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Answering Our Critics, Part 2 of 2: What’s the Harm?

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…)

Posted in: Medical Ethics, Science and Medicine

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Answering Our Critics, Part 1 of 2

Some people don’t like what we have to say on Science-Based Medicine. Some attack specific points while others attack our whole approach. Every mention of complementary and alternative medicine (CAM) elicits protests in the Comments section from “true believer” users and practitioners of CAM. Every mention of a treatment that has been disproven or has not been properly tested elicits testimonials from people who claim to have experienced miraculous benefits from that treatment. In previous articles I have compiled the criticisms of what I wrote about Protandim and Isagenix. It’s instructive to read through them. We welcome rational and substantive criticism, but most of these comments are neither.

Our critics keep bringing up the same old memes, and it occurred to me that rather than try to answer them each time, it might be useful to list those criticisms and answer them here. In future, when the same points are raised, we could save time and effort by linking to this page and citing the reference number. I know this list is not comprehensive, and I hope our readers will point out anything I’ve omitted. Here are some of the criticisms we keep hearing:

1. Big Pharma is paying you to promote their products and discredit CAM.

No it isn’t. We are not Pharma shills. We are not paid anything for writing this blog. We do not get money from pharmaceutical companies. We do not accept gifts from drug companies. We do not get kickbacks for prescribing certain drugs. We have no incentive to favor drugs over other treatments. Incidentally, critics who prefer natural remedies to pharmaceuticals should note that many CAM diet supplements are sold by subsidiaries of Big Pharma. (more…)

Posted in: Science and Medicine

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Baby’s DNA in Mom’s Blood: Noninvasive Prenatal Testing

Until recently, the moment of birth was a surprise. We anxiously awaited the obstetrician’s announcement: “It’s a boy!” or “It’s a girl!” Then we checked to see if any crucial parts were missing and we counted the fingers and toes. We had to wait for a baby to be born before we could know its sex and whether it was normal. Today, thanks to prenatal testing, we can know the sex of a fetus, diagnose a number of genetic abnormalities and malformations, and we can even operate on the fetus in utero to correct certain problems before birth. I had amniocentesis for my two pregnancies because of the higher risk of Down syndrome at my age (37 and 39). It was reassuring to know the baby didn’t have Down syndrome, and it was fun for my husband to point to my burgeoning belly and introduce it to people as “our daughter Kristin.”

Amniocentesis is invasive, carries risks, and can’t be done until the 15th to 20th week of pregnancy. Now there is a safe, noninvasive, accurate blood test that can be done as early as the 9th week. It analyzes cell-free fetal DNA (cfDNA) circulating in the mother’s blood. It sounds ideal, but there are some caveats. It’s not yet appropriate to recommend it to all pregnant women. An editorial in The New England Journal of Medicine expressed concern that pressures are promoting diffusion of cfDNA testing beyond the boundaries of available evidence. (more…)

Posted in: Diagnostic tests & procedures, Obstetrics & gynecology

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What Can We Learn from the Kitavans?

A Swedish researcher, Staffan Lindeberg, has been studying the inhabitants of Kitava, one of the Trobriand Islands of Papua New Guinea. He claims that sudden cardiac death, stroke, and exertion-related chest pain never occur in Kitava; and he attributes this to their eating a Paleolithic diet.

2,250 people live on Kitava. They are traditional farmers. Their dietary staples are tubers (yam, sweet potato and taro), fruit, fish, and coconut. They don’t use dairy products, alcohol, coffee, or tea. Their intake of oils, margarine, cereals, and sugar is negligible. Western foods constitute less than 1% of their diet. Their activity level is only slightly higher than in Western populations. 80% of them smoke daily and an unspecified number of them chew betel. The macronutrient composition of the Kitavan diet was estimated as 21% of total calories from fat, 17% from saturated fat, 10% from protein, and 69% from carbohydrates.

Lindeberg’s Kitava study examined a sample of 220 Kitavans aged 14-87 and compared them to healthy Swedish populations. They found substantially lower diastolic blood pressure, body mass index, and triceps skinfold thickness in the Kitavans. Systolic blood pressure was lower in Kitava than in Sweden for men over 20 and women over 60. Total cholesterol, LDL cholesterol, and apolipoprotein B were lower in men over 40 and in women over 60. Triglycerides were higher in Kitavans aged 20-39 than in Swedes of the same age. HDL was not significantly different. (more…)

Posted in: Nutrition

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Does Everybody Have Chronic Lyme Disease? Does Anyone?

