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Now there’s something you don’t see on TV every day…

I rather like Late Night with Conan O’Brien. Unfortunately, I seldom get to watch, mainly because I usually show up at work sometime between 7:00 and 7:30 AM, and I don’t like watching more than a few minutes of video on my computer.

However, Hugh Laurie, star of House, was interviewed by Conan and revealed himself to be not unlike me in that he’s definitely a booster of reason and science in medicine over irrationality and dubious “complementary and alternative medicine” (CAM) therapies. In fact, his attitude towards CAM appears to be not at all unlike that of the character he plays on House. Check out the interview. (If you want to watch, the relevant part of the interview begins at about 23:50 into the show.)

For those who might have problems playing Internet video, I’ve found a transcript:
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Posted in: Health Fraud, Humor, Science and Medicine, Science and the Media

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How not to win friends and influence people

BLOGGER’S NOTE: The incident described in this post is true, although somewhat embellished to protect the names and identities of the innocent, if you know what I mean. This conversation occurred a few years ago at a large national cancer meeting.

The question caught me by surprise.

While attending a large national cancer meeting, I was having brunch with a friend, a colleague with whom I used to work when I was doing laboratory research, someone whom I hadn’t seen in a long time. She and her husband had brought along two of their oldest and dearest friends, whom they had known for decades, as well as another of my former coworkers from my old lab. We were idly chatting away and eating, when one of the occupational hazards of being a doctor presented itself. Tthe conversation drifted to medical topics. And then it came.

“What do you think of Dr. Gonzalez?”

Ah, hell.
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Posted in: Cancer, Health Fraud, Science and the Media

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Do over one in five breast cancers detected by mammography alone really spontaneously regress?

ResearchBlogging.orgIt figures.

Last Wednesday, right before the four-day Thanksgiving holiday weekend, as I was far more interested in preparing to have family over the next day than in what was going on in the medical news or the blogs, the results of a most fascinating study hit the news. In Medscape, the title of the news report was Mammography Study Suggests Some Breast Cancer May Spontaneously Regress; on WebMD, the story ran under the title Can Breast Cancer Disappear?; on Medical News Today, Mammograms May Identify Cancers That Would Otherwise Just Regress by Drs. Per-Henrik Zahl, Jan Maehlen, and H. Gilbert Welch. Not surprisingly, the study found its way out of the medical news and into mainstream media outlets as well, given how provocative the findings seemingly are. From the Medscape report on this study:

A mammography study from Norway has come up with the controversial proposal that one fifth of breast cancer detected on screening may spontaneously regress. But there is no easy way to verify whether this is the case, say experts.

The study was published in the November 24 issue of the Archives of Internal Medicine. It found that the cumulative incidence of invasive breast cancer in a cohort of women, aged 50 to 64 years, who received 3 mammograms over 6 years was 22% higher than in a control group of age-matched women who received only 1 mammogram at the end of a 6-year period.

In their review of possible explanations for the difference in the breast cancer rates between the 2 groups — which had similar risk factors for breast cancer — the researchers write that the “natural course for some screen-detected breast cancers may be to spontaneously regress.”

“I anticipate that many clinicians will react negatively to the possibility of spontaneous regression, said coauthor Jan Maehlen, MD, PhD, professor of pathology at the Ulleval University Hospital, in Oslo, Norway, in an interview with Medscape Oncology.

Before I discuss the study itself, let me briefly discuss why clinicians may have a bit of a problem with the implications of this study, if they accurately reflect the biology of breast cancer.
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Posted in: Cancer, Clinical Trials, Diagnostic tests & procedures, Science and the Media

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The (Not-So-)Beautiful (Un)Truth about the Gerson protocol and cancer quackery

Note added by editor: The complete movie is now available on YouTube:

The Beautiful Truth

Although this blog is about medicine, specifically the scientific basis of medicine and threats to the scientific basis of medicine regardless of the source, several of us also have an interest in other forms of pseudoscience and threats to other branches of science. One branch of science that is, not surprisingly, critical to medicine is the science of biology, and the organizing theory of biology is the theory of evolution, which was first reported by Charles Darwin and subsequently synthesized with the developing science of genetics in the early 20th century and then with our increasing knowledge of molecular biology, genomics, and proteonomics whose rise ushered us into the 21st century. However, the implications of evolution, namely that humans and apes both evolved from a common ancestor and that humans, for all their belief of being different and superior to animals, are in fact related to animals in the great chain of life going all the way back to single-celled organisms, does not go down well with certain religious fundamentalists, particularly Christian fundamentalists. Whereas I (and I daresay several of my cobloggers) find the interconnectedness of life, including humans, implied by Darwin’s theory to be beautiful and uplifting, many fundamentalists see it as a profound threat to their world view. Consequently, they have attacked the theory of evolution at every turn and tried to insert creationism, particularly the latest incarnation of creationism known as “intelligent design,” into science classes as an “alternative” to “Darwinism.” The manner in which they torture science, logic, and reason to try to cast doubt on a theory that is every bit as rock solid in terms of massive quantities of experimental and observational evidence to support it as any other theory in science, if not more so, is legendary and well documented at blogs such as The Panda’s Thumb and websites such as Talk Origins.

