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Medicine past, present, and future: Star Trek versus Dr. Kildare and The Knick

mccoyvs20thcen

I’ve been a big Star Trek fan ever since I first discovered reruns of the original Star Trek episodes in the 1970s, having been too young (but not by much!) to have caught the show during its original 1966-1969 run. True, my interest waxed and waned through the years—for instance, I loved Star Trek: The Next Generation, while Star Trek: Enterprise and Star Trek: Voyager pretty much left me cold—but even now I still find myself liking the rebooted movie series. In the original series, my favorite characters tended to alternate between Spock, the Vulcan first officer and science officer on the Enterprise, and Dr. Leonard “Bones” McCoy, the ship’s chief medical officer. I sometimes wonder if my love of these two characters had anything to do with my becoming a doctor and researcher myself. It probably did.

One aspect of all the Trek shows that always interested me was its portrayal of medicine in the 23rd and 24th centuries. After all, what doctor wouldn’t like to have a device like the tricorder that he could wave over the patient and come up with an instant diagnosis and course of treatment? Who knew, of course, that nearly 50 years after the first Trek episode first aired, we would have technology that makes the communicators on the original series (TOS, for those Trek non-fans) look primitive and large by comparison and that we’d be well on the way to developing devices that can do some of what tricorders did on the show. Throughout all the shows and movies, the medical technology of a few hundred years in the future is portrayed as vastly superior to what we have now, with 20th century medicine at times denigrated by “Bones” McCoy and other Star Fleet medical personnel as barbaric quackery.

A confluence of events and media led me to want to explore a couple of questions. First, which procedures that we consider state-of-the-art science-based medicine will be considered “barbaric” 50 or 100 years from now? Second, is the contempt expressed for the medicine of the past (e.g., by “Bones” McCoy) justified? These are questions that I’ll explore a bit with the help of the Star Trek universe, a recent new cable television drama series, and a couple of articles that appeared on medical sites as a result of the premier of that series.
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Posted in: Cancer, History, Science and the Media, Surgical Procedures

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One more time: No, wearing a bra does not cause breast cancer

A red bra

EDITOR NOTE: THERE IS AN ADDENDUM, ADDED SEPTEMBER 10.

Besides being a researcher and prolific blogger, I still maintain a practice in breast cancer surgery. It’s one of the more satisfying specialties in oncology because, in the vast majority of cases I treat, I can actually remove the cancer and “cure” the patient. (I use the quotes because we generally don’t like to use that term, given that some forms of breast cancer can recur ten or more years later, but in many cases the term still fits, albeit not as well as we would like.) Granted, I get a little (actually a lot of) help from my friends, so to speak, the multimodality treatment of breast cancer involving surgical oncology, radiation oncology, and medical oncology, but breast cancer that can be cured will be primarily cured with surgery, with chemotherapy, hormonal therapy, and radiation therapy working mostly to decrease the risk of recurrence, either local in the breast or distant elsewhere in the body. Through this multimodality approach, breast cancer mortality has actually been decreasing over the last couple of decades.

However, as a breast cancer surgeon, I not infrequently have to deal with many of the common myths that have sprung up around breast cancer. Some are promoted by quacks; others are just myths that sound plausible but aren’t true. (That’s why they persist as myths.) One such myth has been in the news lately, in particular last week; so I thought now was a good time to take a look as any. Besides, I spent most of the weekend out of town visiting my wife’s family, and I didn’t have a lot of time for this post. So this week sticking to something I know well makes sense and inspired me to make like Harriet Hall and Steve Novella and keep my post to a reasonable length for a change. There’s also so much less mucking about on PubMed and Google that way to make sure I’m not missing something, too.
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Posted in: Cancer, Epidemiology

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The “CDC whistleblower saga”: Updates, backlash, and (I hope) a wrap-up

Vaccinefear

Given that this is a holiday weekend here in the US and that I’m having a bit of a staycation right now, I had thought of simply not posting today or of rerunning a “classic” (if you want to call it that) blast from the past. But the topic I wrote about last week has only festered and grown bigger since Monday; so at the very least I felt obligated to do a post updating you, our readers, on the twists and turns that have occurred in the saga of the so-called “CDC whistleblower.” For those of you familiar with the story (not to mention following my not-so-secret other blog), much of this will be familiar, but, given that this is SBM, I felt that this material should be on record here for your edification and (hopefully) education. I’ll take (more or less) a chronological approach since last Monday and then finish up by trying to put this whole mess into perspective. This is going to be longer than even my usual posts, but I want to be authoritative. So, if you’re very familiar with what’s happened, you might want to skim everything before the “backlash” and “conclusion” sections to fill in what you might have missed. If you’re less than completely steeped in what happened, read every scintillating word!

