Today the LA Times described a bizarre and troublesome healthcare reform bill provision that would require Medicare to pay for Christian Science Prayer as a medical treatment:
…a little-noticed provision in the healthcare overhaul bill would require insurers to consider covering Christian Science prayer treatments as medical expenses.
The provision was inserted by Sen. Orrin G. Hatch (R-Utah) with the support of Democratic Sens. John F. Kerry and the late Edward M. Kennedy, both of Massachusetts, home to the headquarters of the Church of Christ, Scientist.
I have often mused about the difference between being right and being influential – especially in light of the relative success of the anti-vaccine movement. Despite the fact that there is no evidence for a link between vaccines and autism, celebrities like Jenny McCarthy have manufactured public mistrust in one of the safest, most cost effective means of combating disease known to humankind.
So if scientists are not persuading the public with appeals to carefully designed trials and factual data, how should they make their point? I’m not sure I have the full answer, but I think I might have struck a nerve with the public lately. I decided to try a novel approach to communicating my concerns about pseudoscience on the Internet – and presented 20 slides at 20 second intervals to a conference of ePatients in Philadelphia. I did it with powerful and humorous images, tied together with a long Limerick. Sound kooky? Maybe so… but it resonated, and was received with cheers and applause. Now that’s how we like science to be recognized! (more…)
With some degree of sadness I recently “outed” a former co-resident of mine who has turned to the dark side and begun putting money-making before truth and science. Without any clear evidence of benefit beyond placebo, platelet-rich plasma (PRP) is now being marketed aggressively as a cure-all for sports injuries. And at about $300 per injection (the NYT reports $2000/treatment), there’s plenty of money to be made.
Like the fake “stem cell” clinics in Russia (where, according to Sanjay Gupta’s recent book, Chasing Life, a person’s fat cells are harvested, washed, and re-injected into their blood stream), PRP also involves injection of autologous body fluids. Essentially, a small amount of blood is drawn from the patient, centrifuged, and the plasma supernatant is then injected directly into tendons and/or joints. After a series of 3 injections (one/month), most sports injuries are “cured.” Of course, most injuries would heal themselves in three months anyway. (more…)
The Internet is teeming with false health claims and a long line of celebrities willing to throw their media weight behind every new flavor of snake oil. The irony is that alternative medicine proponents see themselves as a persecuted minority – the victims of some nebulous health industry conspiracy. But in reality, they have ingratiated themselves with the media to such an extent that they may in fact have the upper hand.
Pseudoscience has become Goliath, and physicians have never faced a more pernicious foe. With patients’ lives hanging in the balance, some of us are waging the war for hearts and minds with gumption, zeal, and a little help from a brave minority of media who have finally woken up and realized that alternative medicine is not as soft and cuddly as they once thought.
Take for example those who wrongly believe that vaccines cause autism. Many of them subject their children to unproven and harmful therapies, diets, and regimens – some of which are tantamount to child abuse. Consider the cases described most recently by David Gorski here. One child underwent repeated IV chelation therapy for years followed by the invasive injection of “stem cells” into her cerebrospinal fluid. (more…)
The following is an announcement from my friends at Medgadget.com:
Next Monday, the Nobel Foundation will announce the winner(s) of this year’s Nobel Prize in Physiology or Medicine. In the following two days, two more Nobels will be revealed: in Physics and in Chemistry. Because of the success of last year’s inaugural Guess-A-Nobel Contest, we decided we’ll repeat this event annually until there is no more science worthy of the prize. This year we’re giving out three 8GB Apple iPod Touch devices to those who correctly guess in each of the three science categories. Because we profile a good deal of apps for the iPhone/Touch platform, we thought this might be a useful tool beside all the fun it can provide on the off time. Furthermore, if someone does manage to guess all three correctly, he or she will be getting the souped-up 64 GB version of the iPod device with all the trimmings.
Here are the rules of the game: (more…)
Rudy Tanzi, Joe Perry, Francis Collins
I know. I was just as surprised as you are. Dr. Francis Collins, former director of the Human Genome Project, author of The Language Of God, and new director of the National Institutes of Health performed live in front of a group of Washington locals at the Capitol building today. He actually jammed with Aerosmith’s Joe Perry in an “unplugged” performance of Bob Dylan’s, “The Times They Are A Changin’.” This is not the kind of thing one expects in the hallowed halls of the Capitol building. But maybe it’s time to expect the unexpected?
