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Welcome back, my friends, to the show that never ends, part II: Generation Rescue, the anti-vaccine propaganda machine, and “Fourteen Studies”

I hadn’t planned on writing about the antivaccine movement again this week, so soon after having had to subject myself to yet another round of Jenny McCarthy on Larry King Live and a truly execrable Generation Rescue “study.” I really hadn’t. For one thing, there’s just so much nonsense laid down by antivaccinationists these days that it’s utterly impossible for one blogger to keep up with it all. I could write about them every single day and still not counter the sheer mass of pseudoscience, misinformation, and general ignorance that antivaccine activists spout each and every day, and because this is Autism Awareness Month lately the misinformation has been coming particularly fast and furiously. Sometimes, however, there arrives a bit of misinformation that is so egregious that it requires some response, regardless of how burned out on the topic I might be; so I guess I’ll just have to suck it up and plunge into the morass again.

The reason is that, in retrospect, I now realize that the Jenny and Jim antivaccine propaganda tour was clearly merely phase I of Generation Rescue’s April public relations offensive. In rapid succession last week, courtesy of J.B. Handley, the founder of Generation Rescue, who in order to have a couple of famous faces fronting his organization has allowed himself to be displaced, so that Generation Rescue has now been “reborn” as Jenny McCarthy and Jim Carrey’s Autism Organization (the better to capitalize on her D-list celebrity yoked to Jim Carrey’s formerly A-list (but rapidly plunging) celebrity), announced Generation Rescue’s latest initiative in a post on its antivaccine blog Age of Autism entitled Fourteen Studies? Only if you never read them.:
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Posted in: Politics and Regulation, Public Health, Science and the Media, Vaccines

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This one’s for you, Dana

As you may have noticed, everybody’s “favorite” homeopath, Dana Ullman, has made a return visit to our humble little blog, where he is laying down his usual list of logical fallacies and irrelevencies (such as attacking Oliver Wendell Holmes) in defense of homeopathy. Consequently, now’s as good a time as any to unveil what is perhaps the best ready-for-a-poster criticism of homeopathy I’ve ever seen:

HN09poster1A

Clicking on the picture will lead you to a blog post where you can download a high resolution version suitable for printing up and either distributing or posting on a bulletin board or wall. I particularly like that it was made by The American Institute for the Destruction of Tooth Fairy Science. Truly, a nod to SBM blogger extraordinaire Harriet Hall!

My only objection to the poster is the use of the word “shit.” Don’t get me wrong here. Yes, it’s accurate. No, I’m not some sort of prude who never uses the word and wilts at the very sight or sound of it. My problem with it is that its inclusion on the image means that I can’t actually print up and post this beautiful (and brief) mockery of homeopathy on my lab door or on the bulletin board in my office. I can’t put something like that up in public at work. It also made me a little leery of posting it here, which led me to check with our fearless leader before doing it. So I started thinking of alternatives that get the message across but without any curse words.

Clearly, a version of the poster suitable for a G (or at least PG) audience is required.

How about something like:

If water has a memory, then homeopathy is full of crap
Homeopathy: Potentizing poo by flushing.

After all, flushing should “succuss” the remedy as well as hitting it against a Bible.

Yes, I do watch Dirty Jobs a lot, with its host, Mike Rowe, who likes to use the word “poo” a lot. Come to think of it, perhaps Mike Rowe should do a segment of Dirty Jobs segment at a manufacturer of homeopathic remedies. Why? Think of the potentized poo!

Posted in: Homeopathy, Humor

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Welcome back, my friends, to the show that never ends: The Jenny and Jim antivaccine propaganda tour has begun


As hard as it is to believe, 2009 started out very promising from the perspective of actually countering the misinformation of the antivaccine movement. Antivaccine hero Andrew Wakefield, who with the help of the credulous and sensationalistic media started the entire MMR-autism scare in the U.K. a decade ago, was revealed as not just having been in the pocket of trial lawyers suing vaccine manufacturers and having been an incompetent scientist but as a scientific fraud, thanks to the investigative tenacity of Brian Deer. Thanks to Wakfield, the measles, once declared conquered in the U.K. in the mid-1990s, has come roaring back to the point where it has been declared endemic again by the ealth Protection Agency (HPA), the public health body of England and Wales. This was rapidly followed by the rejection by the Special Masters of the Vaccine Court of the claims of all the test cases in the Autism Omnibus case. It was a one-two body blow to the antivaccine movement.

