In the past I have criticized evolutionary medicine for its tendency to rely on unverifiable “Just-So Stories,” but a new book has helped me appreciate what the best kind of evolutionary thinking can contribute to our understanding of medicine. Doves, Diplomats, and Diabetes: A Darwinian Interpretation of Type 2 Diabetes and Related Disorders by Milind Watve investigates diabetes from an evolutionary perspective, suggesting how it might have originated, why it persisted, and how it is related to survival advantages. Watve develops well-reasoned hypotheses that can be tested by examining their expected consequences. He believes it is impossible to understand metabolism without understanding behavioral ecology, and he makes a good case.
A reassessment of the evidence concerning Type II diabetes (T2D) reveals a number of paradoxes. Elevated blood glucose is the defining feature of T2D but controlling it doesn’t prevent all the complications of diabetes, and it doesn’t appear that elevated blood sugar could produce all the pathological changes of diabetes. Insulin resistance is believed to be central to a cluster of deadly diseases in humans, but in other animals it has no adverse effects on health and even increases lifespan. Studying diabetes from an evolutionary perspective can shed light on such paradoxes. (more…)
I write about a lot of depressing subjects, and sometimes a change of pace is welcome. Mary Roach, billed as “America’s funniest science writer,” has followed up on her earlier explorations of cadavers (Stiff), sex (Bonk), the afterlife (Spook), and survival on spaceships (Packing for Mars) with a new book entitled Gulp: Adventures on the Alimentary Canal.
Forget all that mythology about diet, detoxification, and 10-year-old hamburger accretions in the bowel. The reality of human digestive physiology is far more interesting and has the extra-added attraction of being true. And in Roach’s hands, often howlingly funny. She is a hands-on investigative reporter who is ready to try anything; among other adventures she inserts her entire arm in a cow’s stomach. Her highly entertaining odyssey takes her to Igloolik to eat narwhal skin, to a dog food tasting lab in Missouri, to Minnesota to observe a fecal transplant, and to strange and exotic outposts at the cutting edge of science, populated by colorful characters. (more…)
For many years I have been using Continuing Medical Education (CME) programs offered by the American Academy of Family Physicians (AAFP). The FP Essentials program consists of a monthly monograph with a post-test that can be submitted electronically for 5 hours of CME credit. Over a 9-year cycle, a complete family medicine curriculum is covered to prepare participants for the re-certification board exams. Some examples of typical subjects are skin cancer, hand and wrist injuries, valvular heart disease, and care of the newborn. I rely on these programs to learn, review, and keep up-to-date in my specialty. Imagine my dismay when I opened the latest package to find a monograph on Integrative Medicine.
First it was called various names like folk medicine, quackery, and unproven/untested treatments, then all of those (the less rational right along with the more rational) were lumped together under the umbrella term “Alternative Medicine,” then it became “Complementary and Alternative Medicine” (CAM), and now it has been re-branded as “Integrative Medicine.” The term is designed to make unscientific treatments seem more acceptable to science-based doctors. “Integrative Medicine” is a marketing term, not a meaningful scientific category. It is a euphemism for combining Complementary and Alternative Medicine (CAM) with mainstream medical practice, unproven with proven, magic with science. It has been critiqued many times on this blog. We have stressed that there is only one medicine, and that when a treatment is proven to work by good evidence, it is just “medicine.” When the evidence for a CAM treatment is not good, it essentially amounts to experimental treatments and/or comfort measures. Worse, sometimes CAM even persists in using treatments that have been proven not to work or that are totally implausible, like therapeutic touch or homeopathy. (more…)
Chronic Lyme disease almost certainly does not exist, but a growing number of doctors are diagnosing and treating it with long-term antibiotics and other remedies. They are known as LLMDs (“Lyme Literate” medical doctors). This subject has been covered repeatedly on Science-Based Medicine, here, here, here, here, and elsewhere.