A deplorable article by Suzy Cohen on Huffington Post is titled “Feel Bad? It Could Be Lyme Unless Proven Otherwise.” It consists of irresponsible fear-mongering about a nonexistent disease. A science-based article would be titled “Feel Bad? It Couldn’t Be Chronic Lyme Disease Because CLD Is Nonexistent Until Proven Otherwise.”

Cohen says:

People often attribute uncomfortable symptoms to aging, stress, or the “aches and pains of daily living,” especially if blood tests and body scans are normal. What if you have Lyme and don’t know it? If you’ve ever been for a walk in the woods, laid in the grass, live in or visited a Lyme-endemic area, or have a pet cat or dog, you may have exposed yourself to Lyme disease and associated co-infections. There is even the possibility of contracting Lyme if you were born to a mother who has been exposed. Tick born infections can also be transmitted from blood transfusions.

That pretty much covers everyone. Who hasn’t been for a walk in the woods, lain down on the lawn, or had a pet? (And incidentally, are there no editors or proofreaders at HuffPo who realize that the past participle of lie is lain and that infections are tick-borne, not tick born?) (more…)

Posted in: Diagnostic tests & procedures, Science and Medicine

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Cranial Manipulation and Tooth Fairy Science

Tooth Fairy Science is science that studies a phenomenon that doesn’t exist. You can do studies on the Tooth Fairy; for instance, comparing how much money she leaves to kids in different socioeconomic groups. You can do studies on the memory of homeopathic water. You can do studies on the therapeutic effects of smoothing out wrinkles in the imaginary human energy field with therapeutic touch. Or you can do studies of craniosacral therapy. “Therapeutic Effects of Cranial Osteopathic Manipulative Medicine: A Systematic Review,” by Jakel and Hauenschild, was published 2011 in the Journal of the American Osteopathic Medical Association. It is a perfect example of Tooth Fairy Science.

In the 1930s, William G. Sutherland, DO looked at a disarticulated skull and noticed that the sutures were beveled, like the gills of a fish. He concluded that this indicated articular mobility for a respiratory mechanism. He invented cranial osteopathic manipulation to allegedly move the bones of the skull relative to each other for therapeutic benefit.

In the 1970s, John E. Upledger developed this idea further, inventing craniosacral therapy (CST). It postulates rhythmic fluctuations of the cerebrospinal fluid (CSF), mobility of the cranial bones and dural membranes, and involuntary motion of the sacrum. The CST practitioner palpates the skull, senses pulsations transmitted to the skull by the CSF, gently moves the skull bones relative to each other, and thereby releases restrictions to the flow of CSF, which somehow restores health in an astounding variety of human illnesses. (more…)

Posted in: Energy Medicine

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Brainwashed: Neuroscience and Its Perversions

Sally Satel and Scott Lilienfeld have written a new book, Brainwashed: The Seductive Appeal of Mindless Neuroscience. Its purpose is not to critique neuroscience, but to expose and protest its mindless oversimplification, interpretive license, and premature application in the legal, commercial, clinical, and philosophical domains.

The brain is a wondrous thing: “…the three pound universe between our ears has more connections than there are stars in the Milky Way.” Trying to understand how it works and how it generates conscious awareness and subjective feelings is a daunting task. Neuroimaging is one of the tools we are using to study it. Unfortunately, people get so enthusiastic about its possibilities that they are constantly tempted to read more into the images than is really there. This has given rise to a new phrenology that interprets our mental characteristics with pretty colored pictures. We are easily impressed by pictures; after all, a picture is worth a thousand words.

Brain imaging can’t show us what is going on in the mind of the person. It shows areas that have increased oxygen consumption. A spot lights up when a person thinks or acts, but that doesn’t tell us much. Single blobs that light up in the brain have been interpreted as centers for things like love, rewards, hate, and belief in God. This is sometimes referred to as “blobology.” They found an area in one person that lit up when he thought about an actress he loved. That area was thought to be a “reward” center. But it also lit up when he thought of Ahmadinejad! So they did some fancy footwork and rationalized that he believed that the Jewish people would endure and therefore he derived pleasure from the idea that Ahmadinejad would fail. That’s pretty far-fetched. Occam’s razor would suggest that maybe the area that lit up was reacting not to pleasure, but to something else. People tend to read what they want to see into ambiguous patterns like a Rorschach test. Mental functions are rarely limited to a single spot in the brain; multiple areas are involved and interconnected. Researchers are increasingly moving away from blobology and towards pattern analysis where they look at the patterns of activation across the entire brain. (more…)

