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Antibiotics vs. the Microbiome

missing microbes

In 1850, one in four American babies died before their first birthday, and people of all ages died of bacterial infections that could have been successfully treated today with antibiotics. Unfortunately, treatments that have effects usually have side effects, and we are seeing problems due to the overuse of antibiotics. They are given to people with viral infections for which they are useless and to food animals to improve their growth. As a result, antibiotic-resistant organisms are evolving and the development of new antibiotics is not keeping up with the threat. This is common knowledge, but we’re starting to realize that there may be other problems with antibiotics even when they are used correctly to save lives.

The rates of obesity, diabetes, asthma, food allergies, hay fever, eczema, inflammatory bowel disease, celiac disease, acid reflux disease, and esophageal cancer are all on the rise. Martin Blaser, MD, director of the Human Microbiome Program at NYU, thinks antibiotics may be to blame, either as a causal or a contributing factor. In his book Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues, he describes some of the fascinating research he and others have been doing to elucidate the role of the more than 100 trillion microbes that live on and in each of us, and the possibility that antibiotics may have a causal role in several of the so-called diseases of civilization. (more…)

Posted in: Book & movie reviews, Evolution, Obstetrics & gynecology, Pharmaceuticals

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Misguided Naturopath Claims To Have Cured Cervical Dysplasia

Pap test discoverer

George Papanicolaou, who originated the cervical dysplasia test that bears his name (the Pap smear)

Naturopath Kate Whimster has written a case study of a patient with cervical dysplasia who was allegedly treated successfully with naturopathic treatment. She says:

In many cases conventional treatment can be invasive, ineffective, or can put patients at risk for future complications. Fortunately, there are wonderful naturopathic treatment options available both instead of or in conjunction with conventional medical treatments. This case study is a great example of naturopathic treatment for cervical dysplasia as part of my HPV Healing program.

The Patient

The patient was a 32-year-old woman who first had an abnormal Pap smear at the age of 26. Here is Whimster’s report of the course of events:

  • February 2012: Pap HSIL, Colposcopy CIN I, Biopsy HSIL
  • April 2012: LEEP procedure
  • July 2012: Pap HSIL, Colposcopy CIN I, Biopsy HSIL
  • August 2012: Start of naturopathic treatment
  • Nov 2012: Pap LSIL, Colposcopy normal
  • May 2013: Pap LSIL, Colposcopy CIN I, Biopsy LSIL
  • July 2013: Pap ASCUS, Colposcopy normal, Biopsy normal
  • October 2013: Pap normal, Colposcopy “cannot rule out CIN I,” Biopsy normal
  • May 2014: Pap, Colposcopy and Biopsy all normal.

She was also successfully treated for a bacterial vaginal infection. (more…)

Posted in: Cancer, Naturopathy

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A Misguided Apology

A new book by Thomas Schneider, MD, offers A Physician’s Apology. The subtitle asks, “Are WE making you sick?” I was eager to read it, because I could think of many things doctors might be apologizing for: overdiagnosis, overtreatment, ordering unnecessary tests, pathologizing the vicissitudes of everyday life, offering misleading low-fat diet advice, misrepresenting inadequately tested treatments, not putting enough emphasis on prevention, prescribing medication before giving lifestyle changes a chance, etc. I was disappointed: his basic apology was “Truth is extremely hard to find in medicine and science, and I’m sorry,” which is true but is hardly his fault. Then he promises to “tell you a number of medical and scientific facts that are different from what many have always been told.” He blames commercials, creative marketing, and clueless doctors. Then he offers his own “truths” and his personal recipe for wellness. Some of these “truths” are questionable, and some are frankly wrong.

a-physicians-apology

(more…)

Posted in: Book & movie reviews

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Medical Malpractice Lawsuits

malpractice

We hear a lot about medical malpractice suits and how they affect the practice and the cost of medicine. Doctors sometimes get the feeling that a lawyer is looking over their shoulder as they interact with patients, and sometimes they practice “defensive medicine,” ordering unnecessary tests and doing what they think would look best in court rather than what is really in the patient’s best interests. One of my colleagues in the Air Force, a psychiatrist, said at his retirement ceremony that he considered his career a success because he had never been sued. That struck me as a sad commentary on what it means to practice medicine today.

Some of my preconceived ideas on the subject of malpractice were challenged by a recent survey. Medscape asked 3,480 U.S. physicians about their experience with malpractice suits. 60% of responding physicians reported they had never been named in a lawsuit, 31% had been sued in conjunction with other defendants like hospitals, and only 9% were sued as individuals. (more…)

Posted in: Legal

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Evaluating Treatment Claims: A Primer

TrueFalse2

I recently wrote about the claim that acupuncture can improve vision in patients with macular degeneration. In response, I received this e-mail:

At Discovery Eye Foundation we have an education and outreach program for people with age-related macular degeneration, the Macular Degeneration Partnership. We are constantly getting calls from people who have heard of a new “cure” or a way to stop their vision loss. It is always hard to interject reality into the conversation and hear the hope leave their voice, replaced by frustration or despair.

