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Archive for 2014

Using the fear of Ebola to promote the placebo legislation that is “right to try”

rick-snyder

Perhaps the most pervasive medical conspiracy theory of all involves stories that there exist out there all sorts of fantastic cures for cancer and other deadly diseases but you can’t have them because (1) “they” don’t want you to know about them (as I like to call it, the Kevin Trudeau approach) and/or (2) the evil jackbooted thugs of the FDA are so close-minded and blinded by science that they crush any attempt to market such drugs and, under the most charitable assessment under this myth, dramatically slow down the approval of such cures. The first version usually involves “natural” cures or various other alternative medicine cures that are being “suppressed” by the FDA, FTC, state medical boards, and various other entities, usually at the behest of their pharma overlords. The second version is less extreme but no less fantasy-based. It tends to be tightly associated with libertarian and small government fantasists and a loose movement in medicine with similar beliefs known as the “health freedom” movement, whose members posit that, if only the heavy hand of government were removed and the jack-booted thugs of the FDA reined in, free market innovation would flourish, and the cures so long suppressed by an overweening and oppressive regulatory apparatus would burst the floodgates and these cures, long held back by the dam of the FDA, would flow to the people. (Funny how it didn’t work out that way before the Pure Food and Drug Act of 1906.) Of course, I can’t help but note that in general, in this latter idea, these fantastical benefits seem to be reserved only for those who have the cash, because, well, the free market fixes everything. At least, that seems to be the belief system at the heart of many of these conspiracy theories.

The idea that the FDA is keeping cures from desperate terminally ill people, either intentionally or unintentionally, through its insistence on a rigorous, science-based approval process in which drugs are taken through preclinical work, phase 1, phase 2, and phase 3 testing before approval is one of the major driving beliefs commonly used to justify so-called “right-to-try” laws. These bills have been infiltrating state houses like so much kudzu, and the Ebola outbreak has only added fuel to the fire based on the accelerated use of ZMapp, a humanized monoclonal antibody against the Ebola virus, in some patients even though it hadn’t been tested in humans yet (more on that later). Already four of these laws have been passed (in Colorado, Missouri, Louisiana, and now Michigan) with a referendum in Arizona almost certain to pass next week to bring the total to five states with such laws. Basically, these laws, as I’ve described, claim to allow access to experimental drugs to terminally ill patients with a couple of major conditions: First, that the drug has passed phase I clinical trials and second that the patient has exhausted all approved therapies. As I’ve explained before more than once, first when the law hit the news big time in Arizona and then when a right-to-try bill was introduced into the legislature here in Michigan, they do nothing of the sort and are being promoted based on a huge amount of misinformation detailed in the links earlier. First, having passed phase 1 does not mean a drug is safe, but right-to-try advocates, particularly the main group spearheading these laws, the Goldwater Institute, make that claim incessantly. Second, they vastly overstate the likelihood that a given experimental drug will help a given patient. The list goes on.
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Posted in: Cancer, Clinical Trials, Pharmaceuticals, Politics and Regulation

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Infinite Variety?

Age cannot wither her, nor custom stale. Her infinite variety.
- William Shakespeare

This is not a typical post for me, but something I have been meaning to do to satisfy my own curiosity. I have wondered, how many variations of acupuncture are there? I suspected a lot, but I thought I would go looking and make a list. Since acupuncture is not based in reality but is instead a collection of pseudo-knowledge, there is no reason for acupuncture to have fidelity to fundamental concepts. I suspect in the US that in the future acupuncture will become less heterogenous as schools start teaching to the test that allows for acupuncture licensure. For now variation rules.

Acupuncture needling

So this will be a list, with description and commentary. If a missed form of acupuncture is noted by others, and I am sure I have, I will expand the list in an addendum. (more…)

Posted in: Acupuncture

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“Quackery: A $10 Billion Scandal”

Rubber ducky
Who would you guess authored a 250-page report which begins with this Preface?

This report marks the culmination of an intensive four-year review of quackery and its impact on the elderly. . . As this report details, quackery has traveled far from the day of the pitchman and covered wagon to emerge as big business. Those who orchestrate and profit from the sale and promotion of these useless and often harmful “health” products are no longer quaint and comical figures. They are well organized, sophisticated and persistent. [We estimate] the cost of quackery – the promotion and sale of useless remedies promising relief from chronic and critical health conditions – exceeds $10 billion a year. The costs of quackery in human terms, measured in disillusion, pain, relief forsaken or postponed because of reliance on unproven methods, is more difficult to measure, but nonetheless real. All too frequently, the purchaser has paid with his life. While the impact of quackery on our lives has been increasing and growing in sophistication, public and private efforts designed to address and control this problem have diminished, been redirected or disbanded.

