the cause, rather than reaching for any quick fix that may be for sale. (5-hour Energy, anyone?) And I can use the opportunity to discuss the appropriate role of supplements for treating fatigue. (more…)

Posted in: Herbs & Supplements, Science and Medicine

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XMRV Chronic Fatigue Syndrome Update

Sometimes science works the way it’s supposed to. Scientists make hypotheses, test them by gathering preliminary evidence, and then argue about the inevitable conflicting results. Eventually better and better evidence is gathered until a consensus is achieved. Actually, I think that is how science usually works, it’s just that most questions in science are narrow and technical and don’t command media or public attention. Those that do tend to be the more enduring controversies or where a particular special interest (ideological, social, corporate, etc,) is involved.

In medicine scientific controversies may take on a life of their own, or become manufactured controversies (manufactroversies) that endure long past any genuine scientific debate. Such false controversies are often driven by patient groups who feel they are not being treated fairly or honestly, or by practitioners who do not want to give up on their favorite (lucrative) modality. This leads to a disconnect between the scientific controversy and the public controversy – a frequent theme on SBM.

I am happy to report that one such controversy has taken a turn for the good – a recent study has provided fairly definitive evidence that chronic fatigue syndrome (CFS) is not associated with either the XMRV or the pMLV viruses. The study was a consensus trial with both sides in the controversy collaborating to address all the criticisms of the earlier conflicting studies.

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Posted in: Science and Medicine

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The Obesity Paradox

Being fat is bad except when it’s good. It’s called “the obesity paradox.” (No, that isn’t a mis-spelling for “two physicians who treat fat people.”) The adverse health effects of obesity are well established, but there are exceptions. Obesity appears to confer an advantage in certain subgroups with conditions like heart disease and diabetes.

In the News

Casual consumers of some recent media reports might interpret them as an excuse to stop trying to lose excess weight, especially if they are diabetic. Others might think we have been lied to about the dangers of the obesity epidemic. The reality is more complicated. (more…)

Posted in: Nutrition

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News flash! Doctors aren’t all compliant pharma drones!

There’s an oft-quoted saying that’s become a bit of a cliché among skeptics that goes something like this: There are two kinds of medicine: medicine that’s been proven scientifically to work, and medicine that hasn’t. This is then often followed up with a rhetorical question and its answer: What do call “alternative medicine” that’s been proven to work? Medicine. Of course, being the kind of guy that I am, I have to make it a bit more complicated than that while driving home in essence the same message. In my hands, the way this argument goes is that the whole concept of “alternative” medicine is a false dichotomy. There is no such thing. In reality, there are three kinds of medicine: Medicine that has been shown to efficacious and safe (i.e., shown to work); medicine that has not yet been shown to work (i.e., that is unproven); and medicine that has been shown not to work (i.e., that is disproven). So-called “complementary and alternative medicine” (CAM or, its newer, shinier name, “integrative medicine”) consists almost completely of the latter two categories.

Part of the reason why this saying and its variants have become so commonplace among those of us who support science-based medicine is that they strike at a common truth about medicine, both science-based and “alternative.” That common truth is what we here at SBM have been arguing since the very inception of this blog, namely that there must be one science-based standard of evidence for all treatments, be they “alternative” or the latest creation of big pharma. That point informs everything I write here and everything my blogging parters in crime write about too. What that means is a single, clear set of standards for evaluating medical evidence, in which clinical evidence is coupled to basic science and scientific plausibility. Indeed, one of our main complaints against CAM and its supporters has been how they invoke a double standard, in which they expect their therapies to be accepted as “working” on the basis of a much lower standard of evidence. Indeed, when they see high quality clinical trials demonstrating that, for example, acupuncture doesn’t work, they will frequently advocate the use of “pragmatic” trials, lower quality trials of “real world effectiveness” that do not adequately control for placebo effects. It’s putting the cart before the horse.
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Posted in: Clinical Trials, Pharmaceuticals, Politics and Regulation

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The problem of nonmedical exemptions to school vaccine mandates

It’s that time of year again, namely flu vaccine time. My very own cancer institute will be offering the flu vaccine for its staff beginning October 1, and I plan on getting mine just as soon as I get back from the American College of Surgeons Clinical Congress in Chicago early next week. In the meantime, it’s always great to read Mark Crislip’s take on the yearly flu vaccine kerfuffle, particularly this part:

I have little (actually none) respect for HCW’s [health care workers] who do not get vaccinated. We have a professional and moral obligation to place our patients first. I think those who do not get vaccinated, except for a minority with a valid allergy, are dumb asses.

Preach it, Dr. Crislip!

