Articles

Archive for 2013

Doctors Are Not “Only Out to Make Money”

There’s an old joke about the doctor whose son graduates from medical school and joins his practice. After a while the son tells his father, “You know old Mrs. Jones? You’ve been treating her rash for years and she never got better. I prescribed a new steroid cream and her rash is gone!” The father responds, “You idiot! That rash put you through medical school.”

That’s a joke. It doesn’t reflect reality, but it reinforces a common misconception that doctors care more about their own income than about their patient’s outcome. That accusation is demonstrably untrue.

I’m sick and tired of all the doctor-bashing. They accuse us of being shills for Big Pharma. They say “Doctors are only out to make money.” Or “Doctors are greedy bastards only interested in the bottom line.” Or as one of our commenters recently put it: “First do no harm. Second ? Third, profit [sic]” Some have even made the ridiculous accusation that doctors have found the cure for cancer but have suppressed the information so as to keep people sick and increase their business. If profit were really their primary motivation, doctors would have to be astoundingly clueless, because they keep doing things that are guaranteed to reduce their profits. (more…)

Posted in: General

Leave a Comment (262) →

Science-based medicine throughout time

As 2013 comes to a close, because this probably will be my last post of 2013 (unless, of course, something comes up that I can’t resist blogging about before my next turn a week from now), I had thought of doing one of those cheesy end-of-year lists related to the topic of science-based medicine. Unfortunately, I couldn’t come up with anything I haven’t already done. I even thought of coming up with a list of New Year’s resolutions for 2014. In fact, I even thought of making the first one—in a self-deprecating manner, of course—to be to stop being so mean, nasty, and dogmatic, the better to satisfy my detractors. But then I remembered that nothing is likely to satisfy my detractors and, besides, my ever-lovin’ cuddliness is what makes me so popular. Besides, I have to be me and gotta be true to myself, and all that rot, so that idea went out the window. Of course, what was worse than my inability to come up with something was that I couldn’t think of a way to make it funny. When you’re trying to be funny following the inimitable Mark Crislip, you’d damned well better be funny. So, until my humorous instincts come back, serious it has to be.

But serious doesn’t necessarily mean heavy. The end of a year is a time both to look back on the year before and look forward to the year to come. This year in many ways was a good year for us here at SBM. We launched a Facebook page, reinvigorated our Twitter feed, and have experienced a significant growth in our traffic. Those who know me and/or follow me on various social media know that I’m a big Doctor Who fan, I have been since the 1980s. So the last two big events of the year, the 50th anniversary special in November and the Christmas special on, well, Christmas got me to thinking about time travel, and thinking about time travel revived memories of a topic I covered on my not-so-super-secret other blog four years ago and had been meaning to treat here sometime. It’s a fun topic to finish out the year, not to mention a way for me to blatantly sneak Doctor Who references into an SBM post.

Being a Doctor Who fan and all, not surprisingly, I’ve often wondered what it would be like to be able to travel through time and visit times and places in history that I’m most interested in. For instance, being a World War II buff, I’d certainly want to be able to check out what everyday life was like here in the U.S. during World War II. Given my affinity for psychedelic music and that I was only four years old during most of the Summer of Love, I’d think it cool to check out Haight-Ashbury, although I suspect my reaction to the reality of it would be similar to that of George Harrison when he checked it out for the first time. I guess, if pushed, I’d have to admit that if I were old enough to have been a high school or college student in 1967, I probably would have been one of those straight-laced, short-haired types destined either to go to college to become a doctor or engineer, or to go to Vietnam to fight. Despite loving the music, I never had any interest in experimenting with the drugs. Beer, wine, and—occasionally—a martini or two are my drugs of choice and then only for medicinal purposes, as they say. Heck, I never even tried to smoke tobacco. Even as a child I couldn’t stand the smell of cigarette smoke to the point where it was never even really a temptation.

In any case, what provoked my original bit of musing was a post a few years ago by Martin Rundkvist, who wrote about Fear of Time Travel, where he imagines what it would be like for a modern person to be transported back in time:

First, imagine that you’re dropped into a foreign city with only the clothes you wear. No wallet, no hand bag, no money, no cell phone, no identification. Pretty scary, huh? But still, most of us would get out of the situation fairly easily. We would find the embassy of our country of origin, or if it were in another city, contact the local police and ask to use their phone. A few days later we would be home.

That’s not the scary scenario I rehearse. Imagine that you’re dropped into the city you live in with only the clothes you wear. No wallet, no hand bag, no money, no cell phone, no identification. And it’s 500 years ago. (Or for you colonial types, 300 years ago in one of your country’s first cities.)