Unfortunately, the antivaccine movement is nothing if not resilient. After all, the science has consistently been against each of its favorite claims, namely that the mercury in the thimerosal used as a preservative in vaccines or that the MMR vaccine causes autism. They simply move the goalposts and pivoted effortlessly to much harder to falsify ideas, such as blaming “toxins” in vaccines or proclaiming that our current vaccine schedule is “too many too soon.” After scientific setback after scientific setback that have revealed the antivaccine movement to be nothing more than the 2009 equivalent of creationists or the flat Earth movement, why would it matter to them that Andrew Wakefield has been thoroughly discredited and their signature legal action, the Autism Omnibus, has gone donw in flames? It doesn’t. Certainly it didn’t stop David Kirby from duping Keith Olbermann into chastising Brian Deer for nonexistent conflicts of interest; a group proclaiming loudly “We Support Dr. Andrew Wakefield” with a petition; David Kirby, Generation Rescue, and Robert F. Kennedy, Jr. from trying to distract attention from the defeat of the antivaccine movement in the Autism Omnibus ruling; or Andrew Wakefield himself from “complaining” to a press board about Brian Deer’s alleged misbehavior and errors. After all, science doesn’t matter to the antivaccine movement.
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Posted in: Neuroscience/Mental Health, Public Health, Science and the Media, Vaccines

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Sunday fun: On being “open minded”

One of the most common refrains from advocates of quackery and “complementary and alternative medicine” (CAM) is the charge of being “close-minded,” that they reject out of hand any idea that does not fit within their world view. Of course, this is a canard, given that science, including science-based medicine, thrives on the open and free exchange of ideas, and it is not “close-mindedness” that (usually) leads to the rejection of dubious claims. Rather, it is the knowledge that, for many of such claims to be true, huge swaths of our current scientific understanding would have to be in error to such an extent that a major paradigm shift in various basic science would be necessary. While such paradigm shifts occasionally occur, they do not occur without the confluence of huge amounts of evidence, often coming from different fields and directions. In other words, to show that a paradigm is wrong or seriously incomplete requires evidence even more compelling than the evidence supporting the paradigm.

This video, via The World’s Fair, explains why when woo-meisters wrap themselves in the mantle of “open-mindedness” it’s almost always a crock:

I’ll have to keep this video around for my medical students to help them counter the inevitable charge of “close-mindedness” by CAM advocates. In fact, the part at the end, with the blond guy letting all sorts of rubbish into his brain because he has no critical thinking filter while demanding that others accept his views without evidence reminds me very much of a male version of Jenny McCarthy, full of the arrogance of ignorance. If the cartoon weren’t of such a good-looking young man, I’d say it was J.B. Handley, although the video does get the cartoonishness right.

Posted in: Science and Medicine

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In Jenny McCarthy’s own words

Jenny McCarthy, regular readers of SBM know, has been a frequent target of criticism here. The reasons, of course, are very simple. She has become the most famous public face of the antivaccine movement, releasing a book every year or so since 2007 about how her son Evan has been “cured” of autism through the dubious biomedical treatments she’s given him and how it was vaccines that supposedly caused her son’s autism. Most recently, she’s releasing a paean to antivaccine views and autism quackery entitled Healing and Preventing Autism: A Complete Guide, co-authored by Dr. Jerry Kartzinel. Dr. Kartzinel, some may recall, wrote the foreword to Jenny McCarthy’s very first paean to autism quackery back in 2007 and was properly lambasted by Autism Diva and Kevin Leitch for writing
things like:

Autism, as I see it, steals the soul from a child; then, if allowed, relentlessly sucks life’s marrow out of the family members, one by one…”