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Posted in: Acupuncture, Cancer, Diagnostic tests & procedures, Health Fraud, Herbs & Supplements, Politics and Regulation

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SBM on Wikipedia in Every Language

Four websites smallOne of the most interesting aspects of living through the second half of the 20th century and into the first half of the 21st century is the profound change in access to information. I remember in the 1980s there was a buzz (at least among technophiles and science fiction nerds) about how computers were going to be connected in a worldwide network and it would transform the way we access information and communicate. The reality we are living in now exceeds even the most fevered predictions being made at that time.

What was difficult to anticipate was how rapid access to almost any information would affect our day-to-day lives. Now, during a discussion, if a fact is in dispute we can simply look it up and resolve the dispute. I can no longer imagine doing research in a pre-internet age, promoting science-based medicine without social media, or collaborating without the virtual-time communication of e-mail.

The internet is rapidly becoming humanity’s collective culture and body of knowledge. For that reason it is important to nurture that body of knowledge to ensure that it is complete, accurate, and fair. That goal is frustrated, however, by the fact that the World Wide Web is not simply being used for scholarly information. It is also a tool to promote ideology and commercial interests. Therefore any efforts to provide scientifically accurate and unbiased information are likely to be swamped by well-funded and highly-motivated misinformation. Search on any medical topic and you will quickly see what I mean.

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Posted in: Science and Medicine

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Salk’s swansong: renaissance of the injected polio vaccine

Picture a lab scientist. White coat, pensive expression, microscope in hand. Glasses, perhaps. The person you have in mind (providing you are willing to humour a stereotype or two) may have a striking resemblance to Jonas Salk, the archetypal laboratory researcher, born in New York City on Wednesday 28th October 1914 — one hundred years ago today.

The name will be familiar to many. As creator of the inactivated polio vaccine (or IPV), Salk is cemented firmly into the annals of medical history. When his vaccine hit the shelves in 1955, the annual epidemics of poliomyelitis represented a fierce insult to postwar American civility: one particularly devastating bout in 1952 caused over 20,000 cases of paralysis and more than 3,000 deaths, mostly among children. The arrival of IPV was greeted with nationwide celebrations, and Salk was praised as a worker of miracles.

Jonas Salk at the University of Pittsburgh where he developed the first polio vaccine.

Jonas Salk at the University of Pittsburgh where he developed the first polio vaccine.

IPV has been in demand ever since, and its use in several countries has been sufficient to get rid of polio. Until recently, however, Salk’s injected vaccine has largely played second fiddle in eradication efforts. When the Global Polio Eradication Initiative was launched in 1988, it favoured an alternative formulation, Albert Sabin’s oral polio vaccine (OPV), as its weapon of choice.

But the spotlight may be shifting. With the eradication programme preparing for what is hoped to be a final onslaught, IPV is poised to take centre stage once more. Indeed, the World Health Organization recently recommended that all countries introduce at least one dose of Salk’s vaccine into routine immunisation by the end of 2015.

Why is IPV so important to polio eradication plans? What does the injected vaccine offer that the oral one does not? The centenary of Salk’s birth offers a fitting occasion to consider these issues.

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Posted in: History, Public Health, Vaccines

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Mirror Neurons and the Pitfalls of Brain Research

myth of mirror neurons

[Ed. Note: I realize that I normally post on Monday, but thanks to an R21 grant deadline tomorrow, I will not be able to post new material today (although you might have noticed some "familiar" material posted yesterday.) Harriet has graciously agreed to cover for me today, and we have a special guest post for you tomorrow. Fear not. I'll soon be back. Trying to get the lab funded takes momentary precedence.]

In his new book The Myth of Mirror Neurons: The Real Neuroscience of Communication and Cognition , Gregory Hickok, a professor of cognitive science, challenges current conceptions about mirror neurons. He shows how a complex mythology arose and why it is unwarranted, how experimental results were misinterpreted and disconfirming evidence ignored, and how other interpretations might lead to better insights about how the brain works.

I couldn’t say it any better than Steven Pinker did on the jacket blurb:

Every now and again an idea from science escapes from the lab and takes on a life of its own as an explanation for all mysteries, a validation of our deepest yearnings, and irresistible bait for journalists and humanities scholars…Hickok puts an end to this monkey business by showing that mirror neurons do not, in fact, explain language, empathy, society, and world peace. But this is not a negative exposé—the reader of this book will learn a great deal of the contemporary sciences of language, mind, and brain, and will find that the reality is more exciting than the mythology. (more…)

Posted in: Book & movie reviews, Neuroscience/Mental Health

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A little shameless self-promotion and a plea

Here’s a little shameless self-promotion, which we editors at Science-Based Medicine indulge in from time to time. This time around, I’d just like to mention that I’m the guest on the latest episode of the Skeptics’ Guide to the Universe, where I was permitted to pontificate about children with cancer whose parents deny them chemotherapy. Check it out.