But first, for those who might be entering this saga right now, let me recap a moment. I’m referring to a conspiracy theory, which has been flogged to death by the antivaccine movement for nearly two weeks now, that there is a CDC whistleblower who has made “devastating” reports that the CDC hid data that showed a 3.4-fold increased risk of autism in African American males, based on an incompetent “reanalysis” of a 10 year old CDC study that found no evidence that children with autism were more likely to have received their first MMR vaccine earlier than neurotypical controls. As I (and others) have discussed, Hooker used howlingly bad statistical methodology (for instance, analyzing case control data as a cohort study and using risibly bad statistical analyses) to torture the data until they confess that vaccines cause autism. As I said at the time, when it comes to data, call Hooker the Spanish Inquisition. Such was the weakness of what he found that, even after forcing the data to sit in the comfy chair for extended periods of time, the most damning “confession” he could get from them was a correlation between age at MMR vaccination and autism diagnoses in one small subgroup: African American males.

Based on this utterly incompetent data torture and Hooker’s apparent budding relationship with a “CDC whistleblower,” Wakefield first made a video in which this “whistleblower’s” voice was electronically altered (not to mention edited into such selective snippets that it was impossible to glean any context from his seemingly-damning statements. This video, released through Andrew Wakefield’s and Tommy Polley’s Autism Media Channel, despicably likened this CDC “cover-up” to the Tuskegee syphilis study, and finished with a flourish of Godwin-y nonsense that included Adolf Hitler (of course!), Pol Pot, and Josef Stalin, implying that the CDC’s “crimes” with respect to this alleged cover-up were just as bad. It was a breathtaking demonstration of pure stupid hyperbole. Then, a few days later, Wakefield replaced the video with the alterations in the “whistleblower’s” voice with his real voice and revealed his real name: William W. Thompson, PhD, a psychologist and senior scientist at the CDC, as well as a co-author of the study being “reanalyzed,” DeStefano et al. Now, on to the update! (more…)

Posted in: Science and the Media, Vaccines

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Clinical trials of integrative medicine: testing whether magic works?

 

I just thought that I’d take the editor’s (and, speaking for Steve, the founder’s) prerogative to promote our own efforts. Regular readers of SBM are familiar with our message with respect to randomized clinical trials of highly implausible “complementary and alternative medicine” treatments, such as homeopathy or reiki. Well, believe it or not, Steve and I managed to get a commentary published in a very good journal in which we present the SBM viewpoint with respect to these trials. Even better, at least for now, you can read it too, because it doesn’t appear to be behind a paywall. (I’m at home as I write this, and I can read the whole thing on my wifi, no VPN needed.)

The article is entitled “Clinical trials of integrative medicine: testing whether magic works?” There’s also been a fair amount of news coverage on the article, and I’ve been frantically doing interviews over the last couple of days, including:

There are likely to be at least a couple more, given the interviews I’ve done; that is, unless editors reject the ideas.

In any case, Steve and I are interested in your comments. Trends in Molecular Medicine is good in that it published our article and it’s a pretty high impact review journal, but it doesn’t have a section for comments. So consider this your section for comments on our article.

Posted in: Basic Science, Clinical Trials, Homeopathy

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“Atavistic oncology” revisited: Dr. Frank Arguello responds

gr6

EDITOR’s NOTE: There are three Addendums after this post, containing the complete text of e-mails.

EDITOR’s NOTE #2 (8/19/14 4:51 PM): There is one more Addendum, as Dr. Arguello has sent me another e-mail.

EDITOR’s NOTE #3 (8/20/14 7:18 PM): There is yet another Addendum, as Dr. Arguello is now complaining to my place of work.

EDITOR’s NOTE #4 (8/21/14 5:30 PM): And the beat goes on. See Dr. Arguello’s next e-mail.

The following post will be of a type that I like to refer to as “taking care of business.” That’s not to say that it won’t be, as my posts usually are, informative and entertaining, but it does say that I’m doing it instead of what I had originally had in mind because something came up. That something is a rather unhappy e-mail from the doctor about whom I wrote three weeks ago. It’s just an indication that, although it’s a great thing that this blog is becoming more and more prominent, it’s also a two-edged sword. People actually notice it when I (or other SBM bloggers) criticize them for dubious medicine. We see this in how Dr. Edward Tobinick has launched what I (and many others) consider to be a frivolous lawsuit against SBM founder Steve Novella over a post from 2013 clearly designed to silence criticism. It’s legal thuggery, pure and simple. That’s the bad end of the spectrum. I’ve been at the receiving end of similar retaliation that could have just as bad an impact on me personally as far as my career goes when antivaccine activists tried to get me fired from my job four years ago.