Although one day I plan on writing about how insights from evolutionary theory have led to deeper understandings of human disease and strategies to improve human health in the future, this time I want to concentrate on the similarities in techniques of spreading disinformation between creationists and purveyors of unscientific medical “treatments.” For background, first, you need to be aware of a movie that was released in April. The movie, Expelled!: No Intelligence Allowed was released. Starring Ben Stein at his most unctuous sporting a bullhorn and styling himself as a conservative, buttoned-down version of Angus Young through his choice of apparel in its promotional material, the movie’s main theme is that any academic who “questioned Darwinism” is “expelled” from academia. The basic idea is that “intelligent design” creationism is being “suppressed” by biologists who just can’t accept the thought of the existence of a “designer” (i.e., God). Indeed, the movie goes so far as to equate biologists and scientists who accept the theory of evolution as the best current explanation for the diversity of life to Hitler and the Nazis and their “suppression” of “alternatives” (word choice intentional) to “Darwinism” to Nazi and Stalinist persecution of dissidents and perceived threats to the regime. The movie even features a sequence where Ben Stein visits Dachau and Auschwitz, as though to imply that biologists are busy firing up the ovens for the Brave Maverick Scientists who “dissent from Darwin.”

These Brave Maverick Scientists are a lot like the Brave Maverick Doctors who champion unscientific medicine. After all, Kevin Trudeau has made a cottage industry and sold millions of books based on the claim that there are “natural cures” that “they” (as in doctors, pharmaceutical companies, and the government) don’t want you to know about and that as a consequence the full forces of these groups are being marshalled to “suppress” them and “persecute” the Brave Maverick Doctors who dare to question the “orthodoxy” of “allopathic medicine,” up to and including claims of “Nazi”-like suppression. (Just read those repositories of quackery NaturalNews.com and Whale.to if you don’t believe me.) For the “alternative medicine” movement, it’s all there, in websites, blogs, and books. But one thing that the movement pushing unscientific treatments has lacked, and that’s a movie to call its own, a movie to spread the same message.

That is, until now.

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Posted in: Cancer, Dentistry, Health Fraud, Science and the Media

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On the dangers of using valid placebo controls in clinical trials of acupuncture

ResearchBlogging.orgI don’t recall if I’ve ever mentioned this before on this blog, but there was a time when I was less skeptical of acupuncture than I am now. It’s true. Don’t get me wrong, though. I never for a minute considered that the whole rigamarole about “unblocking” or “redirecting” the flow of that mystical life force known as qi had anything to do with whether or not acupuncture did or did not have efficacy treating disease or other conditions. That was clearly a holdover from the pre-scientific medicine times in which most beliefs about the causes of disease involved either the wrath of the gods or vitalism, the latter of which is, when you come right down to it, the philosophical basis upon which many “complementary and alternative” (CAM) modalities are based, especially the so-called “energy healing” modalities, such as reiki, therapeutic touch, and, of course, acupuncture.

However, because unlike so many other “energy healing” methods, acupuncture involved an actual physical action upon the body, namely the insertion of thin needles into the skin to specified depths, it did not seem to me entirely unreasonable that there might be some sort of physiological effect that might produce a therapeutic result. At least, that’s what I used to think until I actually started paying attention to the scientific literature on acupuncture. That’s when I started to realize that “there’s no ‘there’ there,” if you know what I mean. Horribly designed studies with either no controls or utterly inadequate controls tend to be the norm in the acupuncture “literature” (if you can call it that). Moreover, acupuncture was touted as having value for conditions and procedures for which there is no plausible (or even mildly plausible) physiological mechanism by which it could be reasonably postulated to have an effect. Arthritis, allergies, headache, back pain, gastroesophageal reflux disease (GERD), Parkinson’s disease, post-operative nausea, hot flashes in breast cancer patients caused by the anti-estrogen drugs they have to take, infertility, it doesn’t matter. Seemingly acupuncture can do it all; it’s the Swiss Army knife of CAM therapies. Moreover, the “explanations” given to explain “how acupuncture works” seemed increasingly less plausible to me. Most of these explanations involve counterirritation or the release of opioids, and I’ve had an increasingly hard time believing that, even if these mechanisms are at play, they could have anything other than nonspecific effects, with no mechanism to explain how acupuncture could possibly do all things attributed to it. One rule of medical skepticism is that you should be very skeptical of modalities that are touted to be useful for a wide variety of medical conditions that have very different pathophysiology. Indeed, a funny thing happens when rigorous placebo controls are introduced, and that’s sometimes the placebo control does better than the “true” acupuncture; i.e., the evidence for acupuncture, taken in its totality, is completely compatible with placebo effect.

