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Nonsense about the Health Effects of Electromagnetic Radiation

Helke Ferrie has written an article for The CCPA Monitor, a monthly journal published by the Canadian Centre for Policy Alternatives, entitled “Dirty electricity, EMF radiation can be removed or reduced.” It is in the June 2012 issue, and is not available online. She calls herself a science writer, but this is not the writing of a person who understands science. There is hardly a word of truth in it. It’s a classic example of pseudoscientific propaganda, an appalling farrago of false statements and fallacious arguments. The nonsense starts with the very first sentence:

The symptoms of electropollution-induced sickness involve all organs with many debilitating symptoms, from skin rashes to cancer; they are part of the Multiple Chemical Sensitivity (MCS) spectrum.

The diagnoses of “electromagnetic hypersensitivity” and “multiple chemical sensitivity” are not recognized by the medical and scientific communities. Up to 5% of the population has come to attribute a large variety of nonspecific symptoms to non-ionizing electromagnetic fields from cell phones and other common electrical devices or to the chemicals in their environment. Their complaints have been thoroughly evaluated. Numerous studies and systematic reviews have been done; they are summarized in a Wikipedia article.  Just to give one example, a systematic review published in Psychosomatic Medicine in 2006 analyzed 31 double blind studies comparing real radiation to sham radiation. Patients couldn’t tell the difference. 24 of the studies found no effect, 7 reported “some” supporting evidence (2 of which could not be replicated on subsequent trials by the same researchers), 3 were false positives attributed to statistical artefacts, and the final 2 had mutually incompatible results. They concluded:

The symptoms described by “electromagnetic hypersensitivity” sufferers can be severe and are sometimes disabling. However, it has proved difficult to show under blind conditions that exposure to EMF can trigger these symptoms. This suggests that “electromagnetic hypersensitivity” is unrelated to the presence of EMF.

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Posted in: Public Health, Science and the Media

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Rituximab for Chronic Fatigue Syndrome: Jumping the Gun

Now that the XMRV myth has been put to rest,  patients with Chronic Fatigue Syndrome (CFS) are no longer jumping the gun to demand anti-retroviral treatments. But they are jumping the gun in new ways, based on very preliminary data coming out of Norway.

A correspondent in Norway wrote to tell me patients from Norway with myalgic encephalitis/chronic fatigue syndrome (ME/CFS) are travelling to the US to have Dr. Andreas Kogelnik in San Francisco treat them with IV infusions of rituximab, apparently to no avail. A course of treatment costs over $6000, not to speak of travel and other expenses. (more…)

Posted in: Clinical Trials, Medical Ethics, Pharmaceuticals

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Beyond Informed Consent: Shared Decision-Making

Happy New Year to all our readers! Today marks the completion of 5 years of SBM and the beginning of year 6. My contributions, at one a week, have now reached a total of 260. My first post on this blog, 5 years ago, was a review of an important book about science and alternative medicine, Snake Oil ScienceThis year I’d like to start with an important book about communicating medical science to patients, Critical Decisions,  by Peter A. Ubel, M.D.

I was wrong about informed consent. I thought informed consent was a matter of explaining the risks and benefits of treatments to patients so they could decide what they wanted to do.  That was naïve, simplistic, and misguided. Ubel’s book has radically changed my thinking about how doctors should interact with patients.

Paternalism in medicine is dead. Patient autonomy rules. We respect the right of patients to determine their own treatments, even if their choices seem unwise to us. Patients should do what they want. But there’s a problem: patients may not know what they really want. Emotions and unconscious and irrational forces influence their medical decisions. Preferences can change from one moment to the next, and they can shift with subtle changes in how treatments are described and how the issues are framed. Doctors need to develop a better understanding of what is going on in their patients’ minds, of how the way they present treatment options can inadvertently influence patients, and of how they can participate with patients in a process of shared decision-making. It’s possible to provide direction without paternalism. (more…)

Posted in: Book & movie reviews, Medical Ethics

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An Alternative “Truth” About Flu Shots

Vaccines, and flu shots in particular, have been covered ad nauseum on this blog; but the anti-vaccine propaganda never stops, so forgive me for bringing it up again. A correspondent inquired about a podcast by Steve Wright on Revolution Health Radio entitled “The Truth About Flu Shots (and What to do Instead).” You can either listen or read the transcript. It’s just too funny to pass up. That is, it would be funny if it weren’t endangering our public health by spreading misinformation.   (more…)

Posted in: Herbs & Supplements, Vaccines

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Storytelling in Medicine

We can’t stress often enough that anecdotes are not reliable evidence; but on the other hand, patient stories can serve a valuable purpose in medical education. Hearing how a disease affected an individual patient is more powerful than reading a list of symptoms in a textbook and is far more likely to fix the disease in the student’s memory. When I think of Parkinson’s disease, the first thing that comes to mind is my first patient with Parkinson’s and how he responded to levodopa; and the first thing that may come to many people’s minds is Michael J. Fox. Of course, we must realize that they may not be typical examples; but putting a face to a diagnosis serves as a memory aid and a hook to hang the rest of our knowledge on.