I’ve spent some time on this blog wondering about the difference between being “right” and being “influential” – and how to combat the Jenny McCarthyism that is misleading Americans about their health. I’ve argued that we need to find a way to rekindle the public’s interest in good science, and learn to speak to folks in a way that is captivating and respectful. I guess that some of our peers are engaged in a rebranding of science.
As I mentioned in a not-so-recent blog post, I’ve often marveled at the marketing successes of “integrative” medicine – a practice which generally refers to the act of blending effective treatments with ineffective or untested/equivocal ones. Only the marketing elite know how integrative medicine became associated with enlightenment. Perhaps they’re the very same people who came up with the idea that women should be excessively concerned about cellulite? Thanks a lot, guys.
But I do find a lot of integrative medicine vexing because it often starts with a grain of truth, and then usually proceeds to make wildly exaggerated claims about its efficacy.
I’ll never forget the day when I argued for protecting parents against misleading and false information about the treatment of autism. I was working at a large consumer health organization whose mission was to “empower patients with accurate information” so that they could take control of their health. My opposition was himself a physician who requested that our organization publish an article that advised parents of children with autism to seek out DAN! practitioners and chelation therapy.
I prepared my remarks with the utmost care and delivered them to a committee of our lay executives. I cited examples of children who had died during chelation treatments, explained exactly why there was no evidence that chelation therapy could improve the symptoms of autism and in fact was based on the false premise that “heavy metals” in vaccines were implicated in the etiology of the disease. I concluded that it would be irresponsible for the company to publish such misleading advice/information for parents, and would in fact be counter to our entire mission.
My physician opponent suggested that it was our company’s duty to inform parents of all their options, that we should not be judgmental about treatments, and that I was part of a paternalistic medical establishment that tried to silence creative thinking.
The committee ended up siding with my opponent. I was flabbergasted and asked one of the committee members what on earth they were thinking. She simply shrugged and said that my opponent was more likable than I was.
This experience marked the beginning of my journey towards fighting fire with fire – understanding that being right is not the same as being influential, and that “winning” an argument (where lives are on the line) requires a different skill set than I learned in my scientific training.
And so it was with great interest that I picked up Randy Olson’s book, Don’t Be Such A Scientist: Talking Substance In An Age Of Style. (more…)
So far I have explained why most research (if not carefully designed) will lead to a false positive result. This inherent bias is responsible for many of the illusionary treatment benefits that we hear about so commonly through the media (whether they’re reporting about CAM or Western medicine), because it is their job to relay information in an entertaining way more so than an accurate manner (i.e. good science makes bad television).Then I explained a three step process for determining the trustworthiness of health news and research. We can remember these steps with a simple mnemonic: C-P-R.
The C stands for credibility- in other words, “consider the source” – is the research published in a top tier medical journal with a scientifically rigorous review process?
The P stands for plausibility- is the proposed finding consistent with known principles of physics, chemistry, and physiology or would accepting the result require us to suspend belief in everything we’ve learned about science to date?
And finally we arrive at R – reproducibility. If the research study were repeated, would similar results be obtained? (more…)
In part 2 of the Science-Based Medicine 101 series we take a look at the second pillar of good science: plausibility. This blog post was written for a lay audience so more advanced readers will need to indulge me here…
I really enjoy sci-fi action movies. I love the convincing special effects and the fact that heroes can accomplish the physically impossible without skipping a beat. Implausible events unfurl with convincing reality, and you never know what might happen with the plot.
I also enjoy the TV show, America’s Funniest Home Videos, for different reasons. The mundane nature of actual reality, and the often predictable, but hilarious mistakes made by those I relate to result in some pretty hearty laughs.
But there is a big difference between these two forms of entertainment: science-fiction requires the suspension of belief in plausibility, while home videos are based on plausible outcomes. When it comes to medical research, though, plausibility can mean the difference between science fiction and reality.