(more…)

Posted in: Cancer, Critical Thinking, Science and the Media, Surgical Procedures

Leave a Comment (39) →

Motivations

We received the following letter:

Your blog, the SBM page, has come up for me several times in my research. I’m an RN trying to research cancer treatment, for myself, I am the patient. I’m also a licensed massage practitioner with a 30 year history using “alternative” or “complementary” medicine successfully to treat myself for various things. When your blog has come up I’ve read into it, picking up some useful information.

My question is, why the sarcasm? Why do you and the responders on your site have such disdain and anger? Why do you feel threatened? Your physician status gives you the top of the totem pole, the extensive training, the authority and the privilege. Very doubtful you are going to be knocked off the top of that totem pole in this or any several more lifetimes to come. (more…)

Posted in: Random Thoughts Cause I Can

Leave a Comment (228) →

The Exciting Conclusion

On the slim chance that you’ve been perched on the edge of your seat wondering how the New Mexico appellate court ruled on chiropractic prescription privileges, whether the Council on Chiropractic Education got approved for another three years as an accrediting agency, if NCCAM ever came clean about spinal manipulation, and the fate of Brandon Babcock, DC, at the hands of the judicial system, here are your updates.

Prescription privileges for New Mexico chiropractors

A surprisingly titillating tidbit about New Mexico “advanced practice” chiropractors.

As discussed in previous posts, New Mexico “advanced practice” chiropractors succeeded in getting limited prescription rights. The statute specifically says they can:

prescribe, administer and dispense herbal medicines, homeopathic medicines, over-the-counter drugs, vitamins, minerals, enzymes, glandular products, protomorphogens, live cell products, gerovital, amino acids, dietary supplements, foods for special dietary use, bioidentical hormones, sterile water, sterile saline, sarapin or its generic, caffeine, procaine, oxygen, epinephrine and vapocoolants.

However,

Dangerous drugs or controlled substances, drugs for administration by injection and substances not listed [above] shall be submitted to the board of pharmacy and the New Mexico medical board for approval.

Apparently, the Chiropractic board couldn’t read the plain language of the statute and blew off this requirement, even though their own lawyer told them they couldn’t. This got them hauled into court by the medical and pharmacy boards. The International Chiropractors Association joined the fight. (more…)

Posted in: Chiropractic, Health Fraud, Legal, Politics and Regulation

Leave a Comment (28) →

Garcinia Probably Works But Is Far From a Weight Loss Miracle

Women make up a majority of Dr. Oz’s audience. The majority of women would like to lose weight. That is a match made in heaven, a marketer’s dream. And Oz has never hesitated to exploit that fact to increase audience share, playing fast and loose with sensationalized evidence instead of giving his viewers science-based advice.Garcinia

Dr. Oz has promoted a series of weight loss supplements on his show. Raspberry ketones were presented as a fat-busting miracle, then green coffee bean extract was touted as “magic,” “staggering,” and “unprecedented.” And now both of those miracles have apparently been superseded by an even greater miracle: Garcinia cambogia extract.

Dr. Oz calls it “The newest, fastest fat buster.” A way to lose weight without “spending every waking moment exercising and dieting.” “Triples your weight loss.” “The most exciting breakthrough in natural weight loss to date.” “The Holy Grail.” Oz claims that “Revolutionary new research says it could be the magic ingredient that lets you lose weight without diet or exercise.” That sounds too good to be true, and it is. Garcinia probably does work to some extent to improve weight loss, but the evidence doesn’t begin to justify such grandiose claims. (more…)

Posted in: Herbs & Supplements, Science and the Media

Leave a Comment (46) →

An experiment in paying through the nose for “unnecessary care”

Rats. Harriet stole what was going to be the title of this post! This is going to be something completely different than what I usually write about. Well, maybe not completely different, but different from the vast majority of my posts. As Dr. Snyder noted on Friday, it’s easy to find new woo-filled claims or dangerous, evidence-lacking trends to write about. Heck, I did it just last week, much to the continued consternation of one of our regular readers and commenters. Examining certain other health-related issues from a science-based perspective is more difficult, but I feel obligated to do it from time to time, not just for a change of pace but to stimulate the synapses and educate myself—and, I hope, you as well—about areas outside of my usual expertise.

We spend a lot of time writing about the scientific basis of medicine, clinical trials, what is and isn’t quackery, and how “complementary and alternative medicine” (CAM) subverts the scientific basis of medicine. However, SBM goes far beyond just that. At least I think of it this way. That’s why I’ve looked at issues that go more to the heart of health policy, which should be based on sound science and evidence. That evidence might take different forms than it does for determining, for example, whether Medicaid results in better health outcomes and by how much health insurance does the same. As is the case with policy issues and economics, conclusions are muddled and messy. The error bars are huge, and the number of potential confounders even huger. (more…)

Posted in: Clinical Trials, Politics and Regulation, Public Health

Leave a Comment (47) →

You can’t beat the common cold, and that’s a fact

>> Disclaimer: nothing in this post is meant to be taken as medical advice. Always consult your own provider.