However, this time of year is also a vaccine time of year for another reason (well, actually it was about a month ago). That’s because in late August or early September, depending on your state, the little kiddies (and not-so-little kiddies) return to school and therefore have to be up to date on their required vaccines or face not being able to go to school. No wonder the antivaccine movement goes nuts this time of the year, given the double whammy of antivaccine parents trying to avoid vaccinating their children before going to school by hook or by crook and the yearly promotion of flu vaccines and mandates that health care workers get them. (For the record, my cancer center requires it, and if there’s one thing the administration of my hospital has done that I fully support it’s the yearly vaccine requirement. We’re a cancer hospital, fer cryin’ out loud, and we have lots of immunosuppressed patients that we take care of!) The only other time of year when antivaccinationists are even close to this actively ridiculous is every April, which is Autism Awareness Month, when they start trying to tar attempts to highlight autism and autism research with demands that antivaccine pseudoscience be thrown into the mix like the proverbial cow pie added to the apple pie.

Since Mark’s already covered the flu vaccine so well, let’s talk about the topic of nonmedical exemptions to school vaccine mandates. This topic came up when I noticed that the bloggers and denizens of that most wretched hive of antivaccine scum and quackery, Age of Autism, have swarmed over to a news story about how Washington State has made it harder for parents to obtain nonmedical exemptions to school vaccine requirements:
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Posted in: Politics and Regulation, Vaccines

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Protect Yourself

Flu season is upon us. If there is such a thing as flu season. H1N1 started at the furthest point in time you could get from the traditional start of the flu season. It is an interesting question as to whether global warming will alter the flu season, as it has the RSV season. Classically influenza is a fall/winter disease and fall started today.

It is perhaps worthwhile to review what is known about influenza. (more…)

Posted in: Science and Medicine, Vaccines

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Physicians and “CAM”

In the last 20 or so years, the popularity of so-called “complementary and alternative medicine” began to lure physicians (M.D.s and D.O.s) into employing CAM treatments, or what is now rebranded as “integrative medicine.” Of course, CAM use by a physician necessarily requires some deviation from the “conventional” standard of care. Because deviation from the standard of care can be grounds for discipline by the state medical board, state legislatures and medical boards in the United States have had to grapple with just how much medical practice acts and regulations should accommodate CAM use by physicians.

As it turns out, less than you might think.

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Posted in: Legal, Politics and Regulation, Science and Medicine

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The Sweetener Wars – HFCS Strikes Back

The health conscious and trendy public are a bit obsessed with the food they consume. This can be a good thing, to the extent that it results in a more healthful diet, but unfortunately those interested in improving their diet must wade through a great deal of misinformation before getting to accurate and helpful information.

For example, I recently gave a lecture (ironically on health information) at Google (you can view the entire talk here). Google is a progressive company that tries to help their employees stay healthy. They provide many snack stations and helpfully divide snacks into red, yellow, and green shelves. Employees can freely choose whatever snacks they want, but they are gently encouraged to choose from the more healthful green shelf and avoid the unhealthy red shelf. I noticed that beverages sweetened with sugar cane were placed on the green shelf, while those sweetened with artificial sweeteners like aspartame or Splenda were slumming on the red shelf. It was ironic to see such a high-tech company falling for the naturalistic fallacy.

Sugar cane sweetened sodas are becoming fashionable, mainly to avoid high fructose corn syrup (HFCS), which many claim is associated with obesity and increased cardiovascular risk. Jim Laidler did an excellent job reviewing this controversy two years ago on SBM. To me this represents a general tendency to try to understand a complex question by oversimplifying, specifically by avoiding perceived “villains.” It may seem overwhelming to grapple with all the complex information involved in basic dietary health choices, like which beverages are best. Following simple rules, such as avoiding single ingredients that are perceived to be “bad,” therefore has an appeal. I also think this is part of the appeal of the naturalistic fallacy, a simple litmus test to what is good vs bad.

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Posted in: Epidemiology, Nutrition

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Procera AVH: A Pill to Restore Memory

At the recent Amaz!ng (no, the ! is not a typo) Meeting in Las Vegas, Dr. Gorski, Dr. Novella, “Dr. Rachie” (Rachael Dunlop of Australia) and I participated in a workshop on “Dr. Google” about how to find reliable health information on the Internet. In my presentation, I described step by step how I researched a typical diet supplement product, Procera AVH. Later, one of our readers wrote to ask us about that very product, so I decided to convert part of my presentation into this blog post.

The Trigger

A half-page spread in my local newspaper proclaimed: “Memory Pill Does for the Brain What Prescription Glasses Do for the Eyes, Claims US Surgeon General Candidate.” It looked superficially like a news report, but it was actually an advertisement for the diet supplement Procera AVH. Closer inspection revealed the words “Paid advertisement” in tiny print, the required FDA disclaimer for diet supplements, a “Call Toll-Free” number and offers of a FREE Bonus Bottle, FREE book, and FREE supply of Rapid Detox Formula for First 500 Callers. (more…)

Posted in: Herbs & Supplements

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