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Archive for 2014

False “balance” on influenza with an appeal to nature

One of the encouraging shifts I’ve seen in health journalism over the past few years is the growing recognition that antivaccine sentiment is antiscientific at its core, and doesn’t justify false “balance” in the media. There’s no reason to give credibility to the antivaccine argument when their positions are built on a selection of discredited and debunked tropes. This move away from false balance and towards a more accurate reflection of the evidence seems to have started with the decline and disgrace of Andrew Wakefield and his MMR fraud. And there is now no question that antivaccine sentiment has a body count: Simply look at the resurgence of preventable communicable disease. Today, antivaccinationists are increasingly recognized for what they are – threats to public health. It seems less common today (versus just 5 years ago) that strident antivaccine voices are given either air time or credibility in the media.

But false balance on topics like influenza can occur without giving a voice to groups like antivaccinationists. A more subtle technique to shift perceptions is both widespread and hard to detect, unless you’re aware of it: the naturalistic fallacy, known more accurately as the appeal to nature. In short, it means “It’s natural so it’s good” with the converse being “unnatural is bad.” In general, the term “natural” has a positive perception, so calling a product (or a health intervention) “natural” is implying goodness. The appeal to nature is so common that you may not even recognize it as a logical fallacy. Unnatural can be good, and natural can be bad: Eyeglasses are unnatural. And cyanide is natural. Natural doesn’t mean safe or effective. But the appeal to nature is powerful, and it’s even persuasive to governments. If we believe that health interventions and treatments should be evaluated on their merits, rather than whether or not they’re “natural”, then decisions to regulate “natural” products differently than the “unnatural” ones (like drugs) makes little sense. Yet the Dietary Supplement Health and Education Act was a legislative appeal to nature, introducing a different regulatory and safety standard for a group of products while drawing a fallacious distinction with “unnatural” products like drugs. Canada fell for the appeal to nature too: It has the Natural Health Products Regulations which entrenched a lowered bar for efficacy and safety for anything a manufacturer can demonstrate is somehow “natural”. (more…)

Posted in: Science and Medicine, Science and the Media

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HIV Denial and “Just Asking Questions”

The “just asking questions” maneuver is familiar to many skeptics. The idea is to feign neutrality, to insulate oneself from accountability or being held to answer for any specific position, but meanwhile to sow doubt about a scientific claim by raising (dubious) questions.

Sometimes the “I’m just asking questions” gambit also tries to disguise itself as sincere journalism. That’s what journalists do, right, ask the tough questions, uncover the uncomfortable truth?

I find this approach particularly deceptive. It tries to hide the fact that the journalist is working off of a particular narrative. Asking questions is, in fact, just another narrative style, one that is meant to lead the reader/viewer to a particular conclusion about the subject. The narrative determines what questions are asked and how they are answered.

A perfect example of this deceptive approach is the HIV denialist movie, House of Numbers. Here is the synopsis from the movie’s website:

What is HIV? What is AIDS? What is being done to cure it? These questions sent Canadian filmmaker Brent Leung on a worldwide journey, from the highest echelons of the medical research establishment to the slums of South Africa, where death and disease are the order of the day. In this up-to-the-minute documentary, he observes that although AIDS has been front-page news for over 29 years, it is barely understood. Despite the great effort, time, and money spent, no cure is in sight.

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Posted in: General

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How to Think

Robert Todd Carroll, the author of The Skeptic’s Dictionary, has a new book out: The Critical Thinker’s Dictionary: Biases, Fallacies, and Illusion and what you can do about them. Since some of our commenters and most of the CAM advocates we critique are constantly committing logical fallacies, a survey of logical fallacies is a good idea both for us and for them, and this book fits the bill.

When I received the book in the mail, I set it aside, thinking it would be a somewhat boring listing of things I already knew. When I finally got around to reading it, I was surprised and delighted. It held my interest, reminded me of things I had forgotten, explained other things I had never heard of, and provided entertaining stories to illustrate each point. Best of all, the bulk of his examples are taken from medicine and relate directly to the topics we discuss on SBM.

Carroll is well-qualified to write about logical fallacies: he is a retired professor of philosophy who has long promoted skepticism and taught classes in critical thinking, and he writes in an entertaining, accessible style. He started The Skeptic’s Dictionary website in 1994 with 50 articles and it has now grown to several hundred articles. It attracts more than a million visitors a month, and some of its entries have been translated into more than a dozen languages. It has become a go-to reference for anyone seeking the facts on questionable claims about everything from crop circles to homeopathy. Its articles are thorough and well documented with lots of references and links. (more…)

Posted in: Book & movie reviews, Critical Thinking

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The return of the revenge of high dose vitamin C for cancer

Somehow, I’ve a feeling we’re not in Kansas anymore—except that we are, as you will soon see.

