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Archive for April, 2013

Doves, Diplomats, and Diabetes

In the past I have criticized evolutionary medicine for its tendency to rely on unverifiable “Just-So Stories,” but a new book has helped me appreciate what the best kind of evolutionary thinking can contribute to our understanding of medicine. Doves, Diplomats, and Diabetes: A Darwinian Interpretation of Type 2 Diabetes and Related Disorders by Milind Watve investigates diabetes from an evolutionary perspective, suggesting how it might have originated, why it persisted, and how it is related to survival advantages. Watve develops well-reasoned hypotheses that can be tested by examining their expected consequences. He believes it is impossible to understand metabolism without understanding behavioral ecology, and he makes a good case.

A reassessment of the evidence concerning Type II diabetes (T2D) reveals a number of paradoxes. Elevated blood glucose is the defining feature of T2D but controlling it doesn’t prevent all the complications of diabetes, and it doesn’t appear that elevated blood sugar could produce all the pathological changes of diabetes.  Insulin resistance is believed to be central to a cluster of deadly diseases in humans, but in other animals it has no adverse effects on health and even increases lifespan. Studying diabetes from an evolutionary perspective can shed light on such paradoxes. (more…)

Posted in: Basic Science, Book & movie reviews, Evolution

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Eric Merola’s conspiracy-mongering and more of Dr. Stanislaw Burzynski’s cancer “success” stories

About a month ago, Eric Merola screened his second movie about “brave maverick doctor” Stanislaw Burzynski, Burzynski: Cancer Is A Serious Business, Part 2 (henceforth referred to as “Burzynski II”), a screening that Brian Thompson and an unnamed colleague from the James Randi Educational Foundation (JREF) attended, took notes, and even managed to ask a question. At the time, I took advantage of Brian’s awesome commentary about his experience on the JREF Swift Blog, his copious notes, and my read on Eric Merola’s trailers for the movie, what he said in the first movie, and his own promotional material to write about how Merola dishonestly demonizes what he refers to as “The Skeptics” (i.e., us) and five major misconceptions about Burzynski, cancer, and skeptics promoted in Burzynski II, all with a heapin’ helpin’ of conspiracy mongering. In this post, I will delve into a little more detail about the fundamental intellectual dishonesty behind Eric Merola’s conspiracy mongering and discuss two of the cases being used to “prove” that Burzynski can cure cancer, mainly because they are appearing along with Merola on the publicity trail. Merola himself, thankfully (I guess) has allowed me to do this by posting an edited version of that original Q&A to YouTube:

In particular, note how everything I said in my previous post about what went on at the Q&A is verified, and, in fact, you now have the details. I will try to mention the specific time points to refer to as I go along. Also note that there is a segment at about the 47:45 mark in which JREF’s Brian Thompson (blurred out but still recognizable) speaks with the husband of one of Burzynski’s patients that is worth watching and that I will briefly discuss further into this post.
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Posted in: Cancer, Clinical Trials, Science and the Media

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Veterinary Chiropractic

People are sometimes surprised to learn that all the heavy hitters of alternative medicine, such as acupuncture, chiropractic, homeopathy, etc., are inflicted on animals as well as humans. I’ve written about veterinary homeopathy, and the associated manufactroversyin a previous post, and today I thought I’d take a look at veterinary chiropractic.

The Players

In most states, chiropractic is defined in terms of treatment of humans and chiropractors are thereby licensed only to treat humans. However, there are a variety of ways around this for people who want to subject their animals to this therapy. Some chiropractors will simply treat animals and ignore the fact that it isn’t technically legal for them to do so. And some veterinarians will take one of the many training courses available in animal chiropractic and then employ it as part of their practice of veterinary medicine. A previous SBM article has discussed the lack of consistency or legitimate scientific content in most of these courses.

