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An Overly Pessimistic View of Medicine

doctored book cover

Sandeep Jauhar wrote Doctored: The Disillusionment of an American Physician to express his frustration with the modern system of medical care in America. I found the book profoundly disturbing. If his experience is representative, I can understand why so many people have been criticizing doctors for only caring about money. His experience was so different from mine that I wondered if I had led a sheltered life as a military physician and was oblivious to what was going on in the civilian world. After further reflection, I think Jauhar is unduly pessimistic. Whatever the opposite of rose-colored glasses is, he’s wearing them.

His personal experience of medicine

Dr. Jauhar is a cardiologist who works in a large teaching hospital, where he had been hired to develop a program for patients with heart failure that would implement the most up-to-date medical knowledge and provide the best possible medical care. After long, grueling years of school, residency, and fellowship, he is elated to have finally finished his training and started a job where he can accomplish something good. But he soon sinks into despair. He is appalled by the realities of life as an attending physician, the many ways in which the “system” interferes with his efforts to provide the best care to patients, the unethical behavior of other doctors, and his inability to support his family.
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Posted in: Book & movie reviews

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Does the Movie Fed Up Make Sense?

fed up movie

The 2014 film Fed Up is an advocacy documentary. Its message:

  • There is a worldwide epidemic of obesity.
  • It is endangering our children.
  • Increased sugar consumption is responsible.
  • The food industry is responsible for our increased sugar consumption because it puts hidden sugar in processed foods, bombards us with advertising, favors profits over health, and lobbies against regulation.
  • The government is responsible because it has failed to control the food industry.

The film has received mostly positive reviews and has been called the Inconvenient Truth of the health movement. It was written and directed by Stephanie Soechtig, whose earlier films attacked GMO foods and the bottled water industry, and narrated by Katie Couric, who “gave anti-vaccine ideas a shot” on her talk show in late 2013.

The film shows families struggling with childhood obesity and “experts” expressing their opinions. Their selection of “experts” is heavy on politicians and journalists and light on nutrition scientists.
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Posted in: Book & movie reviews, Nutrition

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Why Does This Immunologist Reject Vaccinations?

Vaccination is arguably medicine’s greatest success. It has eradicated smallpox and has saved millions from death and suffering from a growing list of preventable diseases. It’s surprising that it has so many critics. Most of them are either not educated in medical science (like Jenny McCarthy) or are educated but prefer to reject science in favor of anecdotal experience (like Jay Gordon). Their arguments have been examined ad nauseum on this blog and elsewhere, and are easy to dismiss. But when I learned that an immunologist had written a book rejecting the whole idea of vaccination, I couldn’t dismiss it so easily. An expert in the field obviously knows more than I do about the relevant science; and if nothing else, she might have some valid criticisms of vaccines that I had overlooked. In 2012 Tetyana Obukhanych, PhD, published a short (53 page) book that is available in a Kindle edition: Vaccine Illusion: How Vaccination Compromises Our Natural Immunity and What We Can Do To Regain Our Health. I read the book hoping to learn something, and I did learn some things, but not anything that would make me question the current vaccine recommendations. I tried valiantly to understand her message; I think I succeeded. I’ll try to summarize what she is saying and explain why I think she got it wrong.

Vaccinefear
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Posted in: Book & movie reviews, Vaccines

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K2: The Vitamin, Not the Mountain

Typical example of a Vitamin K supplement.

Typical example of a Vitamin K supplement.

Science is complicated. Simple concepts that appear at first to be obviously true or untrue usually turn out to be more nuanced than we thought. Newtonian physics was taken as “the truth” until we learned in the 20th century that it didn’t apply on cosmological or subatomic scales. Medicine and human physiology are more complicated than most people realize or want to believe. A case in point is the recent realization that vitamin K is not a single chemical compound, but a whole family of them, and that vitamin K2 has unique properties that vitamin K1 lacks.

Recently, there has been some interesting preclinical research on K2 that warrants further study to tease out its implications for human health, diet, and supplementation. There has also been a lot of hype that warrants taking its claims not with a grain but with a large bolus of salt. According to Canadian naturopath Kate Rhéaume-Bleue, author of Vitamin K2 and the Calcium Paradox:

  • It could save your life
  • It is missing from the modern diet
  • It is the most important anti-aging nutrient for fighting wrinkles, Alzheimer’s, heart disease, osteoporosis and more
  • It promotes straight, cavity-free teeth
  • It is needed to get the benefits from calcium and vitamin D supplements; without it, those nutrients will increase the risk of heart attack and stroke
  • It is the only vitamin known to prevent and reverse atherosclerosis

The old adage is still true: if something sounds too good to be true, it probably is. There is only weak evidence behind these strong claims. (more…)

Posted in: Herbs & Supplements

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Bad News and Good News from Down Under: Science-Based Medicine in Australia

iridology-signage

The bad news: in a disturbing attempt to woo customers, some Australian pharmacists are offering in-store consultations with naturopaths. The good news: Australian skeptics and supporters of science have had a lot of recent successes in combatting quackery.

