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Archive for February, 2013

Calcium supplements and heart attacks: More data, more questions

Why take a drug, herb or any other supplement? It’s usually because we believe the substance will do something desirable, and that we’re doing more good than harm. To be truly rational we’d carefully evaluate the expected risks and benefits, estimate the overall odds of a good outcome, and then make a decision that would weigh these factors against any costs (if relevant) to make a conclusion about value for money. But having the best available information at the time we make a decision can still mean decisions turn out to be bad ones: It can be that all relevant data isn’t made available, or it can be that new, unexpected information emerges later to change our evaluation. (Donald Rumsfeld might call them “known unknowns.”)

As unknowns become knowns, risk and benefit perspectives change. Clinical trials give a hint, but don’t tell the full safety and efficacy story. Over time, and with wider use, the true risk-benefit perspective becomes more clear, especially when large databases can be used to study effects in large populations. Epidemiology can be a powerful tool for finding unexpected consequences of treatments. But epidemiologic studies can also frustrate because they rarely determine causal relationships. That’s why I’ve been following the evolving evidence about calcium supplements with interest. Calcium supplements are taken by almost 1 in 5 women, second only to multivitamins as the most popular supplement. When you look at all supplements that contain calcium, a remarkable 43% of the (U.S.) population consumes a supplement with calcium as an ingredient. As a single-ingredient supplement, calcium is almost always taken for bone health, based on continued public health messages that our dietary intake is likely insufficient, putting women (rarely men) at risk of osteoporosis and subsequent fractures. This messaging is backed by a number of studies that have concluded that calcium supplements can reduce bone loss and the risk of fractures. Calcium has an impressive health halo, and supplement marketers and pharmaceutical companies have responded. There are pills, liquids, and even tasty chewy caramel squares embedded with calcium. It’s also fortified in foods like orange juice. Supplements are often taken as “insurance” against perceived or real dietary shortfalls, and it’s easy and convenient to take a calcium supplement daily, often driven by the perception that more is better. Few may think that there is any risk to calcium supplements. But there are now multiple safety signals that these products do have risks. And that’s cause for concern. (more…)

Posted in: Herbs & Supplements, Nutrition

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Doctors and Dying

“I intend to live forever. So far, so good.”

- Steven Wright

The humor in many of comedian Steven Wright’s famous one-liners is that they are simultaneously familiar and absurd. At some level we all know that we are going to die, but as long as we are still alive (or a loved-one is alive) we can cling to the irrational hope, the impossible denial, that death remains a distant abstract concept, not an near inevitability.

We all need to come to terms with death in our own private way, but often those terms are not private because they drive our use (for ourselves or others) of increasingly expensive health care. Two essays over the last year by doctors explored this issue, noting that when doctors face their own mortality they often make different health care decisions for themselves than the general public.

In February of 2012, Dr. Ken Murray wrote an essay in The Wall Street Journal – Why Doctors Die Differently. His primary thesis was that doctors choose less end-of-life care for themselves than the average patient. They do so largely because they are intimately familiar with the futility of much of what we do for patients who are likely going to die anyway. As one example, CPR has a success rate of about 8%, with only 3% of people receiving it going on to have a near-normal quality of life. Those numbers are pretty grim. Meanwhile, TV depictions of CPR are successful 75% of the time with 67% returning to normal life. Sometimes the person wakes up during the CPR, is fine, and then goes on to thwart a terrorist attack without missing a beat.

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Posted in: Politics and Regulation

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Kudos to a Journalist

Many SBM readers will remember the late, great Barry Beyerstein,  a luminary of the skeptical movement and author of a classic article that has been cited many times on SBM, an explanation of why bogus therapies seem to work.

One of his greatest personal accomplishments is not as well known: he produced an exceptional daughter, Lindsay Beyerstein, a freelance writer, philosopher, and polymath who stepped into her father’s shoes as a faculty member of the annual Skeptic’s Toolbox workshop after his death and has done a truly admirable job there.

Among Lindsay’s many other activities, she works for the Sidney Hillman Foundation, a nonprofit that honors excellence in socially conscious journalism. One of her goals has been to reward excellence in science journalism. Bob Ortega has just received a Sidney Award for his exposé of a widely used HPV (human papillomavirus) test that is not FDA approved and has an unacceptably high rate of false negative results. Her interview with him was published on the Hillman Foundation website.  On SBM, we frequently criticize journalists who get the science wrong. For a change, I’d like to congratulate Mr. Ortega for not only getting the science right, but for accomplishing something that could potentially save lives.

