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A favorite tactic of the antivaccine movement: When science doesn’t support you, use the law

As I’ve joked about before, I’m a bit like Dug the Dog from the movie Up whenever a squirrel goes by. In other words, I’m easily distracted by things that interest my primal urge to chase pseudoscience. I originally had a cancer-related topic in mind for this week’s foray into science-based medicine, but then on Friday our favorite group of antivaccine activists over at the antivaccine crank blog Age of Autism induced a squirrel to run in front of me, and the rest is history, at least for the moment. I’ll try to get back to my original topic either as a bonus post later this week or as next week’s post (unlike the topic of today’s post it’s not really particularly time sensitive). In the meantime, I’ll chase this squirrel. Sorry about that. But Dug’s gotta do what Dug’s gotta do. Besides, the topic I had in mind for this week is sufficiently complex that my ultimate post will probably end up being much better if I have a few more days to a week to think about it. At least, that’s what I keep telling myself.

If there’s one thing I’ve learned over the years opposing the antivaccine movement, it’s that these days its “Holy Grail” (well, a “holy grail”) is to have a “vaccinated versus unvaccinated” study performed, or, as it’s frequently abbreviated, a “vaxed verus unvaxed” study. The reason they want such a study so badly is not because they think there’s a scientific question that genuinely cries out for an answer. Rather, they believe it will confirm their fixed, unalterable belief that vaccines are the root of nearly all chronic health conditions children suffer today, particularly autism and autism spectrum disorders. In particular, they believe that a “vaxed versus unvaxed” study would demonstrate once and for all that vaccines are the cause of the “autism epidemic.” Hilariously, a few years back, the antivaccine group Generation Rescue tried to do such a study. It was more an utterly incompetently administered and analyzed telephone survey than anything else, and, ironically, its results actually were just as consistent with the conclusions that vaccines protect against autism as that they predispose to autism. And don’t even get me started on an even more hilariously incompetent vaxed versus unvaxed study by a German antivaccine homeopath (I know; “antivaccine homeopath” is redundant) that antivaccinationists were touting a while back. That took attempts to ape science to depressingly ridiculous extremes.
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Posted in: Politics and Regulation, Vaccines

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The difference between science-based medicine and CAM

“Alternative medicine,” so-called “complementary and alternative medicine” (CAM), or, as it’s become fashionable to call it, “integrative medicine” is a set of medical practices that are far more based on belief than science. As Mark Crislip so pointedly reminded us last week, CAM is far more akin to religion than science-based medicine (SBM). However, as I’ve discussed more times than I can remember over the years, both here and at my not-so-super-secret-other blog, CAM practitioners and advocates, despite practicing what is in reality mostly pseudoscience-based medicine, crave the imprimatur that science can provide, the respect that science has. That is why, no matter how scientifically implausible the treatment, CAM practitioners try to tart it up with science. I say “tart it up” because they aren’t really providing a scientific basis for their favored quackery. In reality, what they are doing is choosing science-y words and using them as explanations without actually demonstrating that these words have anything to do with how their favored CAM works.

A more important fundamental difference between CAM and real medicine is that CAM practices are not rejected based on evidence. Basically, they never go away. Take homeopathy, for example. (Please!) It’s the ultimate chameleon. Even 160 years ago, it was obvious from a scientific point of view that homeopathy was nonsense and that diluting something doesn’t make it stronger. When it became undeniable that this was the case, through the power of actually knowing Avogadro’s number, homeopaths were undeterred. They concocted amazing explanations of how homeopathy “works” by claiming that water has “memory.” It supposedly “remembers” the substances with which it’s been in contact and transmits that “information” to the patient. No one’s ever been able to explain to me why transmitting the “information” from a supposed memory of water is better than the information from the real drug or substance itself, but that’s just my old, nasty, dogmatic, reductionist, scientific nature being old, nasty, dogmatic, reductionist, and scientific. Then, of course, there’s the term “quantum,” which has been so widely abused by Deepak Chopra, his acolytes, and the CAM community in general, while the new CAM buzzword these days to explain why quackery “works” is epigenetics. Basically, whenever a proponent of alternative medicine uses the word “epigenetics” or “quantum” to explain how an alternative medicine treatment “works,” what he really means is, “It’s magic.” This is a near-universal truth, and even the most superficial probing of such justifications will virtually always reveal magical thinking combined with an utter ignorance of the science of quantum mechanics or epigenetics.
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Posted in: Clinical Trials, Diagnostic tests & procedures, Homeopathy, Medical Academia

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Stanislaw Burzynski: The Early Years, part 1

It’s been a week now since I got back from TAM, where Bob Blaskiewicz and I tag-teamed a talk about a man who has become a frequent topic of this blog, namely Stanislaw Burzynski. I’ve been meaning to come back to the topic of Burzynski, but from a different angle. There hasn’t been much in the way of news lately other than the release of Eric Merola‘s most recent propaganda “documentary,” Burzynski: Cancer Is A Serious Business, Part 2, but, believe it or not, there remain lots of loose ends that I haven’t covered. This time around, the angle is this: How did Burzynski get his start? His is a story that goes back over 46 years, and in the beginning he seemed to be a promising young academic physician and a perfectly respectable researcher. So what happened? How did he evolve from a seemingly idealistic young Polish physician to what he has been for many years now?

