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Archive for March, 2014

Autism prevalence: Now estimated to be one in 68, and the antivaccine movement goes wild

There used to be a time when I dreaded Autism Awareness Month, which begins tomorrow. The reason was simple. Several years ago to perhaps as recently as three years ago, I could always count on a flurry of stories about autism towards the end of March and the beginning of April about autism. That in and of itself isn’t bad. Sometimes the stories were actually informative and useful. However, in variably there would be a flurry of truly aggravating stories in which the reporter, either through laziness, lack of ideas, or the desire to add some spice and controversy to his story, would cover the “vaccine angle.” Invariably, the reporter would either fall for the “false balance” fallacy, in which advocates of antivaccine pseudoscience like Barbara Loe Fisher, Jenny McCarthy, J. B. Handley, Dr. Jay Gordon, and others would be interviewed in the same story as though they expressed a viewpoint that was equally valid as that of real scientists like Paul Offit, representatives of the CDC, and the like. Even if the view that there is no good evidence that vaccines are associated with an increased risk of autism were forcefully expressed, the impression left behind would be that there was actually a scientific debate when there is not. Sometimes, antivaccine-sympathetic reporters would simply write antivaccine stories.

I could also count on the antivaccine movement to go out of its way to try to implicate vaccines as a cause of the “autism” epidemic, taking advantage of the increased media interest that exists every year around this time. Examples abound, such as five years ago when Generation Rescue issued its misinformation-laden “Fourteen Studies” website, to be followed by a propaganda tour by Jenny McCarthy and her then-boyfriend Jim Carrey visiting various media outlets to promote the antivaccine message.
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Posted in: Diagnostic tests & procedures, Epidemiology, Neuroscience/Mental Health, Science and the Media, Vaccines

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A little more weekend shameless self-promotion to spread an important message about Stanislaw Burzynski

Weekends seem to be the time for shameless self-promotion. At least, some weekends are. So, in that tradition, I can’t help blowing my own horn a bit and urging SBM readers to head on over to listen to The Skeptics’ Guide to the Universe, Episode #455, March 29, 2014. There, Bob Blaskiewicz and I are interviewed about Stanislaw Burzynski and what you, as supporters of science-based medicine, can do to counter the efforts of his supporters to pressure the FDA to let children with cancer receive antineoplastons, efforts that are yielding fruit.

Bob Blaskiewicz has set up a Change.org petition “Protect Desperate Patients from the Houston Cancer Quack“. Bob and I urge you to check it out and sign it.

In the meantime, for those of you in Rep. Darrell Issa’s district, note that I will be in San Diego from April 5th to 9th attending the American Association for Cancer Research Meeting. If there are any skeptics in the San Diego area who would like advice on getting this message to Rep. Issa and/or having a meetup, drop me a line at my e-mail address on our contact page.

Posted in: Announcements, Cancer

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An Update on Water Immersion During Labor and Delivery

Science Based Medicine last covered the increasingly common practice of laboring while immersed in water, in many cases followed by delivering the baby while still submerged, a little over four years ago. In that post, Dr. Amy Tuteur focused primarily on the contamination of the water with a variety of potentially pathogenic bacteria and the associated risk of infection. She also touched on the some of the other risks of giving birth underwater and made some excellent arguments against many of the claims made by proponents. I recommend reading that post and the ensuing comments.

This week, a new joint clinical report from the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) on immersion in water during labor and delivery was published in both the April Pediatrics and on the ACOG website. The media has responded with the typical flurry of falsely dichotomous coverage, pitting maternal-fetal medicine experts against midwives and other waterbirth proponents and leaving it up to the reader to decide which side is right. This March 23rd, an NPR article by Nancy Shute is a particularly frustrating example of weak medical reporting. In the article she essentially portrays giving birth underwater as an established and safe practice and medical experts as overly focused on a few flimsy anecdotes and case reports:

“Case reports are the lowest form of evidence,” Shaw-Battista counters. She is completing a study of 1,200 women who labored or birthed in water, and says they did as well or better than women who did not. “Given the bulk of the data, I don’t think we should use case reports to reject options that women are currently enjoying.”

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Posted in: Obstetrics & gynecology

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More questions about acetaminophen: Does it cause ADHD?

 

pregnant

“Will Tylenol harm my baby?”

 

Pharmacists are among the most accessible of health professionals, and so we receive a lot of questions from the public. No appointment required, and the advice is free. Among the most frequent sources of questions are women seeking advice on drug use in pregnancy. This is an area where some health professionals are reluctant to tread. Some prefer to redirect all of these questions to physicians. But physicians are not always easily accessible, and few want to make an appointment just to ask what appears to be a simple question: Is it safe, or not? Admittedly, addressing questions about drug use in pregnancy can be challenging. There are no randomized controlled trials we can look to — there’s only messier, less definitive data. Our responses are filled with cautious hedging about risk and benefit, describing what we know (and don’t know) about fetal effects. In the pharmacy, one of the most common questions from pregnant women is about the use of acetaminophen (aka paracetamol aka APAP), more commonly known by the brand name Tylenol. Google “Tylenol and pregnancy” and you get 4.8 million results. Which source should you trust? (more…)

Posted in: Science and Medicine

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More Measles Myths

Antivaxxers spread misinformation. This does not have to be the case – I can envision those who wish to function as watchdogs on the vaccine industry or prioritize personal freedom over government programs (even good ones), but who strive to be logical and evidence-based. The culture within the anti-vaccine movement, however, is not logical and evidence-based. Rather, they spread whatever misinformation supports their rather extreme ideology – that vaccines do not work and are dangerous.