Second, in less than four weeks, I will be giving a talk at Skepticon. The great thing about Skepticon is that it’s free, but that requires donations. So, as a speaker, I’m going to ask you all once again to give until it hurts.

Posted in: Announcements

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Brian Hooker and Andrew Wakefield accuse the CDC of scientific fraud. Irony meters everywhere explode.

conspiracy-theories-everywhere

The antivaccine movement and conspiracy theories go together like beer and Buffalo wings, except that neither are as good as, yes, beer and Buffalo wings. (Maybe it’s more like manure and compost.) In any case, the antivaccine movement is rife with conspiracy theories. I’ve heard and written about more than I can remember right now, and I’m under no illusion that I’ve heard anywhere near all of them. Indeed, it seems that every month I see a new one.

There is, however, a granddaddy of conspiracy theories among antivaccinationists, or, as it’s been called, the central conspiracy theory of the antivaccine movement. That conspiracy theory postulates that “they” (in the U.S, the CDC) have known for a long time that vaccines cause autism, but “they” are covering it up. In other words, the CDC has, according to this conspiracy theory, been intentionally hiding and suppressing evidence that antivaccinationists were right all along and vaccines do cause autism. Never mind what the science really says (that vaccines do work don’t cause autism)! To the antivaccine contingent, that science is “fraudulent” and the CDC knew it! Why do you think that the antivaccine movement, in particular Robert F. Kennedy, Jr., went full mental jacket when Poul Thorsen was accused of financial shenanigans (i.e., fraud) with grant money from the federal government? It was a perfect story to distract from the inconvenient lack of science supporting the antivaccine view that vaccines cause autism. More importantly, from the antivaccine standpoint, it was seen as “validation” that the CDC studies failing to find a link between autism and vaccines were either fraudulent or incompetently performed. Why? Because Thorsen was co-investigator on a couple of the key studies that failed to find a link between the MMR and autism, antivaccinationists thought that his apparent financial fraud must mean that he committed scientific fraud. They’re the same thing, right? Well, not really. There were a lot of co-investigators, and Thorsen was only a middle author on those studies.
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Posted in: Neuroscience/Mental Health, Public Health, Vaccines

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The “It’s All Good!” Fallacy of Complementary and Alternative Medicine…..

usedcars-01

“Trust me, have I got a deal for you!”

As a young mother comforts her feverish and uncomfortable infant, a doctor enters the dimly-lit exam room. The child’s mother and the bedside nurse look at him expectantly.

“I’ve got the results. There is an infection in your son’s spinal fluid, which was one of the things we discussed as a possible cause of his high fever and irritability,” the physician explains to the now-crying mother. “We need to start treatment right away and admit him to the hospital.”

After answering the distraught mother’s questions and discussing her child’s treatment plan, the doctor leaves the room and begins to write orders in the patient’s chart. The nurse, eager to begin appropriate therapy looks over his shoulder with a confused look on his face.

“Excuse me doc, but you’ve got to be a little more clear on that order don’t you think?”

Written in barely-legible doctor scribble, next to the date and time of the encounter and above his signature and hospital number, is the lone word “antibiotics”.

“What do you mean? This child is sick and he needs antibiotics stat!”

“Sure doc, but which one, how much and how often? Where did you go to medical school again?”

“Clearly you aren’t current on the literature. Antibiotics have been around for decades and have been proven time and time again to treat infections. Millions of people take them every day and are pleased with the results. Now you are wasting precious time that could be spent caring for this sick child!”

The nurse, unhappy with the response, storms off to find assistance from his supervisor. The doctor, confident that he is providing competent medical are for his patient, expresses dismay at how closed-minded some of his colleagues are.

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Posted in: Science and Medicine

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Lessons from the dubious rise and inevitable fall of green coffee beans

Green-Coffee-Bean-BOGUS

News this week that a randomized controlled trial of green coffee bean (GCB) has been officially retracted from the medical literature signals what is hopefully the end to one of the most questionable diet products to appear on the market in years. Plucked from obscurity and then subjected to bogus research, it’s now clear that the only people that actually benefited from GCB were those that profited from its sale. GCB had some powerful boosters, too. Once it became one of Dr. Oz’s “miracle” weight loss cures, sales exploded following two hype-filled episodes. Oz even did a made-for TV clinical trial with GCB, ignoring the requirements for researchers to obtain ethical approvals before conducting human subject research. Oz’s promotion of GCB was so breathless and detached from the actual evidence that his actions were subsequently eviscerated by Senator Clair McCaskill during televised hearings on weight loss scams. It’s a long, sordid, ugly and yet entirely predictable story. (more…)

Posted in: Clinical Trials, Health Fraud, Herbs & Supplements, Science and the Media

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