In his new book, The Power of Patient Stories: Learning Moments in Medicine, Paul F. Griner, MD relates more than 50 stories that distill the wisdom he has developed over a 58-year career of practicing medicine and teaching young doctors. He describes them as “stories that provided a learning moment for me.” It’s interesting to see how much medicine has changed over his professional lifetime and yet how cases from the 50s and 60s are still highly relevant. Ethical dilemmas and lessons about medical practice come alive under his pen. Each story is followed by incisive questions and exercises that engage the reader and challenge him to think about the issues. (more…)

Posted in: Book & movie reviews, History, Medical Academia, Medical Ethics

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Isagenix Study Is Not Convincing

Isagenix is a wellness system sold by multilevel marketing. It consists of a suite of products to be used in various combinations for “nutritional cleansing,” detoxification, and supplementation to aid in weight loss, improve energy and performance, and support healthy aging. It allegedly burns fat while supporting lean muscle, maintains healthy cholesterol levels, supports telomeres, improves resistance to illness, reduces cravings, improves body composition, and slows the aging process. And makes millions for distributors who got on the bandwagon early and are high on the pyramid.

I have written about it before and have been roundly criticized by its proponents.   It generated my all-time favorite insult: “Dr Harriet Hall is a refrigerator with a head.”

My biggest concern with Isagenix was that it had not been clinically tested. They claimed that clinical tests were in progress (funded by Isagenix).  An e-mail correspondent recently told me I should take another look at Isagenix, since a clinical study had been completed. It had not yet been published, and I asked her to get back to me when it was. Ask and you shall receive (but you may be sorry!). She contacted me when the study by Kroeger et al. was published in the journal Nutrition and Metabolism.   The full study is available online and I urge readers to click on the link and look at Table 2, which I will be referring to later. The journal is peer-reviewed but, as will become painfully obvious, the peer reviewers did not do a competent job. It is an open-access online journal with a low impact factor. The authors had to pay to get their article published: it cost them $1805.

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Posted in: Clinical Trials, Herbs & Supplements

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Fun With Statistics

Statistics is the essential foundation for science-based medicine.  Unfortunately, it’s a confusing subject that invites errors and misunderstandings.  We non-statisticians could all benefit from learning more about statistics as well as trying to get a better understanding of just how much we don’t know. Most of us are not going to read a statistics textbook, but the book Dicing with Death: Chance, Risk, and Health by Stephen Senn is an excellent place to start or continue our education. Statistics can be misused to lie with numbers, but when used properly it is the indispensable discipline that allows scientists:

 …to translate information into knowledge. It tells us how to evaluate evidence, how to design experiments, how to turn data into decisions, how much credence should be given to whom to what and why, how to reckon chances and when to take them.

Senn covers the whole field of statistics, including Bayesian vs. frequentist approaches, significance tests, life tables, survival analysis, the problematic but still useful meta-analysis, prior probability, likelihood, coefficients of correlation, the generalizability of results, multivariate analysis, ethics, equipoise, and a multitude of other useful topics. He includes biographical notes about the often rather curious statisticians who developed the discipline. And while he includes some mathematics out of necessity, he helpfully stars the more technical sections and chapters so they can be skipped by readers who find mathematics painful. The book is full of examples from real-life medical applications, and it is funny enough to hold the reader’s interest. (more…)

Posted in: Book & movie reviews, Science and Medicine

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Ecstasy for PTSD: Not Ready for Prime Time

Hundreds of desperate combat veterans with Post-Traumatic Stress Disorder (PTSD) are reportedly seeking experimental treatment with an illegal drug from a husband-wife team in South Carolina. The Bonhoefers recently published a study showing that adding MDMA (ecstasy, the party drug) to psychotherapy was effective in eliminating or greatly reducing the symptoms of refractory PTSD. It was widely covered in the media, for instance in this article in the NY Times. It was only a small preliminary study, and the treatment is not yet ready for prime time; but media reports have sparked enthusiasm not justified by the evidence. (more…)

Posted in: Clinical Trials, Neuroscience/Mental Health

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True Informed Consent Is Elusive

Most of us would agree that doctors should not treat patients without their consent, except in special cases like emergency care for an unconscious patient.  It’s not enough for doctors to ask “Is it OK with you if I do this?” They should get informed consent from patients who understand the facts, the odds of success, and the risk/benefit ratio of treatments. The ethical principle of autonomy requires that they accept or reject treatment based on a true understanding of their situation and on their personal philosophy. Numerous studies have suggested that patients are giving consent based on misconceptions. There is a failure of communication: doctors are not doing a good job of providing accurate information and/or patients are failing to process that information. I suspect it is a combination of both.

An article in The New England Journal of Medicine reports that while the great majority of patients with advanced lung cancer and colorectal cancer agree to chemotherapy, most of them have unreasonable expectations about its benefits. For some cancers chemotherapy can be curative, but for metastatic lung or colorectal cancer it can’t. For these patients, chemotherapy is only used to prolong life by a modest amount or to provide palliation of symptoms. Patients were asked questions like “After talking with your doctors about chemotherapy, how likely did you think it was that chemotherapy would… help you live longer, cure your cancer, or help you with problems you were having because of your cancer?” A whopping 69% of lung cancer patients and 81% of colorectal cancer patients believed it was likely to cure their cancer, and most of these thought it was very likely. (more…)

Posted in: Cancer, Medical Ethics, Pharmaceuticals

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Fan Mail from an ASEA Supporter

We have an active comments section on our blog, but for some reason some people prefer not to comment there, but to send personal e-mails to authors when they disagree. Some of them make me laugh. Some of them make me despair. We can carry on our struggle better if we know what we are fighting; and in that spirit, I want to describe a recent e-mail exchange.

If an e-mail is filled with angry CAPITALS and abusive language, I know there is no point in responding. But I still get suckered in by the ones that start out sounding as if a productive dialog might be possible; unfortunately, discussions almost always degenerate. In this case, it started with a polite request for my opinion about a specific study. (more…)

Posted in: Herbs & Supplements

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