Countering anti-vaccine misinformation can be almost a full time job. It is the proverbial game of whack-a-mole, especially in the social media age where old debunked anti-vaccine memes can resurface over and over again on Facebook or Twitter. The game is also rigged in that it is easier to spread fear with misinformation than to reassure with accurate information. Even if we address every anti-vaccine trope, parts of the public can be left with the vague sense that there is something dangerous about vaccines, or that the government is not playing entirely straight with us.

In any case, here is this week’s edition of whack the anti-vaccine mole. The particular varmint that popped its head up recently is the claim that 2-5% of children who receive the MMR vaccine (mumps-measles-rubella trivalent vaccine) contract measles from the vaccine. This specific claim was made on the realfoodeater blog (another thing you should know about the anti-vaccine community is the broad overlap with the natural, alternative medicine, and conspiracy subcultures). The blogger gave as a reference a conversation she had with an unnamed doctor at DeVos Children’s Hospital. (more…)

Posted in: Vaccines

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Point-of-Care Ultrasound: The Best Thing Since Stethoscopes?

A bit of good news for a change: a “Perspective” article in the New England Journal of Medicine describes how point-of-care ultrasound devices are being integrated into medical education. The wonders of modern medical technology are akin to science fiction. We don’t yet have a tricorder like “Bones” McCoy uses on Star Trek, but we are heading in that direction, and the new handheld ultrasound devices are a promising development.

The stethoscope has become iconic, a symbol of medical expertise draped proudly around the neck by doctors and other medical personnel. Before it was invented, doctors could only try to listen to a patient’s heart by direct application of ear to chest. In 1816, Laennec interposed a tube of rolled paper between ear and chest, and the stethoscope was born. It quickly became an essential tool, allowing us to hear the distinctive murmurs produced by different heart valve abnormalities, to take blood pressures, to detect the wheezing of asthma or the collapse of a lung , to hear the bruits caused by atherosclerotic narrowing of blood vessels, to detect intestinal obstructions by listening for borborygmi (I love that onomatopoeic word!).

The stethoscope allows us to hear sounds produced by the body, but sound also allows us to see inside the body. Diagnostic ultrasound has a multitude of uses. With prenatal sonograms, we can determine the sex of a fetus, watch it suck its thumb, and even take its picture for the family album. With echocardiography we can evaluate heart valves, see fluid accumulation in the pericardium, observe the thickness and motion of the heart wall, and even quantify the efficiency of the pumping process. Ultrasound lets us see clots in blood vessels and stones in the gallbladder, evaluate abdominal organs, detect cysts, screen for carotid artery narrowing and abdominal aortic aneurysms, and guide needles into the body for therapeutic and diagnostic purposes. (more…)

Posted in: Diagnostic tests & procedures, Medical Academia, Medical devices

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Stanislaw Burzynski’s propaganda victory on antineoplastons: The FDA caves

Mark Crislip, founder of the Society for Science-Based Medicine, whose board of directors I’m proud to be serving on, an organization that you should join if you haven’t already, sometimes jokes that our logo should be an image of Sisyphus, the king of Ephyra whom Zeus punished by compelling him to roll an immense boulder up a hill. However, the boulder was enchanted and, as soon as Sisyphus reached the top, it would roll back down the hill. Sisyphus was thus forced to repeat this action throughout all eternity. The metaphor is obvious. Those of us who try to combat quackery and the infiltration of pseudoscience in medicine often feel a lot like Sisyphus. I always used to argue that, as amusing as it might be to have such a logo as an “in” joke, it’s far too much of a downer to inspire what SSBM wants to inspire: Action in the form of volunteers taking on projects, such as converting Quackwatch into a wiki and then continuously updating and adding to that wiki indefinitely. We have to believe that there is hope of someday succeeding. “Let’s push that boulder up a hill one more time!” does not exactly constitute an inspiring rally cry, although I can definitely understand the feeling at times the older I get and the longer I’ve been doing this. We can all appreciate gallows humor at times, and, besides, I’m not that pessimistic. I can’t afford to be.