As Harriet Hall put it in her excellent analysis of a study purporting to show that acupuncture is useful for GERD:

This study falls into the category of what I call Tooth Fairy science. You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists.

One area that acupuncturists keep needling away at is infertility. Somehow, in the CAM community it’s become conventional wisdom that acupuncture can somehow increase the chance of success for couples undergoing in vitro fertilization (IVF). Indeed, early this year I wrote about a meta-analysis that concluded that acupuncture did actually increase the success rate of IVF and why it did not show what its authors thought it showed. Tooth fairy science, indeed.

Now comes yet another study being publicized in the media that examines once again the question of whether sticking needles into women before they undergo IVF can increase their chances of conceiving. I could not help but be extremely amused by the title given to the ScienceDaily story about it: Placebo Acupuncture Is Associated With Higher Pregnancy Rate After IVF Than Real Acupuncture. You have to love a headline like that, and opening paragraphs like this:
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Posted in: Acupuncture, Clinical Trials, Medical Academia, Science and the Media

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Robert F. Kennedy, Jr., vaccines, the EPA, and the interface with science-based medicine and public policy

This blog is entitled Science-Based Medicine for a reason, and that’s because we here at SBM believe that the best method to result in the most efficacious treatments for the most people is through the application of science to the evaluation of the biology, pathophysiology, and treatment of disease and disorders.

I may (or may not) be departing a bit from the views of my co-bloggers with this belief, but for purposes of this blog I consider “medicine” to go far beyond what we as physicians do when we undertake to treat patients. In fact, in my view, the purview of science-based medicine should not be so limited but should include any area where decisions, actions, or policy have a direct impact on health. Thus, my definition of science-based medicine encompasses environmental policy, because of the profound effect on human health environmental pollution and toxins can have. Unfortunately for those of us who don’t like its messiness, such a view drives me even more directly into politics than previous issues I’ve taken on. Like Dr. Novella, I rarely write about politics, but when it directly impacts science-based medicine. Mostly, such discussions here on SBM have involved the regulation of the medical profession by government, as Dr. Atwood discussed recently (1, 2, 3) in the context of the difficulties medical boards have in preventing quackery to my discussion of how a quack like Dr. Rashid Buttar could continue to practice in North Carolina, despite his despicable preying upon desperate cancer patients and the parents of children with autism, not to mention the frequent criticisms of the National Center for Complementary and Alternative Medicine. Dr. Sampson, on the other hand, was more than willing to examine a much more explicitly political issue, namely the number of Iraq War dead (1, 2), and that provoked a bit of disagreement with our commenters, not to mention me.

Recently, hot on the heels of the election of Barack Obama in the Presidential election last week, an issue relevant to several aspects of where science-based medicine intersects public policy popped up. Steve Novella has already commented on it on his own blog, as have numerous other medical bloggers, science bloggers, and political bloggers but I feel justified in commenting on it here, for the reasons that I’ve just mentioned. The controversy is that antivaccine activist and true believer in the scientifically discredited notion that mercury in the thimerosal preservative in vaccines causes autism, Robert F. Kennedy, Jr., is being seriously considered by Barack Obama either to head the Environmental Protection Agency or even to be Secretary of the Interior. Like our fearless leader Steve, I believe that such a selection would be an unmitigated disaster for science policy in government.
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Posted in: Politics and Regulation, Public Health, Science and the Media, Vaccines

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“Urban Zen” and homeopathy at Beth Israel Medical Center, or: Dr. Gorski destroys his chances of ever being invited to join the faculty at BIMC or the Albert Einstein College of Medicine

I guess I never really wanted to work in Manhattan anyway. At least, that’s what I keep telling myself.

I mean, why on earth would I want to? What’s the attraction? Living in the heart of it all, all those shows and all those amazing cultural activities, all those world-class restaurants? Being close to Boston, Philadelphia, and other cool East Coast cities, which are all just a quick Acela train ride away? Who cares about those things, anyway?

