Note: This was written as a book review for Skeptical Inquirer magazine and will be published in its Jan/Feb 2014 issue.
Medicine is chock-full of philosophy and doesn’t know it. Mario Bunge, a philosopher, physicist, and CSI (Center for Skeptical Inquiry) fellow, wants to bring philosophy and medicine together for mutual benefit. He has written a book full of insight and wisdom, Medical Philosophy: Conceptual Issues in Medicine.
Whether doctors recognize it or not, medicine is firmly based on the philosophical principles of materialism, systemism, realism, scientism, and humanism. Bunge explains that:
Without materialism, both diseases and therapies would be taken to be purely spiritual.
Without systemism, every disease would be attributed to an independent module.
Without realism, diseases would be viewed as either imaginary or as social flaws.
Without scientism, either nihilism or dogmatism would prevail, and all the achievements of biomedical research of the last 500 years would be consigned to oblivion.
Without humanism, all medical practice would be mercenary, and there would be no public health care. (more…)
On November 15, the American College of Cardiology and the American Heart Association released an updated guideline for the use of statins to prevent and treat atherosclerotic cardiovascular disease (ASCVD). The full report is available online. It has already generated a lot of controversy. The news media have characterized it as a “huge departure” from previous practice and have trumpeted that it will lead doctors to prescribe statins to millions more people. As usual, the truth is much more nuanced. There are some problems with the guidelines, but on the whole they represent an improved, more rational approach to prescribing statins.
Statins have always been a source of controversy: people seem to either love them or hate them, and discussions about them generate a lot of emotion. The International Network of Cholesterol Skeptics denies that cholesterol has anything to do with cardiovascular disease. An article on HuffPo calls statins “an unsafe, unnecessary product that will now be recommended to healthy people to make them sicker.” Mercola says they can actually make heart disease worse and cause premature aging, and no one should take them unless they have the genetic defect of familial hypercholesterolemia. A website collects patient self-reports of adverse effects; but like the vaccine reports on VAERS, these are only anecdotal reports of correlation, not evidence for causation.
At one time the evidence only supported using statins for secondary prevention and for men. We now have better evidence showing that they are effective for both primary and secondary prevention in patients of both sexes and all ages, and that they are more effective for those with higher risk factors. (more…)
We have written a lot about people who reject science-based medicine and turn to complementary/alternative medicine (CAM), but what about people who reject the very idea of medical treatment?
Faith healing is widely practiced by Christian Scientists, Pentecostalists, the Church of the First Born, the Followers of Christ, and myriad smaller sects. Many of these believers reject all medical treatment in favor of prayer, anointing with oils, and sometimes exorcisms. Some even deny the reality of illness. When they reject medical treatment for their children, they may be guilty of negligence and homicide. Until recently, religious shield laws have protected them from prosecution; but the laws are changing, as are public attitudes. Freedom of religion has come into conflict with the duty of society to protect children. The right to believe does not extend to the right to endanger the lives of children. A new book by Cameron Stauth, In the Name of God: The True Story of the Fight to Save Children from Faith-Healing Homicide, provides the chilling details of the struggle. He is a master storyteller; the book grabs the reader’s attention like a fictional thriller and is hard to put down. He is sympathetic to both the perpetrators and the prosecutors of religion-motivated child abuse, and he makes their personalities and their struggles come alive. (more…)
When I wrote about colonoscopy in 2010, colonoscopy was thought to be the best screening test for colorectal cancer because it could visualize the entire colon and could remove adenomas that were precursors of cancer. But only fecal occult blood testing (FOBT) and sigmoidoscopy had been proven to decrease colorectal cancer incidence and mortality (by 16% and 28%, respectively). Observational evidence suggested that colonoscopy would reduce the incidence and the number of deaths from colorectal cancer, but there were no randomized controlled trials, and the reduction in incidence of cancer after colonoscopy screening seemed to be restricted to left-sided colon cancers, which didn’t make sense.
We still don’t have any randomized controlled trials of colonoscopy, but a 2013 case-control study from Germany compared patients with and without colorectal cancer and found that those who reported having had a colonoscopy were less likely to develop colon cancer for up to 10 years after the procedure. And now two studies published in the New England Journal of Medicine in September 2013 have shed more light on the subject.
Can neck manipulation cause strokes? Most MDs and many chiropractors agree that it can, but some chiropractors disagree. The subject has been covered on SBM before: here, here, here, here, here, here, here, here, and here. We keep returning to the subject not because it is a common problem (it isn’t), but because it is such a devastating one, and because the general public is still not aware of the risk.
A 2012 study published in the International Journal Of Clinical Practice “Assessing the risk of stroke from neck manipulation: a systematic review” concluded:
Conclusive evidence is lacking for a strong association between neck manipulation and stroke, but is also absent for no association.
Despite the uncertainty, they thought the association was strong enough to recommend informed consent be obtained and patients be warned that neck manipulation “may” increase the risk of a rare type of stroke.