Posted in: Book & movie reviews, Neuroscience/Mental Health

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Homeopathy First Aid Kits

Homeopathy first aid kit

I don’t know how I missed them, but somehow homeopathic first aid kits had not registered on my radar. They’re readily available. Even Amazon.com sells them, for $54.99. They contain 18 vials of tiny sugar pills, all with potencies of 200C, guaranteed by Avogadro not to contain a single molecule of the active ingredient. (For those of you who may not know, Avogadro was the Italian scientist who discovered the Avogadro constant, the number of atoms needed such that the number of grams of a substance equals the atomic mass of the substance.

If that paralyzes your brain, never mind. Just take my word for it that Avogadro’s discovery allows us to calculate that a 13C dilution (a 1 in 100 to the 13th power dilution), is the equivalent of diluting 1/3 of a drop of the original substance in all the water on earth, and to reach a 200C potency you would have to continue to dilute it by 1 to 100 a total of 187 more times.)

What’s in the kits?

On homeopathy websites you can buy special first aid kits for the car, for hiking and camping, for horses, for pets, for pregnancy, for childbirth, and for travel. One website sells a first aid kit that “contains all the major homeopathic first aid remedies which work so amazingly well particularly when given immediately after an accident or injury.” Only $99.95, but you’re also advised to buy a book to explain its use, for an additional $18.95. It contains 15 remedies in a 30C potency:
(more…)

Posted in: Homeopathy

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Cunnilingus, Michael Douglas’s Cancer, and the HPV Vaccine

Conservative Christians are calling for banning oral and anal sex between consenting adults, claiming that the practices allow for the spread of disease. Radio host Brian Fischer says that a rise in head, neck and throat cancers “among millennials” is a direct result of the influence of “Bill Clinton and Monica Lewinsky.” He compares oral sex and homosexual sex to drug trafficking, pedophilia and bestiality. He hasn’t decided how offenders should be punished but he suggests either issuing summonses like parking tickets or putting them into programs akin to drug rehab. He says Liz Cheney (the daughter of former Vice President Cheney) is “not a patriot” because she may support gay marriage.

Those of us who want the government to stay the hell out of our bedrooms will gladly ignore such rants, but the health risks of sexual practices are real. Michael Douglas recently shocked the world by announcing that cunnilingus could have caused his throat cancer. He was right, it could have.

HPV causes several kinds of cancer

Most head and neck cancers are caused by tobacco and alcohol, but researchers believe that up to 80% of oropharyngeal cancers are due to HPV (human papilloma virus) infection. The cause can be confirmed by testing biopsy samples for HPV DNA. The incidence of throat cancer caused by HPV is rising rapidly (a 225% increase from 1988 to 2004) and has been attributed to an increase in oral sex. It is estimated that by 2020 HPV will cause more oropharyngeal cancers than cervical cancers in the US. (more…)

Posted in: Cancer, Vaccines

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What Doctors Feel

Doctors are often accused of being unfeeling technicians who treat their patients like cases of disease rather than people (think Dr. House). We were taught in medical school to remain detached, not get too close to patients, and not show our emotions. That attitude was epitomized in William Osler’s essay Aequanimitas. But doctors have feelings like anyone else, and no one is Spockishly rational. A patient might reasonably say “I don’t give a damn how my doctor feels as long as she gets me better,” but emotions affect everything we do, influencing clinical decisions and patient outcomes. This subject is investigated in a new book, What Doctors Feel: How Emotions Affect the Practice of Medicine, by Danielle Ofri, MD, PhD, an associate professor of medicine and an accomplished writer who has written extensively about her experiences in medicine.

She tells anecdotes from her training to give the reader a feel for what it was like to be in an extremely stressful situation with time pressure, conflicting duties, lack of sleep, life-or-death responsibilities, the highest expectations, and the impossibility of both getting everything done and doing each thing well. It reminded me of times in my own training when I desperately wanted to just somehow survive the day and not kill anyone. Medical residency can be almost as stressful as a war zone, and has its own PTSD victims, complete with flashbacks.

Part of the stress is being suddenly immersed in a new culture with its own tribal customs, slang, in-jokes, and a foreign language: “82WM w/PMH of CAD, CVA, MIx2, s/p 3V-CABG, c/o CP, SOB 2 wks PTA. BIBA s/p LOC. No F/C/N/V/D.” (more…)

Posted in: Book & movie reviews

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