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Placebo Speculations

From the Wikimedia Commons.

From the Wikimedia Commons.

 

I have a new term to add to the English language, ebolasmacked, a derivative of the British term gobsmacked. Ebolasmacked defines my life the last few weeks since Ebola, or at last preparations for Ebola, have taken a huge bite out of my time with many interesting twists and turns. I think this is maybe the 9th outbreak (HIV, MERS, SARS, Legionella, H1N1, Avian flu, West Nile, MRSA) of my career and it has certainly generated more hysteria relative to the risk than any to date. Many of my usual pastimes, like SBM (as this essay will no doubt demonstrate), have had to take a back seat to preparing for what should be a very unlikely, but very disruptive, event. We do not want to get caught with our hazmats down should a case of Ebola come through the door.

What makes life interesting, among other things, is the constant realization that the more you know the more there is to know. I like Richard Dawkins’ metaphor in Climbing Mount Improbable where he pictures scientific progress as a series of false summits extending into infinity. It sure seems that way. Every time I think I understand a topic, I find there is still more to learn.

My Dad told me when I graduated from medical school that half of everything I had just learned was probably not true, the only problem is that you didn’t know which half. It was partially true. There have been ideas that have been abandoned since I was an intern, the most famous being that ulcers were due to stress and diet. But a new paradigm has been the exception, not the rule.

The last thirty years have been more about refining knowledge about the complexity of disease and its treatment and, perhaps equally importantly, having a better understanding of the all slings and arrows of outrageous fortune that can make the results of a clinical trial suspect. (more…)

Posted in: Acupuncture, Basic Science, Science and Medicine

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Chaperones Needed

I receive a monthly newsletter from my medical board. Among other issues discussed are the results of disciplinary actions for physicians. Occasionally a physician who has boundary issues is required to have a chaperone present when doing exams.

I was thinking that the concept of a chaperone could be more widely applicable. Consider “You Docs: Amazing acupuncture,” the latest from Drs Oz and Roizen. Both are Professors at their respective institutions. Professors. To judge from the ability to read and interpret the medical literature, both should not be allowed near a journal without a chaperone to remind them about cognitive biases, logical fallacies and what constitutes a good clinical study. Looking at their recent review of acupuncture suggests they lack an understanding of all three.

They start with the argument from antiquity, which is not only wrong as a logical fallacy, it is wrong historically when they say:

acupuncture has been a go-to therapy for 5,000 years.

Off by a factor of about 500. They are unaware that acupuncture as currently practiced is relatively new, having been a form of bloodletting until recently when the modern version with steel needlesbecame popular under Mao.

However, in the early 1930s a Chinese pediatrician by the name of Cheng Dan’an (承淡安, 1899-1957) proposed that needling therapy should be resurrected because its actions could potentially be explained by neurology. He therefore repositioned the points towards nerve pathways and away from blood vessels-where they were previously used for bloodletting.

They explain the mechanism of action as stimulating

points in the body that affect chi or qi, the life energy.

without noting that chi or qi is a fantasy. No life energy has ever been measured and virtually every point on the body is an acupoint in one of the multiplicity of styles that are acupunctures. Except, as mentioned in the past, the genitals.
(more…)

Posted in: Acupuncture, Science and Medicine, Science and the Media

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Rationalizing the Ridiculous

410px-Chinese_barefoot_doctor_performing_acupuncture

Pictured: Cutting-edge medicine

I remain flummoxed. How do physicians and health care systems, trained in all the sciences that lie at the heart of medicine, justify the use of pseudo-medical interventions with no basis in reality? Rationalization. Making excuses:

a defense mechanism in which controversial behaviors or feelings are justified and explained in a seemingly rational or logical manner to avoid the true explanation, and are made consciously tolerable – or even admirable and superior – by plausible means.

Rationalization of the ridiculous comes in many forms. It has been said that it is a mark of a first rate intelligence to able to hold two contradictory ideas in the mind at the same time and still retain the ability to function. Clever as it is, I suspect the opposite is true. (more…)

Posted in: Acupuncture, Naturopathy, Science and Medicine

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Ebola SCAMs

ebola-virus

Click to embiggen. Transmission electron micrograph of an Ebola viral particle, by Dr. Frederick Murphy (1976), from the Centers for Disease Control and Prevention’s Public Health Image Library (PHIL), with ID #1833.

Ebola, like all diseases, is an opportunity for some to offer up curious treatments. Here is a brief budget of Ebola-related SCAM (supplements, complementary and alternative medicine) and a few Dug the Dog digressions.

Homeopathy

Reality seems valueless by comparison with the dreams of fevered imaginations; reality is therefore abandoned. ~ Emile Durkheim. Homeopath?

In its classic form, as promulgated by Hahnemann, homeopathy is divorced from the modern understanding of medical and chemical reality. I can cut Hahnemann a little slack since he came up with his fictions at the end of the 18th century. But I would think that even a modest understanding of chemistry and physiology would suggest that homeopathy is 100% pure bunkum. But homeopaths are nothing if not inventive. Since Hahnemann’s time they have come up with a remarkable number of variations on their nonsense. The motto “you are only limited by your imagination” must have had homeopaths in mind and they have fevered imaginations. Who knows what they could invent if they only had a box. There are nosodes, the homeopaths answer to vaccines. Of course, it is an answer that would be wrong on any reality-based exam. Nosodes are the vaccines of the homeopathic world, only without efficacy. I have written about nosodes in the past.