Non-Doc in a Box

In an article in the Australian magazine The Skeptic, Loretta Marron reports on naturopaths in pharmacies. You can read it here. Pharmacy customers who want natural treatment alternatives are referred by pharmacy staff to an in-house naturopathy clinic. The cost, $90 for a one-hour consultation, is often covered by insurance. You can even get a Loyalty Card to make your fifth consultation free. They claim to “correct underlying causative factors,” advise about stress, diet, how to promote your vitality and immune system, etc. And they help you make informed decisions about your health (informed by their brand of misinformation).

They offer disproven diagnostic methods like iridology, live blood analysis, and bio-energetic screening with bogus machines that they claim can detect everything from vitamin deficiencies and parasites to “spinal energy” and “vaccination disturbance.” Marron doesn’t describe the treatments they recommend, but we can assume they are offering the usual naturopathic remedies, including homeopathy, in lieu of the pharmaceuticals that are the reason for the pharmacy’s existence. (more…)

Posted in: Naturopathy, Science and the Media

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The Human Mold: Another Example of Self-Deception

This cover picture is scientifically inaccurate. See explanation below.

This cover picture is scientifically inaccurate. See explanation below.

José Jarimba believes that our bodies are physically molded into an asymmetric form by our mothers’ sleeping positions during pregnancy, that this has lifelong adverse impacts on health, and that shoe inserts can eliminate pain and other health problems by realigning the body. This is a silly untested hypothesis by a single individual. As such, it would be too minor to merit mention on SBM; but it is worth analyzing as a teaching opportunity. Jarimba attempts to bypass the scientific process; he provides a prime example of self-deception, confirmation bias, scientific ignorance, and the “Unpersuadables” I recently wrote about.

Much of alternative medicine originated with a “lone genius” who had an epiphany, thought he had discovered something no one had ever noticed before, extrapolated from a single observation to construct an elaborate theory that promised to explain all or most human ills, and began treating patients without any attempt to test his hypotheses using the scientific method. Some of them were uneducated laymen, others were scientifically trained medical doctors who should have known better. I wrote about one of them here, Dr. Batmanghelid, inventor of the Water Cure, who attributed a great variety of illnesses to dehydration after he thought he had cured a prisoner’s peptic ulcer disease by giving him a glass of water. Similar paths were followed by many others. Hahnemann invented homeopathy after he thought a malaria remedy gave him symptoms of malaria. Palmer invented chiropractic after he thought he had restored a man’s hearing by repositioning an out-of-place bone in his back. Nogier invented ear acupuncture after he imagined that the external ear looked sort of like a fetus. Shapiro invented EMDR after she noticed during a walk in a park that moving her eyes seemed to reduce the stress of disturbing memories. Bach invented Bach flower remedies after a walk in the country revealed his intuitive psychic connection to various plants. Jose Jarimba follows in their footsteps. (more…)

Posted in: Critical Thinking, Obstetrics & gynecology

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The Reality of Ancient Wisdom: Acupuncture and TCM Weren’t So Great

Thirty years in Moukden

Thirty years in Moukden

A mythology has grown up around traditional Chinese medicine (TCM). The ancient wisdom of the inscrutable Orient supposedly helped patients in ways that modern science-based medicine fails to understand or appreciate. A typical claim found on the Internet: “The ancient beliefs and practice of traditional Chinese medicine have been healing people for thousands of years.”

As Steven Novella has said, “TCM is a pre-scientific superstitious view of biology and illness, similar to the humoral theory of Galen, or the notions of any pre-scientific culture”. TCM really hasn’t been doing a creditable job of healing people for thousands of years. A book that was brought to my attention by one of our readers (thank you!) provides a unique insight into what Chinese medicine was really like circa 1900. I wish everyone who believes in ancient Chinese medical wisdom would read the chapter on Chinese medicine in this book. It provides a much-needed reality check. (more…)

Posted in: Acupuncture, History, Traditional Chinese Medicine

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The Unpersuadables

The Unpersuadables

The Unpersuadables

We would like to believe people are rational. We would like to believe that if they have formed a false belief based on inaccurate information and poor reasoning, they will change that belief when they are provided with accurate information and better reasoning. We are frequently disappointed.