The more common (and far less agita-inducing) end of the spectrum consists of e-mails or letters of complaint. Sometimes they come from eminent radiologists who don’t like my criticism of their attacks on mammography studies. (Actually, truth be told, it is rarely eminent radiologists—or eminent physicians and scholars—who complain.) More commonly, it’s practitioners who object to how their treatments have been described. This time around, it’s a man named Dr. Frank Arguello, whose “atavistic chemotherapy” I criticized in one of my typical long posts that also explained why. Last week, I received this e-mail from Dr. Arguello:
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Posted in: Cancer, Clinical Trials, Evolution

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The false dichotomies of CAM and “integrative medicine”

Falsedichotomy

A lot of medical specialties have throwaway newspapers/magazines that are supported by advertising and somehow mysteriously managed to show up for free in the mailboxes of practitioners. In my case, I’ve found myself on the subscription list for such papers about oncology, but also general surgery (I’m Board-certified as a general surgeon). When I have to recertify in about three years, it will be as a general surgeon, which was really fun to try to do last time after having specialized as a breast cancer surgeon, and will likely be even more fun next time, when I will be 10 years further out from my general surgery and surgical oncology training. In any case, that must be why, no matter where I end up working, sooner or later I end up receiving General Surgery News (GSN).

As throwaway professional newspapers go, GSN is not bad. However, occasionally it publishes op-ed articles that make me scratch my head or even tick me off with their obtuseness. Lately, apparently, it’s started some blogs. The one in particular that is the center of attention for this post is by Victoria Stern, is called “The Scope” and is billed as “exploring the lesser known sides of surgery.” Of course, it’s a bit odd that some of the first posts on this blog are about work hour restrictions and whether they leave new surgeons unprepared to practice surgery, the debate over breast screening, and what it takes to train expert surgeons, none of which are exactly “lesser known sides of surgery.” Work hour restrictions, in particular, have been discussed in surgery journals, at conferences, and among surgeons ad nauseam, particularly whether we are training a generation of surgeons unable to deal with the rigors of practicing surgery in the real world.
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Posted in: Critical Thinking, Medical Ethics

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Medical marijuana as the new herbalism, part 2: Cannabis does not cure cancer

marijuana-cancer

About a month ago, I finally wrote the post I had been promising to write for months before about medical marijuana. At the time, I also promised that there would be follow-up posts. Like Dug the Dog seeing a squirrel, I kept running into other topics that kept me from revisiting the topic. However, over the past couple of weeks, the New York Times gave me just the little nudge I needed to come back and revisit the topic, first by openly advocating the legalization of marijuana, then by vastly overstating the potential medical benefits of pot (compare the NYT coverage with my post from a month ago), and finally this weekend by running a story lamenting the federal law that makes research into medical marijuana difficult in this country.

I stated my position on marijuana last time, which is that marijuana should be at least decriminalized or, preferably, legalized, taxed, and regulated, just like tobacco and alcohol. I also likened the cult of medical marijuana to the “new herbalism,” because it (1) vastly inflates the potential of medicinal uses of marijuana and (2) ascribes near-mystical powers to smoking or making extracts out of marijuana, rather than identifying and isolating constituents of the plant that might have medicinal value. All of this is very much like herbalism in alternative medicine. Indeed, promoting laws legalizing medicinal marijuana is such an obvious ploy to open the door to full legalization that some advocates don’t even bother to disingenuously deny it any more. Given that I tend to support legalization, as a physician this sort of deception irritates me. It also has consequences, particularly when overblown claims are made for what cannabis can do. Perhaps the best example of this is the claim that cannabis cures cancer, which pops up all over the Internet in memes such as the one in the image above.
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Posted in: Cancer, Herbs & Supplements, Politics and Regulation

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Ebola outbreaks: Science versus fear mongering and quackery

Ebola virus particles.jpg
Ebola virus particles” by Thomas W. Geisbert, Boston University School of Medicine – PLoS Pathogens, November 2008 doi:10.1371/journal.ppat.1000225. Licensed under CC BY 2.5 via Wikimedia Commons.