Even so, I can understand the Sisyphus analogy right now with respect to an unfortunately frequent subject of this blog, the doctor in Houston who proclaims himself a cancer doctor, even though he has no formal training in medical oncology, isn’t even board-certified in internal medicine, the prerequisite for undertaking advanced training in medical oncology, and has no discernable training in clinical trials management. I’m referring, of course, to Stanislaw Burzynski, MD, PhD, the Polish doctor who since 1977 has been treating patients with substances that he has dubbed “antineoplastons” (ANPs). What are ANPs? Burzynski claimed to have discovered ANPs during his time at Baylor and described them as endogenous cancer-fighting chemicals in human blood and urine. Unfortunately, he soon became convinced that only he could develop them into an effective chemotherapy drug and left Baylor to administer ANPs to his own cancer patients. Patients flocked to him because he claimed to be able to cure cancers that conventional medicine can’t cure.

This led to a series of battles between Burzynski and various authorities, including the Texas Medical Board, the FDA, and various attorneys general, because of his use of ANPs, which are not and never have been FDA approved, as well as for various—shall we say?—issues with insurance companies. Ultimately, in the 1990s Burzynski beat the rap and effectively neutered the FDA’s case against him by submitting dozens of clinical trials to the FDA for approval, which, given how much pressure the FDA was under from Burzynski’s friends in high places (like Texas Representative Joe Barton), the FDA ended up approving. However, as Burzynski’s lawyer himself bragged, these clinical trials were shams designed to allow Burzynski to keep treating cancer patients, not clinical trials designed to produce any real evidence of efficacy. Not surprisingly, although Burzynski has published the odd case report or tiny case series, he has not yet published the full results of even a single one of his many phase II trials. There is, quite simply, no convincing evidence that ANPs have significant antitumor activity in vivo in humans, even after 37 years. Meanwhile, the FDA has found numerous examples of Burzynski’s abuse of clinical trials, failure to keep necessary data, and failure to protect human subjects, while exposés by BBC Panorama and Liz Szabo at USA TODAY have been most unflattering, revealing at least one dead child as a result of the toxicity of Burzynski’s drug and a pattern of minimizing and hiding reports of adverse reactions.
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Posted in: Cancer, Clinical Trials, Politics and Regulation

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Agnotology: The Study of Ignorance

A comment from the blog:

Every single time – bar none – I have had a conversation with someone about CAM and its modalities, they are absolutely astonished when I explain to them what the modality really is. One story I love telling comes from my friend in the year behind me. His parents are professional chemists and he came home one day and saw his mother had a bottle of homeopathic medicine. He asked why and she gave the typical non-committal response of “well, I thought it may help and I saw it on the shelf at the pharmacy.” He explained what homeopathy actually is and they were absolutely dumbfounded. They are well aware of Avogadro’s number, after all. People generally don’t study what the CAM in question actually is – merely the fluff PR garbage that gets touted around and without direct and clear demonstration of harm, give it a pass as a result. After all, the business of real medicine is time consuming and difficult enough.

Participating in activities that have a permanent record gives one the fortunate, or unfortunate, opportunity to revisit the past and see just how you worked early in a career. (more…)

Posted in: Critical Thinking, Naturopathy, Science and Medicine

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Naturopathy vs. Science: Allergy Edition

snakeoil

I glanced at my pharmacy license recently, and noticed I became a licensed pharmacist almost exactly twenty years ago. Two decades seems like a long time to do pretty much anything, yet I can still vividly recall some of the patients I encountered early in my career, working evenings in a retail pharmacy that drew heavily on the alternative medicine crowd. It was the first pharmacy I’d ever seen that sold products like homeopathy, detox kits, salt lamps, ear candles, and magnetic foot pads. And the customers were just as unorthodox. There were some that told me they manipulated their own pH, and others that insisted any prescription drug was designed to kill. And there was a huge clientele that relied on the pharmacy for their “bioidentical” hormones. It was an instructive learning experience, as it was as far from the science of pharmacy school as you could expect to find in a place that still called itself a pharmacy. One of the really interesting aspects of that pharmacy was the enormous supply of vitamins and supplements for sale. It stretched over multiple aisles and even back into where the drugs were kept, as there were some brands kept behind the counter. This wasn’t for any regulatory reason – it was because these were the “naturopathic” supply, the brands often recommended by naturopaths. In order for this pharmacy to sell them they had to keep the products behind the counter, presumably to grant these supplements a veneer of medical legitimacy. After all, they were “special”, and had the prices to prove it. (more…)

Posted in: Herbs & Supplements, Homeopathy, Naturopathy, Science and Medicine

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Medical Conspiracies

Anyone publicly writing about issues of science and medicine from a pro-science perspective likely gets many e-mails similar to the ones I see every week. Here’s just one recent example:

Im sorry the medical community has become decadent and lazy as most that follow your stance could care less to study the real truth. I have also seen it much more deviant as many professionals know the risks and harm vaccination cause but continue to push it through there practices because of pure greed. Many are also scared of loosing there practices for not following the corrupt industry. Im sorry but the medical industry has become drug pushing decadent slobs that only care about there bottom line.

The e-mailer clearly has a particular narrative that he is following (in addition to the amusingly common poor grammar and spelling). He even writes at one point in our exchange, “the details really don’t matter at this point what matters is what the bigger picture…” He is certain of his big picture conspiracy narrative. The details are unimportant.

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Posted in: Science and Medicine

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