An example of what should happen

I recently talked with a college professor who believed chiropractic treatment could lower blood pressure. His belief was based on a media report of a chiropractic study. He thought it was plausible that neck manipulation could somehow relieve obstructions to blood flow to the base of the brain, thereby somehow correcting the cause of high blood pressure. I told him that rationale was anatomically and physiologically implausible. I pointed out that the researchers used NUCCA, a form of manipulation that is rejected by most chiropractors. He did not know what NUCCA was. I provided him with information, including links to the study itself and to chiropractor Sam Homola’s excellent critique of the study. My friend changed his mind and thanked me for educating him.

An example of what all too often happens

I was invited to give the “con” side of a pro/con presentation on dowsing to a local discussion group. I lent my opponent my copy of Vogt and Hyman’s classic book Water Witching USA so he would know ahead of time what I was going to say. He read it. The book explains how the ideomotor effect creates the illusion that the dowsing rod moves of its own accord and explains that dowsers have never been able to pass controlled scientific tests. I said as much in my “con” presentation. His “pro” presentation consisted of two arguments: he had personally seen dowsing work, and lots of people believed in it. He didn’t even try to rebut my facts and arguments; he simply refused to engage with them in any way. It was as if he had not read the book and had not heard anything I said. Afterwards, one of the audience was heard to say she would have liked to hear more about how dowsing worked and less about how it didn’t work!

Will Storr investigates

Sadly, some people are unpersuadable. They might as well be saying “My mind’s made up; don’t confuse me with the facts.” We have seen plenty of glaring examples in the comments section of this blog. Will Storr wrote a book The Unpersuadables: Adventures with the Enemies of Science about his struggle to understand the phenomenon. He did a great job of investigative reporting, interviewing people with strange beliefs, spending time with them and also with their critics, and reading pertinent research. (more…)

Posted in: Book & movie reviews, Critical Thinking

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Diet Cults vs. Science-Based Healthy Eating

Diet Cults
This will be shorter than my usual book reviews and is something of an afterthought. I just finished writing a long article on “Food Myths” that Michael Shermer had asked me to write as a cover article for an upcoming issue of Skeptic magazine, and while researching the subject I read a book that someone had suggested to me (I’ve forgotten who you are, but thank you!). It occurred to me that since not everyone who reads SBM subscribes to Skeptic, it would be good to tell this audience about the book too.

(Note: if you subscribed, you could not only read my upcoming “Food Myths” article but also my regular SkepDoc column and my long article “On Miracles” in the next issue. And there’s lots of other great stuff in the magazine, including the Junior Skeptic section for your kids and grandkids. A digital subscription is available for only $14.99 and you can even get a trial issue for free, so you have no excuse not to check it out. End of commercial.)

The book is Diet Cults: The Surprising Fallacy at the Core of Nutrition Fads and a Guide to Healthy Eating for the Rest of Us, by Matt Fitzgerald, an endurance sport and nutrition writer. Not a doctor, but he understands science better than a lot of doctors who have written about diet and nutrition. His reasoning is persuasive and is supported by the scientific evidence. (more…)

Posted in: Book & movie reviews, Nutrition

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Pass the Salt (But Not That Pink Himalayan Stuff)

salt_shaker_on_white

Humans, like many other animals, crave the taste of salt. Animals frequent salt licks, humans have traded salt for equal weights of gold, and the word “salary” comes from the Roman soldier’s allowance for purchasing salt. Salt appears in our language in idioms like “worth its salt” and “salt of the earth.” Shakespeare’s play King Lear is a variant of a folktale where a daughter tells her father she loves him as much as meat loves salt. In a murder mystery I read years ago, a character listed the four food groups as sweet, salty, sticky, and chocolate.

It’s no fair: everything that tastes good turns out to be bad for us. We love the taste of salt, but dietary guidelines tell us we should all limit our sodium intake to less than 2.3 grams (2300 mg) a day to avoid high blood pressure and death from cardiovascular disease. And those who are over 51, African American, or who have high blood pressure, chronic kidney disease or diabetes should limit their intake even further, to 1500mg a day or less. (Note: the salt molecule consists of an atom of sodium and an atom of chloride; 40% of the weight is sodium, so 1500 mg of sodium equals 3750 mg of salt, roughly ¾ of a teaspoon. Over 75% of our salt is already in the food, not added from the salt shaker.) In 2010, the American Heart Association lowered its recommendations to 1500 mg a day for everyone. We thought that was good advice, but new evidence has muddied the waters. (more…)

Posted in: Nutrition, Public Health

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