Sometimes, in order to appreciate just how wrong antivaccinationist are, it’s best to let them speak in their own words. Nowhere recently have I seen a better example of this than in an interview with Jenny McCarthy published on the TIME Magazine website. In it, along with the usual invocation of the “toxins gambit” and appeals to anecdotal evidence over science, Jenny reveals that she clearly thinks it’s regrettable but acceptable that infectious diseases will return because of the efforts of her and her fellow antivaccine activists:
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Posted in: Science and the Media, Vaccines

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When “CAM” is mandatory: A science-based medical student’s dilemma

Early in the history of this blog, I wrote a rather long post expressing my dismay at the infiltration of unscientific “complementary and alternative medicine” (CAM) or “integrative medicine” (IM) modalities into American medical schools. In it, I listed the medical schools that had embraced pseudoscience through having started a CAM/IM program (a list desperately in need of an update). Moreover, we have also complained vociferously here about a clear effort on the part of advocates of faith-based medicine to infiltrate bastions of science-based medicine and to piggyback their agenda onto President Obama’s health care reform initiative in a clear political strategy to slip CAM/IM into any health care reform legislation as a form of “preventative medicine.” It’s all part of a multi-pronged strategy to claim popular and legal legitimacy in the absence of scientific legitimacy. At one point I even despaired because of the apparent success of half physician, half CAM huckster Dr. Andrew Weil at developing a CAM/IM curriculum that would be part of the mandatory training program in several family medicine residencies, while the rest of us watch Senator Tom Harkin try to promote pseudoscience in the halls of the Senate.

However, since one of our newest co-bloggers, medical student Tim Kreider, arrived, I’ve come to appreciate that medical schools and medical school curriculae are ground zero in the battle for science- and evidence-based medicine. Besides the infiltration of non-science-based modalities into the standard curriculum, another technique for making medical students believe that woo is equal to science is the student “campus CAM group” that invites, for example, homeopaths and naturopaths to give talks to medical students, too many of whom are too timid to challenge them on their pseudoscience. However, a reader of a “friend” of mine wrote me an e-mail that truly appalled me. In fact, it appalled not just me, but all of my co-bloggers who read it. It’s from a medical student in an American medical school. It’s not Harvard or a huge famous medical school. However, it is in medical schools like this one where the vast majority of medical students are trained in this country. If the infiltration of CAM/IM into medical schools continues in this way, we’ll have more than just “integrating” woo into the medical school curriculum from day one. We’ll have more tales like this; eventually, no one will find such tales unusual or even unacceptable anymore. The shruggies will no longer even shrug anymore. Such clinics will become simply the way medical students are educated. The following e-mail is de-identified, and I’ve edited it a bit to make as sure as I can that it is not traceable:
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Posted in: Acupuncture, Medical Academia, Medical Ethics

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Alternative medicine use and breast cancer

Of all the posts I and my cobloggers have written for SBM over the last 15 months, most provoke relatively few comments. However, a few stand out for having provoked hundreds of comments. The very first post that provoked hundreds of comments was Harriet’s excellent discussion of the International Network of Cholesterol Skeptics. In fact, Harriet seems to be quite good at writing posts that provoke a lot of comment, as another of her posts, specifically the one in which she discussed circumcision, also garnered hundreds of comments. However, to my great surprise, the one post that stands out as having received the most comments thus far in the history of SBM is one that I wrote. Specifically, it was a post I called Death by “alternative” medicine: Who’s to blame?, which has collected an astonishing 611 comments thus far. The topic of the post was a case report that I had heard while visiting the tumor board of an affiliate of my former cancer center describing a young woman who had rejected conventional therapy for an eminently treatable breast cancer and then returned two or three years later with a large, nasty tumor that was much more difficult to treat and possibly metastatic to the bone, which would make it no longer even potentially curable. My discussion centered on what the obligation of a physician is to such patients who utterly refuse the science- and evidence-based medicine that we know to be able to cure them of a potentially fatal disease, and I was not only surprised but somewhat taken aback by the vehemence of the discussion.