I have a correspondent who joined a Yahoo group for Lyme disease (Northern VA Lyme). She shared with me a message to that group that listed the LLMDs in their area. On that list was Patricia Slusher, ND, CN (naturopath, certified nutritionist). Other messages confirmed that Slusher is treating patients for “chronic Lyme disease.” One message specifically described the treatments prescribed by Patricia Slusher:
For the first 3 weeks my Lyme protocol consist of taking 3 supplements from Percision [sic] Herbs, LLC; LYX, Spirex and Puricell and spending 30 minutes 2X a week getting a Quad Zapper treatment. After the 3 weeks, my test for Lyme was negative. But bartonella was still positive. She has changed my supplements to taking Drainage-tone and Amoeba-chord by energetix and 15 minutes 1x a week of the Quad Zapper to fight the bartonella. I have doing [sic] this protocol for approx. 3 weeks. Along with this protocol I am on several other homeopathic supplements to address some of my symptoms, swollen lymph nodes, nerve pain (feels like someone is stabbing me with an ice pick or bugs crawling on me), numbness, inflammation, low vitamin D, etc. Also, supplements to raise the functioning level of my adrenals and kidneys. [Note: the Quad Zapper is a version of one of the infamous (more…)
Daniel Amen loves SPECT scans (Single Photon Emission Computed Tomography). And well he should. They have brought him fame and fortune. They have rewarded him with a chain of Amen Clinics, a presence on PBS, lucrative speaking engagements, a $4.8 million mansion overlooking the Pacific Ocean, and a line of products including books, videos and diet supplements (“nutraceuticals”). He grossed $20 million last year. Amen is a psychiatrist who charges patients $3,500 to take pretty colored SPECT pictures of their brains as an aid to the diagnosis and treatment of conditions including brain trauma, attention-deficit hyperactivity disorder (ADHD), addictions, anxiety, depression, dementia, and obesity. He even does SPECT scans as a part of marriage counseling and for general brain health checkups.
SPECT imaging uses an injected radioisotope to measure blood flow in different areas of the brain. Amen is exposing patients to radiation and charging them big bucks because his personal experience has convinced him SPECT is useful. So far, he has failed to convince the rest of the scientific medical community.
Amen has just published an article in the journal Alternative Therapies entitled “It’s Time to Stop Flying Blind: How Not Looking at the Brain leads to Missed Diagnoses, Failed Treatments, and Dangerous Behaviors.” It amounts to poorly-reasoned apologetics with false analogies, testimonials, and pretty pictures that don’t prove what he thinks they prove. (more…)
The principles we espouse on Science-Based Medicine are vitally important, but some of the subjects we address are not so important in the big scheme of things. Homeopathy and electrodermal diagnostic devices don’t actually harm very many people. For today’s post, I’m going to follow the Willie Sutton rule and go where the money is, so to speak.
Smoking is the leading preventable cause of death. No prospective double blind randomized controlled studies have been done, or ever could be done; but a mountain of evidence converging from many avenues has established the health dangers of smoking beyond any doubt. Hill’s criteria of causation have been amply fulfilled. Smoking causes 90% of all deaths from lung cancer and chronic obstructive pulmonary disease (COPD). It increases the risk of coronary heart disease, stroke, several types of cancer, infertility, stillbirth, sudden infant death syndrome (SIDS), osteoporosis, and premature skin aging (wrinkles). The dangers of second-hand smoke have been amply documented, and where smoke-free laws have been passed there has been a drop in the incidence of heart attacks and of emergency room visits for children with asthma.
Two new studies published in The New England Journal of Medicine reinforce what we already knew and offer both good news and bad news. (more…)
Electrodermal testing is a bogus procedure where measurements of skin conductance with a biofeedback device are entered into a computer to diagnose nonexistent health problems and “energy imbalances” and to recommend treatments for them, often involving the sale of homeopathic remedies and other useless products. It falls under the general category of EAV (Electro Acupuncture of Voll). The history and variants of EAV are explained in an article on Quackwatch.
I’ve written about electrodermal testing before. I’ve explained how it amounts to fooling patients with a computerized Magic 8 Ball and I’ve discussed the legal and regulatory issues.
Now Stephen Barrett (founder of Quackwatch and Vice-President of the Institute for Science in Medicine) has written an article in FACT (Focus on Alternative and Complementary Therapies) entitled “Bogus electrodermal testing devices: where are the regulators?” He points out that existing regulations are sufficient to ban these devices, but that regulators have failed to take appropriate action.