Without a doubt the big medical story of the last week or so has been the ongoing outbreak of Ebola virus disease in West Africa, the most deadly in history thus far. Indeed, as of this writing, according to a table of known Ebola outbreaks since 1976 at Wikipedia, in Guinea, Sierra Leone, and Liberia, the three nations affected thus far, there have been 1,440 cases and 826 deaths. Worse, the World Health Organization (WHO) is reporting that it is spreading faster in Africa than efforts to control it. In particular, late last week it was announced that two Americans who had been infected with Ebola were going to be flown back to the US, specifically to Emory University, for treatment, a development that ramped up the fear and misinformation about Ebola virus to even greater heights than it had already attained, which, unfortunately, were already pretty high. Indeed, the ever-reliably-histrionic Mike Adams of NaturalNews.com wrote a typically hysterical article “Infected Ebola patient being flown to Atlanta: Are health authorities risking a U.S. outbreak?” On Saturday, we learned that Dr. Kent Brantly, an aide worker for Samaritan’s Purse, a Christian charity run by Franklin Graham, son of the well-known preacher, Billy Graham, who had been evacuated from Liberia aboard a private air ambulance, had arrived in Georgia.

This latest development inspired medical “experts,” such as Donald Trump, to stoke fear based on the arrival of two infected Americans in the US. For instance, last Friday, after it was first announced that the Ebola-infected Americans would be flown back to the US, Trump tweeted:

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Posted in: Epidemiology, Health Fraud, Homeopathy, Public Health, Vaccines

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Cold reality versus the wishful thinking of cryonics

We all seek immortality in some way. Death has been one of the prime terrors haunting us since humans first started realizing that every living thing dies and death is permanent. After all, no one wants to face the end of everything that one has been, is, and will be. Indeed, a key feature of many religions is a belief that death is not the end, that there is an afterlife where we will all live forever. In some religions, in the afterlife evil is punished and good rewarded. Even if, as seems most likely, death is simply the end, and the time after death is just like the time before we were born (or, more properly, before our first memories), something that seems relatively benign just thinking about it, emotionally we still don’t want it. Being human, I get it, particularly now that I’m on the wrong side of 50 and, unless I’m far more long-lived than my genes are likely to permit, have considerably less life to look forward to than the lifetime I’ve already lived. I also realize that the number of people who are remembered long after they are gone by anyone outside of their family and friends is exceedingly small—and even that memory fades rapidly among family members. As the succeeding generation dies off, direct memory of the generation that spawned it disappears. I get it. Fifty years from now, it’s likely that all that will remain of my existence will be some scientific papers and a faint memory held by my nieces and nephews and maybe, if I’m lucky, a few of my youngest readers.

I don’t, however, get cryonics.

Detroit, like many large cities, has a free weekly “alternative” newspaper, The Metro Times. This week’s issue features this cover:

MetroCryonic

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Posted in: Basic Science, Science and the Media

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Dr. Frank Arguello’s “atavistic oncology”: Another dubious cancer therapy to be avoided

EDITOR’S NOTE: Dr. Arguello has responded. See his response and my reply here.

Not infrequently, I’m asked why it is that I do what I do. Why do I spend so many hours of my free time, both here and at my not-so-super-secret other blog (NSSSOB), to write my detailed analyses of various forms of quackery, analyses of scientific studies, and expressions of my dismay at the infiltration of pseudoscience into medicine, particularly medical academia in a phenomenon I like to call “quackademic medicine”? One reason, of course, is because I passionately believe in what I am doing. Another reason is that I want information countering various forms of dubious medicine to be out there, and I have two well-trafficked blogs as a platform, although SBM long ago surpassed my NSSSOB in traffic and reach.

Over the last six years, there are some topics that I’ve written about many times, such as the antivaccine movement, Stanislaw Burzynski, cancer quackery, and common myths about cancer treatment. Surprisingly, there are some topics left that I should have written about a long time ago but haven’t, even though I had heard of them before. One such topic, atavistic oncology and chemotherapy, was brought to my attention a couple of weeks ago by a reader, who basically pointed me to a particular dubious bit of cancer treatment whose chief proponent, Dr. Frank Arguello, is apparently currently touring Canada to do conferences and meet with potential patients, placing ads in local newspapers in the cities in which he will be appearing. His meeting with patients in Canada seems particularly problematic, because his cancer practice is located in San Jose del Cabo, Baja California Sur, Mexico, a location that, given the nature of his practice and claims, struck me as remarkable only because it’s not Tijuana. In any case, Dr. Arguello just appeared in Saskatoon on Friday and is scheduled to appear in Regina on July 30, with appearances in Winnipeg, Vancouver, Calgary, Edmonton, and Toronto promised in the future, as well as U.S. appearances in San Francisco and Los Angeles. Specifically, after his appearance in Regina, advertised here:

ArguelloRegina

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Posted in: Cancer, Health Fraud

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