The e-mail suggested I write an article providing guidelines for consumers to help them evaluate the validity of treatment claims for themselves. On SBM we are constantly stressing the need to apply critical thinking to what you read, and the many pitfalls to be avoided. I’ll try to synthesize some of the principles into a handy list of questions. (more…)

Posted in: Science and the Media

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An Egregious Example of Ordering Unnecessary Tests

flabbergasted

Last week I wrote about doctors who order unnecessary tests, and the excuses they give. Then I ran across an example that positively flabbered my gaster. A friend’s 21-year-old son went to a board-certified family physician for a routine physical. This young man is healthy, has no complaints, has no past history of any significant health problems and no family history of any disease. The patient just asked for a routine physical and did not request any tests; the doctor ordered labwork without saying what tests he was ordering, and the patient assumed that it was a routine part of the physical exam. The patient’s insurance paid only $13.09 and informed him that he was responsible for the remaining $3,682.98 (no, that’s not a typo). I have a copy of the Explanation of Benefits: the list of charges ranged from $7.54 to $392 but did not specify which charges were for which test. It listed some of the tests as experimental and not covered at all by the insurance policy, and one test was rejected because there was no prior authorization. (more…)

Posted in: Diagnostic tests & procedures, Science and Medicine

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Why Doctors Order Too Many Tests

While cleaning out some old files, I was delighted to find an article I had clipped and saved 35 years ago: a “Sounding Boards” article from the January 25, 1979 issue of The New England Journal of Medicine. It was written by Joseph E. Hardison, MD, from the Emory University School of Medicine; it addresses the reasons doctors order unnecessary tests, and its title is “To Be Complete.” Today we have many more tests that can be ordered inappropriately and the article is even more pertinent and deserves to be re-cycled. He says,

When challenged and asked to defend their reasons for ordering or performing unnecessary tests and procedures, the reasons given usually fall under one of the following excuses…

(more…)

Posted in: Diagnostic tests & procedures

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Acupuncture for Macular Degeneration: Why I Reject the Evidence

This post is dedicated to two people who are frequent commenters on SBM, Stephen S. Rodrigues and Peter Moran. Rodrigues is an MD/acupuncturist who tries to persuade us that acupuncture is effective. Moran is a retired surgeon who objects to insulting language and thinks more can be accomplished by trying to better understand why people turn to CAM and by explaining the facts and reasons politely and dispassionately. He has claimed that he “could probably help [Rodrigues] understand better why his views are not having much impact.”

I recently wrote about supplements for age-related macular degeneration (AMD). There is evidence that the supplement mixture tested in the AREDS trial slows the progression of moderate to advanced disease. That is based on a good scientific study, although the study has not been replicated and there is reason to interpret its results with caution. Dr. Rodrigues commented with a link to a website advertising the Santa Fe acupuncture protocol, saying that he uses the method in his office and it helps some of his patients with AMD. The website claims that the Santa Fe acupuncture protocol will reverse vision loss from macular degeneration in 4 days or your money back. That is a bold claim. I will try to explain, as politely as possible, why I reject the claim, and why the evidence for it is unacceptable. (more…)

Posted in: Acupuncture, Clinical Trials, Ophthalmology

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Turmeric: Tasty in Curry, Questionable as Medicine

turmericA correspondent asked me to look into the science behind the health claims for turmeric. He had encountered medical professionals “trying to pass turmeric as some sort of magical herb to cure us from the ‘post-industrial chemical apocalypse.’” It is recommended by the usual promoters of CAM: Oz, Weil, Mercola, and the Health Ranger (who conveniently sells his own superior product, Turmeric Gold liquid extract for $17 an ounce).

Turmeric (Cucurma longa) is a plant in the ginger family that is native to southeast India. It is also known as curcumin. The rhizomes are ground into an orange-yellow powder that is used as a spice in Indian cuisine. It has traditionally been used in folk medicine for various indications; and it has now become popular in alternative medicine circles, where it is claimed to be effective in treating a broad spectrum of diseases including cancer, Alzheimer’s, arthritis, and diabetes. One website claims science has proven it to be as effective as 14 drugs, including statins like Lipitor, corticosteroids, antidepressants like Prozac, anti-inflammatories like aspirin and ibuprofen, the chemotherapy drug oxaliplatin, and the diabetes drug metformin. I wish those claims were true, because turmeric is far less expensive and probably much safer than prescription drugs. It clearly has some interesting properties, but the claims go far beyond the actual evidence. (more…)

Posted in: Herbs & Supplements

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Macular Degeneration and AREDS 2 Supplements

What AMD does to vision

What AMD does to vision

Four years ago I wrote about the premature marketing of a diet supplement for macular degeneration before the results of a trial to test it were available. Now that we know the results of that trial, a follow-up post is in order.

Age-related macular degeneration (AMD) is a leading cause of blindness. The incidence increases with age; it affects 10% of people by age 66-74 and 30% of people by age 75-85. There are known risk factors including genetics and smoking, but there is no effective prevention. There are multiple diet supplement products on the market that are advertised as “supporting eye health.” Some are based on evidence from randomized, controlled studies; but the advertising hype goes beyond the evidence and tends to mislead consumers. There is evidence that supplementation may slow the progression of moderate to severe AMD, but there is no evidence that supplements are effective in milder disease or for preventing AMD from developing in the first place. (more…)

Posted in: Clinical Trials, Herbs & Supplements

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