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Posted in: Chiropractic

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Cranberry, the alt-med zombie

If there’s a characteristic that’s common among proponents of alternative medicine, it’s tenacity. The willingness to stick with an idea, no matter the evidence, must give one a certain clarity. The naturalistic fallacy is often the foundation. Natural is good, synthetic is bad, no matter the evidence. In some cases, in spite of the evidence. How one deals with contradictory evidence is an effective tool to differentiate between medicine and alternative medicine – given sufficient convincing evidence, medicine changes its practices. The same can’t be said for alternative medicine, where few treatments are ever discarded. Otherwise practices like homeopathy, acupuncture, reiki, and chiropractic would have disappeared long ago. It’s also why disproven products continue to have occasional resurgences in interest. Cranberry is one. It has been touted as a treatment and a preventative for urinary tract infections for years.  And it doesn’t seem to work – not well, and not reliably, if you look at all the trials. And that’s being generous, considering the poor quality of the evidence with its inherent biases. I know a dead parrot when I see one. Yet its advocates, mainly manufacturers (is there a Big Cran?) keep insisting it’s alive, supported by the occasional positive report that appears. With a new systematic review and meta-analysis that declares it’s effective, it’s time to update our review. (more…)

Posted in: Clinical Trials, Herbs & Supplements

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Pseudoacademia

The integrity of the scientific basis of medicine is under attack from numerous fronts. It is not only the intrusion of pseudoscience and mysticism into mainstream institutions of medicine, but also attempts to distort or game the scientific process for ideological and financial reasons.

Ideological groups such as the anti-vaccine movement, or grassroots organizations promoting pseudodiseases such as chronic Lyme, electromagnetic sensitivity, or Morgellon’s often misrepresent the scientific evidence while they lobby for special privilege to avoid the science-based standard of care within medicine.

Pharmaceutical companies, with billions on the line, have been very creative in figuring out ways to optimize their chances of getting FDA approval for their drugs, and then promoting their drugs to the medical community. Ghost-writing white papers, hiding negative trials, and designing trials to maximize positive outcomes have all been documented.

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Posted in: Science and Medicine

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Adventures on the Alimentary Canal

I write about a lot of depressing subjects, and sometimes a change of pace is welcome. Mary Roach, billed as “America’s funniest science writer,” has followed up on her earlier explorations of cadavers (Stiff), sex (Bonk), the afterlife (Spook), and survival on spaceships (Packing for Mars) with a new book entitled Gulp: Adventures on the Alimentary Canal.

Forget all that mythology about diet, detoxification, and 10-year-old hamburger accretions in the bowel. The reality of human digestive physiology is far more interesting and has the extra-added attraction of being true. And in Roach’s hands, often howlingly funny.  She is a hands-on investigative reporter who is ready to try anything; among other adventures she inserts her entire arm in a cow’s stomach. Her highly entertaining odyssey takes her to Igloolik to eat narwhal skin, to a dog food tasting lab in Missouri, to Minnesota to observe a fecal transplant, and to strange and exotic outposts at the cutting edge of science, populated by colorful characters. (more…)

Posted in: Basic Science, Book & movie reviews, History

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The “no compassion” gambit

As usual, I was impressed with Mark Crislip’s post on Friday in which he discussed the boundaries between science-based medicine and what we sometimes refer to as woo or what Mark often refers to as sCAM. It got me to thinking a bit, which is always a dangerous thing, particularly when such thinking leads to my writing something for my not-so-super-secret other blog (NSSSOB). Of course, this is not my NSSSOB, but that doesn’t make it that much less dangerous. Be that as it may, I started thinking about a gambit I started noticing a few years ago being directed at me by the targets of my logorrheic deconstructions. Actually, I noticed it from the very beginning, when I first started blogging about SBM versus quackery way back in 2004 and even before, back when I was one of a doughty band of pro-science types who waded into the Wild West of online forums known as Usenet, in particular the misc.health.alternative newsgroup.

I happen to be in Washington, DC as I write this. In fact, as I write this I’m here to attend the annual meeting of the American Association for Cancer Research (AACR), the better to soak in all that cancer science goodness and (hopefully) be pumped up to go back and keep trying to do good science and, hopefully, manage to get my lab funded. Of course, the latter task is a really daunting these days, a truly depressing thing to contemplate, given that the current payline for the National Cancer Institute is around the 7th percentile, which makes me worry about how much longer my lab will be open. My self pity aside, Mark got me to thinking about the characteristics of purveyors of non-science-based medicine (i.e., quackery and quackademic medicine) compared to SBM. More precisely, I started thinking about a difference that what Mark calls sCAMmers try to pin on those of us who try to defend SBM against the forces of pseudoscience. To introduce this concept, I think it’s worth going back a few years to a comment I got a long, long time ago on a blog far, far away (i.e., my NSSSOB):

When it comes to autism, you seem to have lost something that I think every physician is well-served to have in abundance: compassion.