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Posted in: Cancer, Obstetrics & gynecology, Science and the Media

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Blame and magical thinking: The consequences of the autism “biomed” movement

That the myth that vaccines cause autism is indeed nothing more than a myth, a phantom, a delusion unsupported by science is no longer in doubt. In fact, it’s been many years now since it was last taken seriously by real scientists and physicians, as opposed to crank scientists and physicians, who are still selling the myth.  Thanks to them, and a dedicated cadre of antivaccine activists, the myth is like Jason Voorhees, Michael Myers, or Freddy Krueger at the end of one of their slasher flicks. The slasher or monster appears to be dead, but we know that he isn’t because we know that he’ll eventually return in another movie to kill and terrorize a new batch of unlucky and invariably not so bright teenagers. And he always does, eventually.

Unfortunately, the myth has a price, and autistic children pay it when they are unlucky enough to have parents who have latched on to this particular myth as an explanation for why their child is autistic. One price is blame. Parents who come to believe the myth that vaccines cause autism also express extreme guilt that they “did this” to their children, that it’s their fault that their children are autistic. At the same time, they have people and entities to blame: Paul Offit, big pharma, the FDA, the scientific community, pediatricians. As a result, the second price is paid: Their children are subjected to pure quackery, such as “stem cell” injections (which almost certainly aren’t actually stem cells, given the provenance of the clinics that offer such “therapies”) into their cerebrospinal fluid, and what in essence constitutes unethical human experimentation at the hands of “autism biomed” quacks. Meanwhile these same quacks reap the financial benefits of this belief by offering a cornucopia of treatments to “recover” autistic children that range from the ineffective and usually harmless (such as homeopathy) to the ineffective and downright dangerous (dubious “stem cell” injections by lumbar puncture into a child’s cerebrospinal fluid). These treatments drain the parents’ pocketbook and do nothing other than potential harm to the children. These prices are intertwined, and just last week I saw examples of both prices on full display at various antivaccine blogs. Worse, the concept appears to be metastasizing beyond vaccines. As more and more scientific evidence fails to find even a whiff of a hint of a correlation between vaccines and autism, the One True Cause of Autism, which was once vaccines or mercury in vaccines, has become the Many True Causes of Autism, in which vaccines (it’s always the vaccines) mix with pharmaceuticals, pollution, diet, and chemicals to produce autism in a manner that is a lot harder to falsify than the older, all too scientifically testable hypothesis that vaccines cause autism.
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Posted in: Health Fraud, Neuroscience/Mental Health, Science and the Media, Vaccines

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Warts

As this is published I am finishing the last day of a 12 day stretch covering my partner while he is off trying to get MDRTB and typhoid fever.  He is in India. I may have to autoclave him when he returns before I let him in the hospital.  Double the work means double the fun, but free time goes down by the power.  Same thing happens with the kids.  If you have two kids, the work squares, three kids, the work cubes.  A linear change in one domain leads to exponential change in other domains.  I am sure that phenomena has a name that one of our readers will know.

I lack the mad typing skills of other contributors and it usually takes me at least a week to carefully construct the spelling errors and grammatical faux paux for which I am justly famous.  And then I have to come up with content to surround the faulty English.  This week I have little time and so a ‘fun’ post.

When I make rounds it is not unusual for people to ask questions about their health and their family.  I learned long ago to ask why they want an answer to a particular question so I do not inadvertently offend a colleague.  When I offend I like to be advertent.  Years ago I was asked what I thought of hyperbaric oxygen, and I replied that it is great for the bends but otherwise mostly serves to enrich the hyperbaric doctors.  Why do you ask?  I am the new director of the hyperbaric program, was the reply.  Open mouth and insert foot.

So recently a nurse asked me if duct tape would remove warts.  Wary, I asked why, and she showed me a huge wart on her hand.  I have used duct tape for many purposes; few home repairs cannot be (temporarily) accomplished with duct tape. But treating warts?  Do you use the tape as a way to yank the wart out by its roots?  Got me.  I gave my best Gallic shrug and went looking for information. (more…)

Posted in: Clinical Trials, Naturopathy

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A Final Word: On T-Shirts and Teapot Tempests

I wore a T-shirt at The Amazing Meeting 2012 that generated a lot of controversy. You can see a picture of it on my Wikipedia article.  I didn’t want to talk about the T-shirt, but I’ve been repeatedly challenged to explain myself, and I’m afraid I can no longer avoid it. Steven Novella has recommended that we try to give other people’s arguments the most charitable interpretation. I hope my critics will do that, but I’m not optimistic. If past experience is any guide, they will misinterpret my explanation and put it in the worst possible light, which is why I haven’t offered it before. So be it; I have a tough skin. Once this T-shirt explanation is out of the way, I will have done my duty and had my say and will feel free to ignore all these divisive and nonproductive arguments. I don’t plan to write about gender or feminism or the squabbles in the skeptic movement again.