I started to think about this when I was writing my post about “alternative cancer cures” circa 1979, because one of the three articles written by Gary Null and various coauthors that appeared in Penthouse magazine in the fall that year, The Suppression of Cancer Cures, was dedicated primarily to Stanislaw Burzynski and his “antineoplastons,” which at the time were new news, so to speak. However, Null’s article, even though it was contemporaneous with Burzynski’s having recently struck out on his own and started his own clinic, didn’t reveal everything that I was interested in learning. Actually, the more I read, the more I realize that no source really reveals everything that I want to know about that time period in the 1970s and early 1980s that produced the Stanislaw Burzynski that we know and don’t love today. Available sources all tend to be either pro-Burzynski, Burzynski himself, or vague in the extreme about what happened. Fortunately, my research for my TAM talk will serve multiple purposes. Since the talk was so brief and required me to cover 40+ years of history in a mere 20 minutes, there was a lot left out. I hate to let all that research go to waste; so I’m going to use it for an intermittent series of blog posts.
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Posted in: Cancer, Clinical Trials, Politics and Regulation

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Doing Eric Merola a favor…

Believe it or not, I’m going to do Eric Merola (who doesn’t particularly like me, to the point of thinking, apparently, that I’m a white supremacist who doesn’t like evidence but does like to eat puppies) a favor. Having been away at TAM and otherwise occupied hanging out with fellow skeptics and, more stressfully, getting ready to give a talk in front of as many as 1,000 people on Saturday, somehow I missed this. Well, actually, I didn’t miss it, but somehow I forgot to post it, even though it would have only take a few minutes. Then when I got home I still forgot to post it. Now there are only three days left (four, counting today) for me to do it; so I’d better get to it. My having forgotten to do this is particularly amazing given the subject of my main stage talk at TAM, our old buddy Stanislaw Burzynski. I’m even doing it as an extra “bonus” post on a day that I don’t usually post on SBM.

I wonder if Merola will appreciate the favor I’ve done him?

Eric Merola, as you recall, is a filmmaker who was responsible for two propaganda films about Stanislaw Burzynski, the dubious cancer doctor who has used “antineoplastons” to treat cancer without having published any decent clinical trial evidence that they do what he claims. Back in 2010, Merola released the first of a not-so-dynamic duo of films, the first of which was called Burzynski The Movie: Cancer Is A Serious Business (or B1, as I like to call it). The movie didn’t do much for a year or more, but then über-quack Joe Mercola promoted it, and somehow Eric Merola landed an interview with Dr. Oz on his radio show. The sequel, the slightly less pretentiously titled Burzynski: Cancer Is A Serious Business, Part 2 (or B2, as I like to call it), was then released June 1 on various pay-per-view modes. As has been pointed out, it’s no better than the first, and it features direct attacks on the skeptics who had the temerity to criticized Burzynski and Merola over the last couple of years.
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Posted in: Cancer, Science and the Media

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Do clinical trials work? It depends on what you mean by “work”

Introduction

(Skip to the next section if you want to miss the self-referential blather about TAM.)

As I write this, I’m winging my way home from TAM, crammed uncomfortably—very uncomfortably—in a window seat in steerage—I mean, coach). I had been thinking of just rerunning a post and having done with it, sleeping the flight away, to arrive tanned, rested, and ready to continue the battle against pseudoscience and quackery at home, but this seat is just too damned uncomfortable. So I might as well use the three and a half hours or so left on this flight to write something. If this post ends abruptly, it will be because I’ve run out of time and a flight attendant is telling me to shut down my computer in those cloyingly polite but simultaneously imperious voices that they all seem to have.