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Posted in: Cancer, Health Fraud, Public Health, Science and the Media, Vaccines

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Boundaries

Vacation then taxes have consumed my focus the last two weeks, and I have had little time to devote to issues of infectious diseases, much less SBM, so I will instead meander around a more philosophical terrain.  I feel guilty when I do not have a substantive, data driven post evaluating a paper or essay in detail, but some weeks there just is not the time.

Being involved with SBM has been, like all intellectual endeavors, a process rather than result. I keep experimenting with conceptual frameworks with which I can understand the differences between a SBM approach and a SCAM (supplements, complementary and alternative medicine) approach. Nothing clarifies thoughts quite like writing them down. Or maybe not.

The motto of the blog is “exploring the relationships between science and medicine” but it is often more about non-overlapping boundaries* than relationships. We are often separated more by Berlin walls than Venn diagrams.

There are perhaps four boundaries that separate science-based medicine from those who prefer SCAMs. More if you are a splitter; I am a lumper by nature. At work I am an Occam kind of guy. (more…)

Posted in: Science and Medicine

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Homeopathic regulation diluted until no substance left

Homeopathy is quackery but it is perfectly legal to prescribe homeopathic products and to sell them directly to consumers in the United States as well as other supposedly civilized countries such as the United Kingdom and Germany. This makes as much sense as allowing the sale of batteries that don’t produce electricity.

What makes this state of affairs even stranger is that homeopathic products are classified as drugs under U.S. law. Does this mean that they undergo the same pre-market approval process and are subject to the same post-market requirements as pharmaceutical drugs? No, not by a long shot. In fact, the federal government and the FDA have pretty much handed regulation of homeopathic products over to their manufacturers.

How did this happen?

In 1938, Congress passed the Food, Drugs and Cosmetics Act. The Act’s principle author was Senator Royal Copeland, a physician who practiced homeopathy. He managed to include all articles monographed in the Homeopathic Pharmacopeia of the United States (HPUS) in the definition of drugs within the FDCA, although why he did so remains in dispute. The HPUS is a source for monographs, identity, methods of manufacture, standards and controls and potency levels of homeopathic products, both prescription and OTC. (The vast majority of homeopathic products are OTC.) In short, if the product is in the HPUS, it’s legal.

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Posted in: History, Homeopathy, Legal, Naturopathy, Politics and Regulation

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Important Security Notice: SBM Hacked

UPDATE 2013-04-04 1:25 PM EDT: All passwords have been reset. Users will have to use the “Forgot password” function to set a new password.

UPDATE 2013-04-04 6:06 PM EDT: Those interested in knowing if one of their passwords was one of the less secure may use this tool to check their email address. No matter the result with that tool, the only way to be 100% secure is to change your password on other sites if you also used it here.

ScienceBasedMedicine.org (SBM) was recently hacked, and user account information may have been stolen: usernames, passwords, and email addresses. Most of the potentially stolen passwords were strongly encrypted — that is, extremely difficult to read. About 2000 random accounts, roughly 5% of the total, were not protected as effectively and may be at greater risk.

If your SBM password was used for any other service, website, or account, you should change that duplicate password as soon as possible. (For example: if your SBM password is the same as your password for Gmail, you should immediately go to Gmail and change your password there.)

When hackers get your password from one place, they often try to use the same password with other services and websites. Unfortunately, this is a fairly effective strategy, because many people use the same password for many of their logins. This is why all security experts strongly recommend using unique passwords for all critical services.

What exactly happened to ScienceBasedMedicine.org?

On Sunday, March 10, hackers successfully gained access to the SBM server, and attempted to use it to attack other servers. Eventually it gave itself away by using too much computing power.

On Monday, April 1, our hijacked server was shut down by the service provider. We remained offline for a full day as we repaired the damage and strengthened our protections against hackers. SBM is now back online but all users will have to reset their passwords before commenting again.

There is no way to know if the attacker actually took any data from ScienceBasedMedicine.org itself, but the safest course is to act on the assumption that they did. However, most of that data was strongly protected by encryption — standard practice for user account information on WordPress blogs for exactly this reason. (You can find details on this encryption here.)

Nevertheless, we know that some of the passwords (again, only about 5%) were less protected. (Specifically, they used an older MD5-based encryption.) Therefore, we strongly urge all SBM users to make sure they are not using their SBM password anywhere else.

SBM login is now available, and will require you to reset your password.

Posted in: Science and Medicine

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