First, a brief digression about charitable interpretations and the whole “queer” discussion. I said “most” people in the LGBT community find the term offensive. Instead of attacking me as totally clueless, a charitable reader might have gently corrected me by providing quantitative evidence that the majority of people in the LGBT community do not find the word offensive (so far, no one has provided such evidence). When shown quantitative evidence, I would gladly have changed the word “most” to “many” or “some” or even “a few,” depending on the actual numbers, and we would all have learned something. What actually happened served as a perfect illustration of the points I made in my “Enemies” article. The ensuing discussion was bizarre, nit-picking, surreal, divisive, unproductive, and failed to emphasize the one thing we ought to all agree on: we don’t want to use labels that others find offensive.  The silly quibbling about my use of the one word “most” just derailed the discussion from the more important issues, and from all the other words in my post.

To set the scene for the T-shirt incident, there was a complex backstory involving Elevatorgate, Richards Dawkins, insults and threats directed at women, a perception that TAM’s anti-harassment policy was not being enforced, objections to a statement JREF President DJ Grothe made, accusations that Grothe had lied about reports of harassment, and numerous other incidents, many of which were blown way out of proportion. All this had left big chips firmly glued to shoulders. (more…)

Posted in: General

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Legislative Alchemy: Chiropractic 2013

Via the magic of legislative alchemy, chiropractors are already licensed health care providers in all 50 states. Thus their legislative efforts tend to focus on expanding their scope of practice and forcing public and private insurers to cover their services, in some cases at the same rate as medical doctors. Those efforts continue in 2013 with 65 bills impacting chiropractors introduced so far. Of those including substantive provisions (as opposed to, say, simply raising fees), only one is not to their advantage.

New Mexico chiropractors are once again attempting expansion of their scope of practice. In 2008 and 2009, the New Mexico legislature created a new iteration of chiropractor, called “the certified advanced practice chiropractic physician.” A certain faction of the chiropractic industry is attempting to rebrand chiropractors nationwide as primary care physicians and this was a signature event in those efforts. With 90 hours of additional education, these advanced practice chiropractors can administer a bevy of dubious remedies, such as bioidentical hormones.

The new law also permitted prescription of dangerous drugs and controlled substances and administration of drugs by injection, but only if on a formulary approved by the state pharmacy and medical boards. The chiropractic board didn’t like having to get approval from pharmacists and medical doctors, so they went ahead and added what they wanted to the formulary, ignoring the other boards despite their own attorney’s advice that they couldn’t do this. This got them into a couple of court battles with the pharmacy and medical boards. The International Association of Chiropractors (ICA), the traditional, subluxation-only chiropractic faction, jumped into the fray to oppose this power grab. The ICA believes chiropractic should remain drug and surgery free.

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Posted in: Chiropractic, Herbs & Supplements, Homeopathy, Legal, Pharmaceuticals, Politics and Regulation

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I Am Not Your Enemy: An Open Letter to My Feminist Critics

Note: The previous post is my usual weekly contribution to SBM. I am taking the liberty of posting this additional entry today on an issue that is peripheral to Science Based Medicine. If you are not interested in the recent squabbles within the skeptical movement, you will probably want to skip it. But it does respond to a detailed critique of an article I posted here two weeks ago, and some might find that of interest. We have seen the same kind of behavior on this blog, where commenters have responded not to what we said, but to what they wanted to believe we said.

 


 

I have been falsely identified as an enemy of feminism (not in so many words, but the intent is clear). My words have been misrepresented as sexist and misinterpreted beyond recognition. I find this particularly disturbing and hard to understand, because I’m convinced that my harshest critics and I are basically arguing for exactly the same things. I wish my critics could set aside their resentments and realize that I am not the enemy.

Two weeks ago I published an article on gender differences and the recent divisions in the skeptical community.  Ophelia Benson showed up in the comments. Not unsurprisingly, she disagreed with me about the Shermer incident, but then she said “I like the rest of this article a lot. I particularly like the point about averages and individuals, which is one I make all the time.”

I took that as a hopeful sign that friendly communication might be achieved, but my bubble was quickly burst by a hostile takedown of my article on Skepchick by “Will.”  His critique is demonstrably unfair. He attacks me for things I never said and tries to make it look like I believe the exact opposite of what I believe.

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Posted in: General

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Sex, Gender, and Sexuality: It’s Complicated

When a baby is born, the obstetrician or midwife announces “It’s a boy” or “It’s a girl.” As toddlers, children learn to classify everyone as either boy or girl. When our firstborn was very young, we overheard her talking to herself as she grappled with the concept:

Let’s see… I’m a girl, and Kimberly [her baby sister] is a girl, and Mommy’s a girl… but Daddy’s not a girl… He’s a boy. [Pause followed by exasperated sigh] Cause he doesn’t know any better!

As with most things in science, the concept of boy versus girl is more complicated than it appears at first glance. It’s not a simple dichotomy. We humans like to classify everything into neat pigeonholes, but Nature’s inventiveness outsmarts us at every step.

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Posted in: General

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