A new study in the same journal, “Chiropractic and Stroke: Association or Causation?” applies Hill’s criteria of causation to the evidence and concludes that causality has not been determined. The author is Peter Tuchin, a senior lecturer in chiropractic at Macquarie University in Australia, and a known apologist for chiropractic. I agree with him that the existing evidence is inadequate to conclusively determine causality, but I think it supports a high probability of causality, and the alternate explanations he offers to exonerate chiropractors are questionable. And other factors should be considered, like the many “smoking gun” cases and whether there is any conclusive evidence of benefit to set against the possibility of risk. (more…)
There is a new book critical of chiropractic: Chiropractic Abuse: An Insider’s Lament. The author, Preston Long, DC, PhD, is a chiropractor who says he made a big mistake when he chose chiropractic as a career. He has written an intriguing book explaining his mistake and the experiences that resulted from it during 3 decades as a chiropractor and a critic of chiropractic.
Chiropractic encourages self-delusion, and those who break free of delusion have two choices: to fight or run. Preston Long chose to fight, to keep the baby and throw out the bathwater polluted with pseudoscience and quackery, to try to practice rationally and ethically, and to try to reform chiropractic from within. He soon learned that it was next to impossible for a chiropractor to make a living with a science-based, ethical practice. He eventually found his niche and put his knowledge of chiropractic to good use. He evaluates chiropractic cases for disability and fraud, has worked with the FBI, and has testified at over 200 trials. He has written two previous books, The Naked Chiropractor (2002) and The P.R.E.S.T.O.N. Protocol for Back Pain (2006). This new book tells the story of his life and exposes the delusions and misbehaviors of his chiropractic colleagues.
He reveals “20 things most chiropractors won’t tell you”: (more…)
Recently a correspondent asked me for advice about his parents. He said they use things like homeopathy, acupuncture, and copper bracelets. They use conventional medicine too, but it seems to be a 50/50 approach that gives each an equal weighting. He has tried to talk to them about things like homeopathy and the placebo effect, but the shutters come down hard and fast. He tries to criticize the alternative treatment itself without offending or attacking the person, but his mother still sees it as a personal attack. He worries that as they get older and in need of more medical care, his parents may not make the best decisions. He asks about how to tactfully have these conversations and perhaps change their point of view.
That’s a very tough question that gets asked a lot, and I don’t have any good answers; but I do have some thoughts and untested ideas that could serve as the starting point for a discussion, and I hope readers will pipe up in the comments and tell us what has or hasn’t worked for them. (more…)
Chiropractors would like to reinvent themselves as family doctors. I’ve written about that before and Jann Bellamy has written about it here, here, here, and here. A new study in The Journal of Chiropractic Education alleges that the National University of Health Sciences is nearing its institutional goal of training chiropractic students as primary care practitioners. The data they collected don’t even begin to support that assertion. The study is not only meaningless, it demonstrates a gross misunderstanding of the education required to practice competent primary care. (more…)
A friend asked me, “What do you know about biotin?”
I said, “Not much. Why do you ask?”
She explained that the woman who cuts her hair at the hair salon recommended she take biotin to strengthen her nails and improve hair growth. She tried it, and within a couple of months, her nails looked better than they ever had in her whole life: the ridging was gone and they were no longer splitting or bending. And her hair, which had begun to thin, was noticeably thicker again.
I know what you’re going to say: this is nothing but a testimonial, and she could have been mistaken: post hoc ergo propter hoc and all that. Hair salons are not reliable sources of health advice, and perhaps not even a very reliable source of hair advice. I am leery of their recommendations for expensive shampoos and gimmicky conditioners. They offer things I don’t want, like hair coloring (I consider my gray hairs hard-earned badges of honor), waxing, eyebrow arch threading, scalp massage, and facials. Some of them have tanning beds in a back room. Incredibly, several of them in my area even offer ear candling! (more…)
Last week I posted a list of 30 rebuttals to many of the recurrent criticisms that are made by people who don’t like what we say on SBM. I thought #30 deserved its own post; this is it. At the end, I’ve added a few items to the original list.
What’s the harm in people trying CAM? Science-based medicine has been criticized for being too rigid and intolerant. Why do we insist on randomized placebo-controlled trials to prove that a treatment is safe and effective? Isn’t it enough that patients tell us they feel better? Isn’t that what we all want, for our patients to feel better? Even if the treatment only works as a placebo, isn’t that a good thing? What’s the harm in that?
The albuterol/placebo study
I would argue that we don’t just want our patients to think they are better, we want them to actually be better. A study that illustrates that principle has been discussed on this blog before, here and here.
A group of patients using an effective albuterol asthma inhaler was compared to 2 placebo groups (a placebo inhaler group and a sham acupuncture group), and to a group that got no treatment at all. Patients reported the same relief of symptoms with each of the two placebo controls as with the albuterol inhaler; all three groups reported feeling significantly better than the no-treatment group. It could be argued that placebos are an effective treatment for the subjective symptoms of asthma. (more…)