Since that post, I’ve always been meaning to take a look at what, exactly, the effect of choosing “alternative” medicine over “conventional” medicine is on the odds of survival for breast cancer patients. Even though intuitively one would hypothesize that refusing scientific medicine and relying on placebo medicine instead would have a detrimental effect on survival, it turns out that this question is not as easy to answer as you might think. For example, if you do a search on PubMed using terms like “alternative medicine,” “breast cancer,” and “survival,” the vast majority of the hits will be studies of complementary and alternative medicine (CAM) and breast cancer with little reference to what possible effect these therapies might have on survival. I can envision several reasons for this, the first being that–thankfully–relatively few women actually use alternative medicine exclusively to treat their breast cancer. Also, those that do probably drop off the radar screen of their science-based practitioners, and it is difficult, if not impossible, to capture data regarding their outcomes, given that they all too often stick with their alternative healers until the end. True, they may pop up again in their surgeon’s or primary care doctor’s office with huge, fungating tumors, only to be told that they have to undergo chemotherapy to shrink the tumor before any surgery is possible, after which they will often disappear again. Another important reason is that the natural history of breast cancer is extremely variable, from nasty, aggressive tumors that kill within months to indolent, slow-growing tumors that, even when metastatic, women can survive with for several years. (It is, of course, these women who usually show up in “alternative medicine” testimonials, because they can survive a long time with little or no treatment before their tumors progress.)
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Posted in: Cancer, Herbs & Supplements, Science and Medicine, Surgical Procedures

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Welcome another new blogger for SBM

I’d like to take this opportunity to announce the arrival of another new blogger for SBM. Please wecome Dr. John Snyder.

John Snyder, M.D., is Chief of the Section of General Pediatrics and Medical Director of Pediatric Ambulatory Care at Saint Vincent’s Hospital in New York City. He is also Assistant Professor of Pediatrics at New York Medical College. Since 1994 Dr. Snyder has been active in pediatric resident and medical student education with a particular interest in evidence based pediatrics. His main area of interest is medical myth and the ways in which parents utilize information in making medical decisions for their children. One area of focus has been vaccine myth, and he lectures frequently on this subject in both academic and community settings. Dr. Snyder graduated form Mount Sinai School of Medicine and completed his residency training in pediatrics at The Mount Sinai Hospital in New York City. He is board certified in Pediatrics, and is a Fellow of The American Academy of Pediatrics. He is the founding partner of Pediatric Associates of Saint Vincents, a mutli-specialty pediatric faculty practice in New York City.

I first encountered Dr. Snyder on the HealthFraud mailing list, where, along with our very own Harriet Hall, he’s done yeoman’s work in the discussions there. Given how much the antivaccine movement has figured into the topics discussed here, I’ve also been looking for a skeptical pediatrician for quite a while now, which is why I’m very glad we’ve landed Dr. Snyder, who will be posting approximately once or twice a month. His first contribution to SBM will be posted later this week.

Please welcome him and be sure to comment on his first post, which will likely appear by Wednesday afternoon.

Posted in: Announcements

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When fraud undermines science-based medicine

The overriding them, the raison d’être if you will, of this blog is science-based medicine. However, it goes beyond that in that we here at SBM believe that science- and evidence-based medicine is the best medicine. It’s more than the best medicine, though; it’s the best strategy for medicine to improve therapy for our patients. We frequently contrast science-based medicine with various forms of “complementary and alternative medicine,” specifically pointing out that SBM changes its practices as new science and new evidence mandates it while CAM tends to rely on ancient, vitalistic, pre-scientific or pre-modern scientific beliefs about how disease occurs as the basis for its therapies. Although it may be painfully slow and frustrating at times and even though there may be major stumbles along the way, the overall course of SBM over the last century has in general been to produce ever more effective therapies and to discard therapies that are either ineffective or whose risk-benefit ratios are insufficiently favorable. The one single most important thing behind the advancement of medicine is good science.