Because I’m the resident cancer specialist on this blog, it usually falls on me to discuss the various bits of science, pseudoscience, and quackery that come up around the vast collection of diseases known collectively as “cancer.” I don’t mind, any more than my esteemed colleague Dr. Crislip minds discussing infectious diseases and, of course, vaccines, the most effective tool there is to prevent said infectious diseases. In any case, there are certain things that can happen during a week leading up to my Monday posting slot on SBM that are the equivalent of the Bat Signal. Call them the Cancer Signal, if you will. One of these happened last week, thus displacing that post I’ve been meaning to write on a particular topic once again. At this rate, I might just have to find a way to write an extra bonus post. But not this week.

In any case, this week’s Cancer Signal consisted of a series of articles and news reports with titles like:

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Posted in: Basic Science, Cancer, Clinical Trials

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I Visited a Chickasaw Healer and All I Got Was an Elk Sinew and Buffalo Horn Bracelet

Which headline is real?

  • I Visited a Alchemist. As American alternative chemistry grows in popularity, I decided to experience an even older style of nontraditional transmutation of metals.
  • I Visited an Astrologer. As American alternative astronomy grows in popularity, I decided to experience an even older style of nontraditional stargazing.
  • I Visited a Bloodletter. As American alternative medicine grows in popularity, I decided to experience an even older style of nontraditional treatment.
  • I Visited a Chickasaw Healer. As American alternative medicine grows in popularity, I decided to experience an even older style of nontraditional treatment.

Difficult? They are similar in that alchemy, astrology, bloodletting and (as we will see) Chickasaw healing are not based on reality. Bloodletting, as best I can determine, is not offered in the US, at least based on the notion of an imbalance of the 4 humors. I have no doubts that a reader will find a practitioner, likely with Hepatitis B and C, somewhere in the US. Probably in Sunnydale.

It was the final option, from The Atlantic. Given their medical reporting in the past, I would not be surprised if any of the above headlines originated in that magazine. This gets to an issue I have with all media. There are two things about which I have expertise: infectious diseases and SCAM. So often the media get both wrong, although I probably notice more when they get it wrong in the areas of my expertise. If they get it so wrong in areas about which I know something, how can I trust the veracity of reporting in all the areas where I have no knowledge? (more…)

Posted in: Energy Medicine, Science and the Media

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Twenty days in primary care practice, or “naturopathic residency”

The metastasis of alternative medicine throughout the health care system comes, in no small part, at the hands of the federal and state governments, mostly the latter and most particularly the state legislatures. Under their jurisdiction rests the decision of who can, and cannot, become a licensed health care practitioner, and what they can, and cannot, do. This is the gateway through which much of pseudo-medicine flows.

I’ve read many CAM practitioner licensing statutes (all of the chiropractic practice acts, in fact) and many legislative proposals to license or to expand the scope of practice. Typical of the boilerplate recited in support of this legislation is the education and training of these practitioners, which is touted as a means of protecting the public from charlatans and quacks out there selling snake oil to the credulous. Naturopathic licensing bills routinely require graduation from a naturopathic “medical” school accredited by the Council on Naturopathic Medical Education. (See, for example, Michigan House Bill 4152, which both David Gorski and I have discussed on SBM.) Unfortunately, what CAM provider legislation often does is simply provide legal cover for selling that very same snake oil.

Naturopaths are licensed in 17 states so far, although what they can and can’t do varies considerably. In some states, they have a scope of practice similar to that of an M.D. or D.O. primary care physician. At the most liberal end of this spectrum, N.D.s can prescribe drugs (as Michigan’s bill would allow), although this, too, varies depending on what’s listed on the state’s naturopathic formulary.

All of this has led me to conclude that the state legislatures do not have internet connections. Because, if they did, it would be pretty easy to Google around and figure out just what this naturopathic “medical” education entails and how practicing naturopaths apply their education and training in actual practice. In fact, I’ve done this myself and reported the results here on SBM. In the last day or so, I found out even more by looking around the websites of the Council on Naturopathic Medical Education, the American Association of Accredited Naturopathic Medical Schools, and its member institutions. We’ll get to the fruits of that research in a minute. (more…)

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

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Treating Pain Psychologically

One of the goals of rigorous science is to disentangle various causes so we can establish exactly where the lines of cause and effect are. In medicine this allows us to then optimize the real causes (what aspect of treatments actually work) and eliminate anything unnecessary.

Eliminating the unnecessary is more than just about efficiency – every intervention in medicine has a potential risk, so this is also about risk reduction.