I had thought of simply recounting the adventures of the SBM crew who did make it out to TAM to give talks at workshops and the main stage and to be on panels, but that seems too easy. Even easier, I could simply post my slides online. But, no, how on earth can I reasonably expect Mark Crislip to post while he’s at TAM if I’m too frikkin’ lazy to follow suit? I’m supposed to lead by example, right, even if what comes out is nearly as riddled with spelling and grammar errors (not to mention the occasional incoherent sentence) as a Mark Crislip post? Example or not, lazy or not, I would be remiss if, before delving into the topic of today’s post, I didn’t praise my fellow SBM bloggers who were with me, namely Steve Novella, Harriet Hall, and Mark Crislip, for their excellent talks and insightful analysis. Ditto Bob Blaskiewicz, with whom I tag-teamed a talk on everybody’s favorite cancer “researcher” and doctor, Stanislaw Burzynski. It’ll be fun to see the reaction of Eric Merola and all the other Burzynski sycophants, toadies, and lackeys when Bob’s and my talks finally hit YouTube. Sadly, we’ll have to wait several weeks for that. (Hmmm. Maybe I will post those slides later this week.)
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Posted in: Cancer, Clinical Trials

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A Trilogy of (Acupuncture) Terror

A Trilogy of (Acupuncture) Terror

TAM is fast approaching, and I’ve been frantically trying to get my talks together. The theme this year is “Fighting the Fakers,” and one of my talks will be for the Science-Based Medicine Workshop on Thursday, in which I will attempt in a mere 15 minutes to explain what Science-Based Medicine is and how it can be used to combat the infiltration of quackademic medicine into medical academia. Then, the second talk will be a tag-team spectacular with Bob Blaskiewicz about Stanislaw Burzynski as an example of how some cranks skirt the edges of science-based medicine. That doesn’t make them any less dangerous (if anything, it makes them more dangerous), but it does make them not as easy to identify as someone like, say, Hulda Clark.

Trilogy_of_Terror_Poster

Unfortunately, between working on these talks, revising some papers, and having an unusually busy weekend on call, I wasn’t sure what I was going to come up with for the edification of you, our readers. Fortunately, right on the 4th of July holiday, there was an article that gave me my idea, particularly given that I had noticed a couple of studies on the very subject of the article in the week leading up to the long holiday in the US (at least for people not on call). As a result, I’m half tempted to refer to this article as a trilogy of acupuncture terror.

Oh, wait. I just did. (more…)

Posted in: Acupuncture

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Expectations versus reality in science-based oncology

Well, the latest round of grant applications and pre-applications is finally over, which gave me time this weekend to peruse the stack of journals that’s been accumulating on my desk. Oddly enough, despite my being about as plugged in as you can be at my age, I’m still old-fashioned enough to enjoy the physical sensation and the overall experience of picking up the most recent issue of a journal and randomly flipping through it. There’s something about the feel of the paper, the smell of the coating and print, as well as the sheer undirectedness of it all. It’s how I find articles that I probably would never find if I relied just on perusing the table of contents of an electronic edition.

Sadly, that’s not how I found this week’s topic. The study that I’m going to discuss this week is an E-pub ahead of print that I became aware of through a Reuters story, late last week when I still didn’t have time to deal with it. As is my usual practice, I saved the link for later in Safari’s Reading List, and this time I actually managed to come back to it. The story is entitled “Many cancer patients expect palliative care to cure“, and it’s about a recent publication out of the Dana-Farber Cancer Institute published online in the Journal of Clinical Oncology (JCO) entitled “Expectations About the Effectiveness of Radiation Therapy Among Patients With Incurable Lung Cancer“. It caught my eye, even a week ago, because managing expectations in patients with advanced cancer. It then led me to do a search for related articles, which brought me to a similar study from last fall in the New England Journal of Medicine, entitled “Patients’ Expectations about Effects of Chemotherapy for Advanced Cancer“, also from the same group at the Dana-Farber. This latter study looked at patients’ expectations regarding chemotherapy, and I even remember having encountered it when it was first published and wanted to blog about it then. I don’t recall why I didn’t, but here’s my chance to revisit it.
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Posted in: Cancer

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On humility, confidence, and science-based surgery

Every so often, the reality of trying to maintain a career in science-based medicine interferes with the fun that is writing for this blog. Basically, what happened is that I spent the entire weekend working on three different grant applications and, by the time Sunday night rolled around, I was too exhausted to write what I had originally planned on writing. Fortunately, one advantage of having been blogging so long and also having blogged under a pseudonym over at my not-so-super-secret other blog is that there’s a lot of material which is pretty damned good, if I do say so myself, that I can draw on for just these situations. Even better, it’s old enough that it’s unlikely that most of you have actually come across it before, which makes it new to you (well, at least most of you). As a special bonus, the jumping off point was a post by an occasional contributor to this blog, Peter Lipson. Actually, I wish Peter would contribute more regularly, but he’s too busy moving on to bigger things at Forbes.