That’s why I really, really hate scientific fraud, and I’m really, really upset, perhaps even more so than Dr. Atwood, over the discovery last week of what is arguably one of the most massive scientific frauds in medical history. It doesn’t matter that Dr. Atwood is an anaesthesiologist and I am not, meaning that the specific scientific fraud unearthed, which was perpetrated by an anesthesiologist studying multimodal anesthesia, as reported in Anesthesiology News, the Wall Street Journal, and the New York Times. I am a surgeon, and the relief of surgical pain in my patients is an important part of my practice. If the scientific basis of what my colleagues in anesthesiology do before, during, and after my operations is called into doubt, I have to wonder if I am giving my patients the best surgical care. Aside from that, there is the intellectual outrage I feel as a result of seeing science and patients betrayed in such a systematic and blatant manner.
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Posted in: Clinical Trials, Health Fraud, Pharmaceuticals, Science and Medicine, Surgical Procedures

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An all-too-common breast cancer testimonial for “alternative medicine”

One of the consistent themes of SBM since its very inception has been that, when it comes to determining the efficacy (or lack thereof) of any particular medicince, therapy, or interventions, anecdotes are inherently unreliable. Steve Novella explained why quite well early in the history of this blog, and I myself described why otherwise intelligent people can be so prone to being misled by personal experience and anecdotal evidence. Unfortunately, as I have also demonstrated, it’s not just patients who can allow themselves to be misled by anecdotes, but certain physicians who do not understand the scientific method but in their hubris think that their “personal clinical experience” trumps science, clinical trials, and epidemiology.

None of this is to say that there aren’t frequent instances when applying data from population-based studies to individual patients is problematic. It can indeed be. However, it often goes beyond that, and, indeed, if there is one defining characteristic of a quack that I’ve never failed to find when looking at individual cases, it’s a belief that he is able to identify when a treatment works based on his own personal experience and anecdotes. Unfortunately, it’s not just quacks who sometimes fall prey to this, because humans are cognitively wired to infer causation from correlation. This tendency, which was no doubt adaptive early in our evolution, simply doesn’t work well when it is applied to medicine and science. Without a doubt, it is the key driver, for example, behind the widely believed myth that vaccines somehow cause autism and that chelation therapy and other biomedical quackery can “cure” autism, a view popularized most recently by the very popular but very ignorant Jenny McCarthy in the U.S. and before that by the outright dishonest Andrew Wakefield in the U.K.

One of the other reasons why testimonials for quackery seem convincing is because most people simply do not know enough about disease, be it my specialty (cancer) or any other disease, how it is treated, and what its natural course can be expected to be. That is why, when I came across an example of just such a testimonial, specifically a breast cancer testimonial, I saw what is known as a “teachable moment. This teachable moment occurred on the very popular science blog Pharyngula, written by the ever sarcastic biology professor from Minnesota, P.Z. Myers. It actually surprised me in that the usual topics on Pharyngula include evolution, biology, the pseudoscience known as “intelligent design” creationism, politics, and atheism. P.Z. doesn’t usually dabble much in the realm of medical quackery, but my guess is that he was attracted to this particular piece of pseudoscience because of the religious angle.

Specifically, the quackery under consideration is known as God’s Answer to Cancer (GAC). Basically, it looks a lot like any number of quack electronic devices that promise to cure cancer; examples include Bill Nelson’s Electro Physiological Feedback Xrroid (EPFX) machine (1, 2, 3), Hulda Clark’s parasite zapper, or Alan Back’s Advanced Bio-photon Analyzer. All of these devices promise, in essence, to use low level electrical energy to “boost the immune system” and “replenish your life energy” plus or minus an additional promise to “zap parasites” (Hulda Clark’s unique spin on these devices, in which she claims that all cancer, AIDS, and most other diseases are due to a liver fluke, which her device supposedly “zaps.” Like these devices, the maker of GAC promises vague “immune system boosts,” but with the added twist that he claims that all disease is due to original sin (along, apparently, with the conventional alt-med “toxins,” diminished qi, and uncharacterized immune dysfunction). Amusingly, the Monsignor who created this device also disses Hulda Clark and advocates the use of laetrile and Linus Pauling’s orthomolecular medicine. The main difference is that he claims to have received the design for the device from God through a dream.
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Posted in: Cancer, Health Fraud, Science and Medicine

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