For those of us dedicated to supporting science-based medicine and fighting the ever-widening reach of sCAM, pseudoscience, and health fraud, finding a new woo-filled claim or a dangerous, evidence-lacking trend to write about is relatively easy. Many of us may not realize, however, that some of the most commonly used and recommended treatments, one of which at least is probably sitting in your medicine cabinet as you read this, is equally devoid of evidence to support its use.

Every drug store has row upon row of medicines designed to treat or prevent an acute upper respiratory tract infection, otherwise known as the common cold. Despite this, very few are able to live up to their promise. In most cases, particularly where children are concerned, the side effects of these medicines can be worse than the symptoms they are intended to treat. Because I am a pediatrician, and because the evidence for cough and cold medicines (I will refer to them here as CCMs) for children is particularly absent and because adverse events due to CCMs are most frequently seen in children, I will focus mainly on this population. (more…)

Posted in: General, Pharmaceuticals, Science and Medicine

Leave a Comment (73) →

More evidence that routine multivitamin use should be avoided

If scientific evidence guides our health decisions, we will look back at the vitamin craze of the last few decades with disbelief. Indiscriminate use is, in most cases, probably useless and potentially harmful. We are collectively throwing away billions of dollars into supplements, chasing the idea of benefits that have never materialized. Multivitamins are marketed with a veneer of science but that image is a mirage – rigorous testing doesn’t support the health claims. But I don’t think the routine use of vitamins will disappear anytime soon. It’s a skillfully-marketed panacea that about half of us buy into.

Not all vitamin and mineral supplementation is useless. They can be used appropriately, when our decisions are informed by scientific evidence: Folic acid prevents neural tube defects in the developing fetus. Vitamin B12 can reverse anemia. Vitamin D is recommended for breastfeeding babies to prevent deficiency. Vitamin K injections in newborns prevent potentially catastrophic bleeding events. But the most common reason for taking vitamins isn’t a clear need, but rather our desire to “improve overall health”. It’s deemed “primary prevention” – the belief that we’re just filling in the gaps in our diet. Others may believe that if vitamins are good, then more vitamins must be better. And there is no debate that we need dietary vitamins to live. The case for indiscriminate supplementation, however, has never been established. We’ve been led to believe, through very effective marketing, that taking vitamins is beneficial to our overall health – even if our health status is reasonably good. So if supplements truly provide real benefits, then we should be able to verify this claim by studying health effects in populations of people that consume vitamins for years at a time. Those studies have been done. Different endpoints, different study populations, and different combinations of vitamins. The evidence is clear. Routine multivitamin supplementation doesn’t offer any meaningful health benefits. The parrot is dead. (more…)

Posted in: Herbs & Supplements, Science and Medicine

Leave a Comment (202) →

An Apple a Day

We (the authors and editors) at SBM get accused of many nefarious things. Because we deliberately engage with the public over controversial medical questions, we expect nothing less. It goes with the territory. In fact, if there were a lack of critical pushback we would worry that we were not doing our job.

Still, it is disconcerting to see the frequently-repeated ideological accusations in response to simply evaluating and reporting the evidence. That is what we do here – follow the science and evidence. When that trail leads to a conclusion that some people do not like (usually for ideological reasons) a common response is to accuse us of ideology, malfeasance, being part of a conspiracy, or having conflicts of interest or ulterior motives. That is easier, I suppose, than engaging with us on the science.

One common accusation is that we are shills for the pharmaceutical industry, and downplay or ignore the benefits of diet and “natural” treatments. A search through the SBM archives demonstrates that this accusation is false – we criticize bad science and poor-quality control, regardless of who is committing it. Sometimes pseudoscience is used to promote a drug, sometimes a nutritional supplement, and sometimes pure magic. (more…)

Posted in: Nutrition, Public Health

Leave a Comment (104) →

And Now for Something Completely Different

This will be a departure from my usual posts. Several announcements in the news and medical journals have caught my attention recently, and as I delved into the details, I thought I would share them with our SBM readers. Topics include AIDS cures, the continuing danger of polio, eating nuts for longevity, racial differences in vitamin D, and the use of pharmacogenetic testing to guide the dosage of anticoagulant drugs. They are all examples of science-based medicine in action.

Have patients been cured of AIDS?

I read that the HIV virus had returned in patients thought to have been cured by bone marrow transplants, and I mistakenly thought they were referring to the original claim of cure I had read about. Nope, that one still stands. (more…)

Posted in: Clinical Trials, Nutrition, Pharmaceuticals, Vaccines

Leave a Comment (84) →
Page 1 of 29 12345...»