This time around, I’m half-recycling, half-revising a post that was a bit more navel-gazing than usual. However, as the only surgeon on SBM I think it’s actually useful every now and then to discuss the trials and tribulations of practicing science-based surgery. It began when Peter wrote an excellent meditation on a topic that’s always been a difficult issue for me to face as a surgeon, namely how one balances confidence in one’s ability with humility in the face of disease and uncertain science. He started with a spot-on observation:

The practice of medicine requires a careful mix of humility and confidence. Finding this balance is very tricky, as humility can become halting indecision and confidence can become reckless arrogance. Teaching these traits is a combination of drawing out a young doctor’s natural strengths, tamping down their weaknesses, and tossing in some didactic knowledge.

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Posted in: Medical Academia, Science and Medicine, Surgical Procedures

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“Sense and nonsense” about alternative medicine in USA Today

Sometimes, between blogging, a demanding day (and night) job doing surgery and science, and everything else, I embarrass myself. Sure, sometimes I embarrass myself by saying something that, in retrospect, I wish I hadn’t. More often, I embarrass myself by letting things slide that I shouldn’t. For instance, when friends send me a prepublication copy of their books, I should damned well read them, don’t you think? So it was that Paul Offit sent me a copy of his latest book, which just hit the bookstores and online outlets this week, Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine, and I haven’t finished it. Oh, I’ve read a good chunk of it, but it’s not a huge book (around 335 pages); so I should have finished it by now, particularly since it’s quite good. My failure to properly read and plug the book aside, I’m glad to see that the book’s getting attention in a large media outlet, namely USA Today, in an article by Liz Szabo Book raises alarms about alternative medicine. There’s also a companion piece How to guard against a quack. I figure that the least I can do is to plug Dr. Offit’s book and the USA Today story in which he is featured, just as Harriet plugged his recent speaking appearance.

It’s also nice that Steve Novella and I were both interviewed. Now, excuse me while I get back to doing what I really should have had finished a month or two ago: Reading Dr. Offit’s excellent book.

Posted in: Book & movie reviews, Cancer, Health Fraud, Herbs & Supplements

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More bad science in the service of anti-GMO activism

More bad science in the service of anti-GMO activism

I never used to write much about genetically modified organisms (GMOs) before. I still don’t do it that often. For whatever reason, it just hasn’t been on my radar very much. That seems to be changing, however. It’s not because I went seeking this issue out (although I must admit that I first became interested in genetic engineering when I was in junior high and read a TIME Magazine cover article about it back in the 1970s), but rather because in my reading I keep seeing it more and more in the context of anti-GMO activists using bad science and bad reasoning to justify a campaign to demonize GMOs. Now, I don’t have a dog in this hunt, (Forgive me, I have no idea why I like that expression, given that I don’t hunt.) I really don’t. I was, not too long ago, fairly agnostic on the issue of GMOs and their safety, although, truth be told, because I have PhD in a biomedical science and because my lab work has involved molecular biology and genetics since I was a graduate student in the early 1990s, I found the claims of horrific harm attributable to GMOs not particularly convincing, but hadn’t bothered to take that deep a look into them. It was not unlike my attitude towards the the claims that cell phones cause cancer a few years ago, before I looked into them and noted the utter lack of a remotely-plausible mechanism and uniformly negative studies except for a group in Sweden with a definite ax to grind on the issue. Back then, I realized that there wasn’t really a plausible mechanism by which radio waves from cell phones could cause cancer in that the classic mechanisms by which ionizing radiation can break DNA molecular bonds and cause mutations don’t apply, but I didn’t rule out a tiny possibility that there might be an as-yet unappreciated mechanism by which long term exposure to radio waves might contribute to cancer. I still don’t, by the way, which has gotten me into the odd kerfuffle with some skeptics and one physicist, but I still view the likelihood that cell phone radiation can cause cancer as being just a bit more plausible than homeopathy.

As was the case for the nonexistent cell phone-cancer link, there has now been a steady drip-drip-drip of bad studies touted by anti-GMO activists as “evidence” that GMOs are the work of Satan that will corrupt or kill us all (and make us fat, to boot). Not too long ago, I came across one such study, a truly execrable excuse for science by Gilles-Eric Séralini at the University of Caen purporting to demonstrate that Roundup-resistant genetically modified maize can cause horrific tumors in rats. I looked at the methods and conclusions and what I found was some of the worst science I had ever seen, every bit as bad as the quack “science” used by the antivaccine movement. It wasn’t for nothing that I made the comparison, because the anti-GMO movement is very much like the antivaccine movement and the cranks who claim that cell phone radiation causes cancer. As if to demonstrate that very point, last week I came across an article by the all-purpose crank to rule all cranks, Mike Adams, at NaturalNews.com entitled GMO feed turns pig stomachs to mush! Shocking photos reveal severe damage caused by GM soy and corn:
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Posted in: Basic Science, Genetically modified organisms (GMOs), Nutrition, Science and the Media

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