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Tylenol May Not Be As Safe and Effective As We Thought

I’ve always thought of Tylenol (AKA acetaminophen in the US and paracetamol in the UK) as one of the safest drugs around, with essentially no side effects when used as directed. But it has been in the limelight lately. Several SBM articles have addressed it here, here, and here. We know there is a risk of liver damage and death with acetaminophen overdose or accidental ingestion (458 deaths a year in the US). Since it is included in many other products (painkillers, cold and cough remedies, etc.) consumers may not realize how much they’re taking. The FDA has addressed this problem, and reformulations and lower daily dose recommendations are being implemented; but there is still no guarantee that consumers will realize that their “non-aspirin pain reliever,” pain pills like Vicodin, and many cold, sinus, and cough remedies have the same ingredient as Tylenol.

We have gradually become aware of other dangers not associated with overdose. Acetaminophen has been associated with kidney damage (especially with long-term use), gastrointestinal symptoms, and cardiovascular events. Combining the recommended dose with alcohol ingestion can lead to liver failure. It can also interact with some other drugs, for instance isoniazid. Allergic reactions can occur, and 7% of patients who are allergic to aspirin or NSAIDs also react to acetaminophen. It is excreted in breast milk, but in very low concentrations. The manufacturer’s professional product information includes detailed listings of reported reactions, drug/drug interactions, and safety studies in patients with various diseases. There is no need to adjust dosage for the elderly or for those with liver or kidney disease. For most patients, including those with chronic disease, acetaminophen is the pain-reliever of choice due to its low risk. But recently a draft recommendation from the UK’s NICE (National Institute of Health and Care Excellence) has warned us against using it, at least to treat the pain of osteoarthritis. (more…)

Posted in: Pharmaceuticals

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How to Think

Robert Todd Carroll, the author of The Skeptic’s Dictionary, has a new book out: The Critical Thinker’s Dictionary: Biases, Fallacies, and Illusion and what you can do about them. Since some of our commenters and most of the CAM advocates we critique are constantly committing logical fallacies, a survey of logical fallacies is a good idea both for us and for them, and this book fits the bill.

When I received the book in the mail, I set it aside, thinking it would be a somewhat boring listing of things I already knew. When I finally got around to reading it, I was surprised and delighted. It held my interest, reminded me of things I had forgotten, explained other things I had never heard of, and provided entertaining stories to illustrate each point. Best of all, the bulk of his examples are taken from medicine and relate directly to the topics we discuss on SBM.

Carroll is well-qualified to write about logical fallacies: he is a retired professor of philosophy who has long promoted skepticism and taught classes in critical thinking, and he writes in an entertaining, accessible style. He started The Skeptic’s Dictionary website in 1994 with 50 articles and it has now grown to several hundred articles. It attracts more than a million visitors a month, and some of its entries have been translated into more than a dozen languages. It has become a go-to reference for anyone seeking the facts on questionable claims about everything from crop circles to homeopathy. Its articles are thorough and well documented with lots of references and links. (more…)

Posted in: Book & movie reviews, Critical Thinking

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Food for Thought

I am excited to tell you about a wonderful new endeavor that is helping to promote critical thinking about science and medicine. It’s a free online course on “Food for Thought” that offers a scientific framework for understanding food and its impact on health and society from past to present.

The “Food for Thought” course is a product of EdX, which offers online college courses from Harvard, MIT, and other prestigious universities. They provide videos with interactive features and access to online student communities. Students can audit a course and get full access to all the materials including tests, assignments, and discussion forums with no commitment, and can choose what and how much they want to do. (more…)

Posted in: Critical Thinking, Nutrition

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Washington State’s Unconscionable, Unconstitutional Child Protection Law

I recently wrote about the conflict between child protection and the religious freedom of believers in faith healing. That issue has reared its ugly head again in the state of Washington.

Washington law currently denies the children of Christian Scientists equal protection under the law governing child abuse and neglect, and it grants a special exemption from criminal prosecution for abuse and neglect to that one specific religion and not to any others. Even if you supported religious exemptions in principle, there would be no excuse for the preferential treatment of one single religion. This law is clearly unconstitutional. (more…)

Posted in: Faith Healing & Spirituality, Politics and Regulation, Religion

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Top 10 Chiropractic Studies of 2013

ChiroNexus recently listed the top 10 chiropractic studies of 2013. In my experience, chiropractic studies tend to be of poor quality. A media report says “study shows chiropractic works for X,” and when I look for the study it turns out to be a single case report or an uncontrolled study. When Simon Singh was sued by the British Chiropractic Association for saying chiropractic treatment for certain childhood ailments was bogus, the BCA responded with a list of 29 studies they said provided evidence for their claims. Steven Novella showed that out of 29 studies on the list, only 17 actually constituted evidence for 4 clinical claims, and those 17 were poor quality, cherry-picked, and too weak to support the claims. I have a copy of a chiropractic textbook entitled Somatovisceral Aspects of Chiropractic: An Evidence-Based Approach and there is nothing in it that would qualify as credible evidence to a science-based thinker. Chiropractic commenters on SBM have told us that modern chiropractic rejects the “subluxation” paradigm and relies on evidence, and I am always willing to look at new evidence and give chiropractors another chance to convince me that a reform movement is really underway, so I looked up the top 10 studies and read them. I was not impressed.

Note: This is a long article with mind-numbing details that will not be of interest to most readers. Feel free to scroll down to the Summary section. You can just read the bold-faced headings describing the claims of each study on the way down.

Also note: For those who want more detail, the “Study #” headings are links to the full text when available online, or to the PubMed citation.