It often seems to me that the goal of “alternative” medicine is to blur the lines of cause and effect, to exploit non-specific effects in order to promote a useless but profitable ritual (acupuncture comes to mind).

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Posted in: Clinical Trials, Neuroscience/Mental Health

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Food for Thought

I am excited to tell you about a wonderful new endeavor that is helping to promote critical thinking about science and medicine. It’s a free online course on “Food for Thought” that offers a scientific framework for understanding food and its impact on health and society from past to present.

The “Food for Thought” course is a product of EdX, which offers online college courses from Harvard, MIT, and other prestigious universities. They provide videos with interactive features and access to online student communities. Students can audit a course and get full access to all the materials including tests, assignments, and discussion forums with no commitment, and can choose what and how much they want to do. (more…)

Posted in: Critical Thinking, Nutrition

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Animal rights activism: Petitions aren’t science

I had originally planned on writing about a different topic today, but, as is so often the case in blogging, something came up that caught my attention, much as the errant thought of a squirrel distracts Dug the Dog. It’s no big deal. My original topic is not time-sensitive, and I’ll get to it next week (that is, unless something like this happens again). In any case, my tendency towards blogging ADHD notwithstanding, the “inspiration” for this post began on Friday morning, making it timely. Let me tell you what happened, and then I’ll delve into the topic.

We all have our daily rituals, and I’m no different. When I wake up in the morning, I usually check my iPhone to see how many e-mails I’ve gotten overnight. If there’s time before I have to leave for work, I’ll frequently go through them all right then, answering ones I can answer quickly and filing for later responses those that I can’t. If I don’t have time (as in I overslept), I’ll check them whenever I get an opportunity. Last Friday, I was rather surprised to see that the little badge on the Mail app showed well over three times the usual number of messages I get overnight, even accounting for e-mail notifications of comments on the blogs and the usual smattering of mailing list messages and the odd junk spam that got through the filters. So having that many messages in my unread mail queue caught my attention. Even when a new troll shows up in the comments of one of the blogs, I usually don’t get that many notifications. I figured I’d better go and check to see what was going on right then, rather than waiting until later. What I found was something that I never would have guessed.

As odd as it seems to me now, I had apparently been targeted by a Change.org petition Animal Experimenters – JUSTIFY YOUR SCIENCE CLAIMS. (more…)

Posted in: Basic Science, Cancer, Evolution

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Osteopathy in the NICU: False Claims and False Dichotomies

I would like to preface this post by stating that I have worked with many DOs (Doctors of Osteopathy), and I have helped train many pediatric residents with DO degrees. I have found no difference in the overall quality of the training these students have received, and some of the very best clinicians I have ever worked with have been DOs. I would never prejudice my assessment or opinion of a physician based on whether they have an MD or a DO after their name.

Now, on to the discussion at hand.

I recently stumbled upon an article entitled, “Effect of osteopathic manipulative treatment on length of stay in a population of preterm infants: a randomized controlled trial”. There is nothing particularly exciting or interesting about this study, as there have been many published on the use of osteopathic manipulative therapy (OMT) in children. There aren’t that many RCTs, however, and this particular one, although published in the open-access BioMed Central Pediatrics (impact factor 1.98), was chosen to be included in AAP Grand Rounds. AAP Grand Rounds is a publication put out by the American Academy of Pediatrics (AAP) to help pediatricians “Stay current and save time with monthly critical, evidence-based summaries of clinical content from nearly 100 journals.” Because the AAP found this important enough for mention in this widely read publication, with a distribution of 19,000 (source: AAP, 2014), I thought it would be interesting to take a closer look at it. I am also interested in the very odd existence of the two, distinct paths to becoming a physician in this country, osteopathic and traditional medical school training. The distinction between the two is rarely discussed, even within the halls of academia or in our health care centers. That’s not to say that the topic isn’t discussed at all (in fact it was highlighted very recently right here on SBM), it has just remained a somewhat politically incorrect subject, sliding mostly under the radar. Having worked with and trained pediatricians with osteopathic degrees, I can tell you that discussions about this are considered taboo. This is primarily because osteopathic physicians have become mainstreamed over time (see below), and discussing the validity of the existence of their “specialness” is an awkward proposition. After taking a look at the paper in question, I’ll address this issue some more as I think it deserves additional attention.

Effect of osteopathic manipulative treatment on length of stay in a population of preterm infants: a randomized controlled trial.

This was a single-blinded RCT conducted at Santo Spirito Hospital in Pescara, Italy to explore whether OMT could shorten the length of stay among premature infants in their neonatal ICU (NICU). Secondary outcomes studied were the differences in daily weight gain and total cost of the NICU stay.

I’ll discuss the methods in a moment, but first let’s review the results.
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Posted in: Clinical Trials

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