Apparently I don’t, because I’m about to destroy my chances of working at what has been considered one of the premiere academic hospitals in New York City, specifically Beth Israel Medical Center, an academic affiliate of the Albert Einstein College of Medicine. It’s possible for me to have been ignored when I first included the Albert Einstein College of Medicine and its affliated Continuum Center for Health & Healing in my roll call of shame as a medical center that has not just added woo to its offerings, but actively embraced it. At the time I originally discovered it, though, its offerings seemed limited to fairly mild woo, the usual stuff like acupuncture, what I like to call “gateway modalities” that centers embrace first because they’re relatively tame and commonplace. All too commonly, though, dabbling in gateway modalities leads to the “hard stuff,” outright quackery with zero scientific basis like homeopathy, reflexology, and craniosacral therapy. Such is the pathway an academic medical center follows when it degenerates from science-based medicine to what Dr. R. W. famously dubbed “quackademic medicine,” usually driven by a few famous true believers, which, alas, is exactly what happened at fearless leader Steve Novella’s institution of Yale, thanks to Dr. David Katz and his “more fluid concept of evidence.”

In any case, last week, I realized that I’ve been completely neglecting the aforementioned roll call of shame. Perusing it, I now realize that it’s been over five months since I did a significant update to it. You just know that, given the rate of infiltration of unscientific medical practices into medical academia as seemingly respectable treatment modalities that there must be at least several new additions to this roll of shame. Alas, even today, having been shamed myself by the realization of my failure to keep the list updated, I’m not going to do the full update and revamping that the Roll Call of Quackademic Medicine cries out for. However, that doesn’t mean I can’t do a piecemeal addition here and there. That doesn’t mean I can’t point out new additions as they pop up, even if it takes me a while to find the time to give the list the facelift it cries out for. It doesn’t mean I can’t call out hospitals like Beth Israel when they fall into woo, especially when they dive into quackademic medicine in a big way for cancer patients.
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Posted in: Cancer, Homeopathy, Medical Academia, Science and the Media

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Another take on those “50 Facts About Homeopathy”

You may recall that a week ago fellow SBM blogger Mark Crislip did a truly amusing takedown of an article by a homeopath purporting to provide us with 50 Facts About Homeopathy that supposedly validate the efficacy of this most amazing form of quackery. Not surprisingly, others wanted to get in on the fun, given how outrageously ridiculous and riddled with numerous logical fallacies the homeopath’s article was. Indeed, that’s why prominent Australian skeptic Peter Bowditch, whose website The Millenium Project is always an entertaining read (except that, at only once every one or two weeks, its updates are too infrequent) couldn’t resist getting in on the action with his answer to A Homeopathic Challenge.

Unfortunately, by the time he hit “Fact” #25 Peter was laughing so hard that, try as he might, he just couldn’t continue with his deconstruction. He does, however, promise to finish up the list in a future installment.

Posted in: Homeopathy, Humor

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Placebos in the news again

ResearchBlogging.orgTowards the end of last week, I was contemplating what I would be writing about for Monday. No topic had quite floated my boat, but I hated to dip into the archive of topics I’ve written about before to update a post. After all, I like to be topical whenever possible. Then what to my wondering eyes should appear (yes, I know Christmas is still two months away) but a study in the British Medical Journal by a group lead by Jon C. Tiburt at the Department of Bioethics at the National Institutes of Health in collaboration with investigators at the Osler Institute at Harvard University and the McClean Center for Clinical Medical Ethics at the University of Chicago entitled Prescribing “placebo treatments”: results of national survey of US internists and rheumatologists.

Serendipity? Who cares? The study addresses a very important aspect of science-based medicine.
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Posted in: Herbs & Supplements, Science and Medicine, Science and the Media

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Another new blogger, or SBM is going to the dogs (well, horses, actually)

We at Science-Based Medicine are pleased to announce the recruitment of yet another blogger to add to the discussion of the scientific basis of medicine. We’re especially pleased because he will help us address questions that we were not particularly well-equipped to address before his joining us. So, please welcome to the SBM fold David Ramey, DVM, who will be discussing science- and evidence-based veterinary medicine.

David Ramey, DVM, is a 1983 graduate of Colorado State University. After completing an internship in equine medicine and surgery at Iowa State University, he entered private equine practice in southern California. Dr. Ramey is an author of numerous books on equine health care, and a prominent voice for the application of evidence-based standards to veterinary medicine. He was a member of the task for on “Therapeutic Options” of the American Association of Equine Practitioners, as well as a member of the task force that wrote the current guidelines for the use of “Complementary and Alternative” veterinary medicine for the American Veterinary Association. He has published numerous articles and books pertaining to “alternative” approaches to veterinary medicine, including the 2004 Complementary and Alternative Veterinary Medicine Considered, co-authored with world renowned veterinary ethicist Dr. Bernard Rollin.

We get a fair number of questions about the use of “alternative” medical practices such as homeopathy and acupuncture on animals, particularly from people who ask us how they can appear to work on animals when animals supposedly don’t exhibit placebo effects. Dr. Ramey will be of great value in discussing such issues. Unfortunately, he will only be able to contribute posts around once a month or so. Fortunately, his first post will appear tomorrow. Don’t miss it.

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