(more…)

Posted in: Chiropractic

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Tribalism and Medical Ethics

Science is intended to discover the “is”, not the “ought;” facts, not values. Science can’t tell us whether an action is moral; it can only provide evidence to help inform moral decisions. For instance, some people who believe abortion is immoral reject birth control methods that prevent implantation of a fertilized ovum on the grounds that it constitutes abortion; science can determine that a particular birth control method prevents fertilization rather than preventing implantation of a fertilized ovum. A new book, Moral Tribes: Emotion, Reason, and the Gap Between Us and Them, by Joshua Greene, provides some intriguing insights that are pertinent to medical ethics.

He thinks tribalism is the central tragedy of modern life. Evolution equipped us for cooperation within our own tribe but not for cooperation with other tribes. Cooperation with related individuals helps spread our own genes, but we are in competition with other tribes and cooperating with them might help spread their genes to the detriment of our own. It boils down to Us vs. Me and Us vs. Them. He uses the word “tribes” not in the original sense (Hutus vs. Tutsis), but to include Democrats vs. Republicans, Catholics vs. Protestants, CAM vs. science-based medicine, Arabs vs. Israelis, climate change activists vs. climate change deniers, and any other ideological or nationalistic group. (more…)

Posted in: Book & movie reviews, Critical Thinking, Evolution, Medical Ethics

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Vitamin E for Alzheimer’s

Recently you may have seen headlines like “Vitamin E slows decline in patients with mild Alzheimer’s” or “There’s still no cure for Alzheimer’s disease, but the latest hope for slowing its progression is already on drugstore shelves.” They were referring to an article in the January 1, 2014 issue of the Journal of the American Medical Association (JAMA) announcing the results of the TEAM-AD VA Cooperative Randomized Trial of vitamin E and memantine (Namenda) for Alzheimer’s disease (AD).

The study attracted a lot of media attention. Most of the news reports I have seen were accurate and cautious, explaining the nuances of the study rather than suggesting that everyone should run out and buy vitamin E; but I wouldn’t be surprised to learn that a lot of readers ignored the fine print and did just that. It would be interesting to track sales of vitamin E and see if there was a bump following the publicity.

We know of no treatment that will delay, prevent or cure Alzheimer’s disease, or that affects the underlying disease process. It’s a tragic, frustrating disease that takes away the very things that make us who we are: memory and personality. It is affecting more and more people as the numbers of elderly increase. Available prescription medications are only modestly effective in slowing functional decline and delaying the need for institutionalization. They are expensive, they don’t help everyone, and when they do help, they only help for a limited time. It is very exciting to think an inexpensive vitamin could help patients with mild to moderate AD, but we must resist the temptation to read too much into this study. (more…)

Posted in: Clinical Trials, Herbs & Supplements, Neuroscience/Mental Health

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Doctors Are Not “Only Out to Make Money”

There’s an old joke about the doctor whose son graduates from medical school and joins his practice. After a while the son tells his father, “You know old Mrs. Jones? You’ve been treating her rash for years and she never got better. I prescribed a new steroid cream and her rash is gone!” The father responds, “You idiot! That rash put you through medical school.”

That’s a joke. It doesn’t reflect reality, but it reinforces a common misconception that doctors care more about their own income than about their patient’s outcome. That accusation is demonstrably untrue.

I’m sick and tired of all the doctor-bashing. They accuse us of being shills for Big Pharma. They say “Doctors are only out to make money.” Or “Doctors are greedy bastards only interested in the bottom line.” Or as one of our commenters recently put it: “First do no harm. Second ? Third, profit [sic]” Some have even made the ridiculous accusation that doctors have found the cure for cancer but have suppressed the information so as to keep people sick and increase their business. If profit were really their primary motivation, doctors would have to be astoundingly clueless, because they keep doing things that are guaranteed to reduce their profits. (more…)

Posted in: Science and Medicine

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Garcinia Probably Works But Is Far From a Weight Loss Miracle

Women make up a majority of Dr. Oz’s audience. The majority of women would like to lose weight. That is a match made in heaven, a marketer’s dream. And Oz has never hesitated to exploit that fact to increase audience share, playing fast and loose with sensationalized evidence instead of giving his viewers science-based advice.Garcinia

Dr. Oz has promoted a series of weight loss supplements on his show. Raspberry ketones were presented as a fat-busting miracle, then green coffee bean extract was touted as “magic,” “staggering,” and “unprecedented.” And now both of those miracles have apparently been superseded by an even greater miracle: Garcinia cambogia extract.

Dr. Oz calls it “The newest, fastest fat buster.” A way to lose weight without “spending every waking moment exercising and dieting.” “Triples your weight loss.” “The most exciting breakthrough in natural weight loss to date.” “The Holy Grail.” Oz claims that “Revolutionary new research says it could be the magic ingredient that lets you lose weight without diet or exercise.” That sounds too good to be true, and it is. Garcinia probably does work to some extent to improve weight loss, but the evidence doesn’t begin to justify such grandiose claims. (more…)

Posted in: Herbs & Supplements, Science and the Media

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And Now for Something Completely Different

This will be a departure from my usual posts. Several announcements in the news and medical journals have caught my attention recently, and as I delved into the details, I thought I would share them with our SBM readers. Topics include AIDS cures, the continuing danger of polio, eating nuts for longevity, racial differences in vitamin D, and the use of pharmacogenetic testing to guide the dosage of anticoagulant drugs. They are all examples of science-based medicine in action.

Have patients been cured of AIDS?

I read that the HIV virus had returned in patients thought to have been cured by bone marrow transplants, and I mistakenly thought they were referring to the original claim of cure I had read about. Nope, that one still stands. (more…)

Posted in: Clinical Trials, Nutrition, Pharmaceuticals, Vaccines

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