Many SBM readers will remember the late, great Barry Beyerstein, a luminary of the skeptical movement and author of a classic article that has been cited many times on SBM, an explanation of why bogus therapies seem to work.
One of his greatest personal accomplishments is not as well known: he produced an exceptional daughter, Lindsay Beyerstein, a freelance writer, philosopher, and polymath who stepped into her father’s shoes as a faculty member of the annual Skeptic’s Toolbox workshop after his death and has done a truly admirable job there.
Among Lindsay’s many other activities, she works for the Sidney Hillman Foundation, a nonprofit that honors excellence in socially conscious journalism. One of her goals has been to reward excellence in science journalism. Bob Ortega has just received a Sidney Award for his exposé of a widely used HPV (human papillomavirus) test that is not FDA approved and has an unacceptably high rate of false negative results. Her interview with him was published on the Hillman Foundation website. On SBM, we frequently criticize journalists who get the science wrong. For a change, I’d like to congratulate Mr. Ortega for not only getting the science right, but for accomplishing something that could potentially save lives.
I wore a T-shirt at The Amazing Meeting 2012 that generated a lot of controversy. You can see a picture of it on my Wikipedia article. I didn’t want to talk about the T-shirt, but I’ve been repeatedly challenged to explain myself, and I’m afraid I can no longer avoid it. Steven Novella has recommended that we try to give other people’s arguments the most charitable interpretation. I hope my critics will do that, but I’m not optimistic. If past experience is any guide, they will misinterpret my explanation and put it in the worst possible light, which is why I haven’t offered it before. So be it; I have a tough skin. Once this T-shirt explanation is out of the way, I will have done my duty and had my say and will feel free to ignore all these divisive and nonproductive arguments. I don’t plan to write about gender or feminism or the squabbles in the skeptic movement again.
First, a brief digression about charitable interpretations and the whole “queer” discussion. I said “most” people in the LGBT community find the term offensive. Instead of attacking me as totally clueless, a charitable reader might have gently corrected me by providing quantitative evidence that the majority of people in the LGBT community do not find the word offensive (so far, no one has provided such evidence). When shown quantitative evidence, I would gladly have changed the word “most” to “many” or “some” or even “a few,” depending on the actual numbers, and we would all have learned something. What actually happened served as a perfect illustration of the points I made in my “Enemies” article. The ensuing discussion was bizarre, nit-picking, surreal, divisive, unproductive, and failed to emphasize the one thing we ought to all agree on: we don’t want to use labels that others find offensive. The silly quibbling about my use of the one word “most” just derailed the discussion from the more important issues, and from all the other words in my post.
To set the scene for the T-shirt incident, there was a complex backstory involving Elevatorgate, Richards Dawkins, insults and threats directed at women, a perception that TAM’s anti-harassment policy was not being enforced, objections to a statement JREF President DJ Grothe made, accusations that Grothe had lied about reports of harassment, and numerous other incidents, many of which were blown way out of proportion. All this had left big chips firmly glued to shoulders. (more…)
Note: The previous post is my usual weekly contribution to SBM. I am taking the liberty of posting this additional entry today on an issue that is peripheral to Science Based Medicine. If you are not interested in the recent squabbles within the skeptical movement, you will probably want to skip it. But it does respond to a detailed critique of an article I posted here two weeks ago, and some might find that of interest. We have seen the same kind of behavior on this blog, where commenters have responded not to what we said, but to what they wanted to believe we said.
I have been falsely identified as an enemy of feminism (not in so many words, but the intent is clear). My words have been misrepresented as sexist and misinterpreted beyond recognition. I find this particularly disturbing and hard to understand, because I’m convinced that my harshest critics and I are basically arguing for exactly the same things. I wish my critics could set aside their resentments and realize that I am not the enemy.
Two weeks ago I published an article on gender differences and the recent divisions in the skeptical community. Ophelia Benson showed up in the comments. Not unsurprisingly, she disagreed with me about the Shermer incident, but then she said “I like the rest of this article a lot. I particularly like the point about averages and individuals, which is one I make all the time.”
I took that as a hopeful sign that friendly communication might be achieved, but my bubble was quickly burst by a hostile takedown of my article on Skepchick by “Will.” His critique is demonstrably unfair. He attacks me for things I never said and tries to make it look like I believe the exact opposite of what I believe.