[A nosode] is a homeopathic remedy prepared from a pathological specimen. The specimen is taken from a diseased animal or person and may consist of saliva, pus, urine, blood, or diseased tissue.

and they are usually diluted to between 30 and 300 C. (more…)

Posted in: Energy Medicine, Homeopathy, Science and Medicine

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That’s so Chiropractic

Alien autopsy (Wikimedia Commons), by Flickr user Jim Trottier

Alien autopsy (Wikimedia Commons), by Flickr user Jim Trottier

Old bad studies: Fantastical autopsy results

I found the following quote at “Chiropractic care can treat more than just bad backs” (FYI. Chiropractic can’t):

Luse references a study published in The Medical Times authored by Dr. Henry Windsor [sic], M.D. that showcases the correlation of spinal health to overall wellness. Windsor dissected 75 human cadavers to investigate their causes of death. The study showed that 138 of the 139 diseases of the internal organs that were present were in connection to the misalignments of the vertebrae.

But I was intrigued. So I went to the video tape. Well, the PDF.

It is an interesting read by a physician who was looking for an association between curvature of the spine and visceral pathology.

He had 50 corpses, age unknown, that he dissected, looked at the spine for curvature and then looked for pathology in organs in the same distribution of sympathetic nervous system as the level of the spine curvature.
(more…)

Posted in: Chiropractic, Clinical Trials, Energy Medicine, Science and Medicine

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Yet another plague panic


Case #3 from the 1976 Ebola outbreak in Zaire; picture by Dr. Lyle Conrad, Centers for Disease Control – Centers for Disease Control and Prevention’s Public Health Image Library (PHIL), with identification number #7042.

This image is in the public domain and thus free of any copyright restrictions. As a matter of courtesy the CDC requests that the content provider be credited and notified in any public or private usage of this image. Taken from the Wikimedia Commons.

Thirty plus years in medicine has given me some perspective as has infectious diseases (ID). One of the almost TNTC cool things about ID is that infections, unlike the diseases of modernity, have been plaguing humans since before we were humans.

There is a sense, a usually unvoiced assumption, on the part of many people that we are supposed to be healthy, that our default mode is good health and that with the proper diet and attitude we could obtain the health that was ours before the fall.

I think not. I see no perfection in any human, except maybe my wife who would achieve perfection if only she liked beer and steak.

We are a hodgepodge of anatomic and physiologic compromises that allowed us to spread across the world. But if you like to read history, you realize that most of the time we died like flies from infections, trauma and other medical problems. The variations that allowed us to survive malaria or tuberculosis led to sickle crises and the metabolic syndrome. Even with evolution no good mutation ever goes unpunished. (more…)

Posted in: Homeopathy

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Why People Continue to use SCAMs

Rodin's The Thinker
I remain curious as to why people use, and continue to use, useless pseudo-medicines. I read the literature, but I find the papers unsatisfactory. They seem incomplete, and I suspect there are as many reasons people choose a pseudo-medicine as those use them.

There are numerous surveys on what SCAMs people use. Designing and offering these surveys to every possible medical condition is a growth industry: the old, the young, cancer patients, AIDS patients. All need be asked which SCAM they use. It seems to be a ready way to get a quick entry in your CV, but which SCAM is used does not speak to the why a particular SCAM is being used. Why try acupunctures, say, instead of reflexology?

There are numerous reasons suggested for why people partake of SCAMS as a general concept: dissatisfaction with standard medical care is a common one but is not always supported in the literature. Gullibility, ignorance, and stupidity are often credited, none of them are particularly valid. Dr. Novella covered the topic in 2012. There is some data to suggest that which SCAM and why is a moving target, changing over time. (more…)

Posted in: Basic Science, Critical Thinking

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The Truth?

Facepalm
Summertime and the living is easy. I am in Sunriver, Oregon for the week and I though, hilariously, that I would have plenty of time to write a post. Between the hiking, the biking, the golf, the food and the beer, there has been little time to sit in from of a keyboard. There may be no better place to spend a week if you like the outdoors, but they do not have internet on the hike around Paulia Lake. So while a caramel banana cake bakes for a dinner tonight, I have an hour or so churn out a post. Do not expect much.

One person’s ethics is another’s belly laugh, but in medicine ethics are formalized. The basic principles in the US are

  • Respect for autonomy – the patient has the right to refuse or choose their treatment (Voluntas aegroti suprema lex)
  • Beneficence – a practitioner should act in the best interest of the patient (salus aegroti suprema lex)
  • Non-maleficence – “first, do no harm” (primum non nocere)
  • Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).

These are guidelines, not mandated, but if you get an ethics consult in my institutions the above concepts are the framework within which the consult will be completed.

Patients can only be autonomous if they are given accurate, truthful information with which to make a decision about their treatments. You can’t lie to patients, but we all know how you phrase an idea can subtly alter the response. Do you say an 80% success rate or a 20% failure rate? I tend to say both. And not everyone can handle the unvarnished, blunt truth. Part of the art of medicine is trying to tell each patient the truth, the whole truth and nothing but the truth in a manner palatable for the individual patient. It is not easy and I am certain I do not always do a good job. (more…)

Posted in: Medical Ethics, Science and Medicine

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TCM Hodgepodge

acupuncture
I suspect there is more published about traditional Chinese medicine than any other SCAM. Here are some of the recent curiosities of TCM.

Burning genitals

The little girls laughed about the germs, because they didn’t believe in them; but they believed about the disease, because they’d seen that happen. Spirits caused it, everyone knew that. Spirits and bad luck. Jack had not said the right prayers.
- Oryx and Crake

I long ago gave up on the idea that there are a finite number of pseudo-medical treatments. Anything a human can imagine will probably be used as a SCAM intervention. I remain amazed at the permutations that occur in the pseudo-medical world, not unlike the mix and match bioforms in Oryx and Crake.

Not everyone knows basic anatomy and physiology that allows for understanding of disease. Instead, people often rely on metaphor and magic for their understanding, especially in the world of pseudo-medicine. Sympathetic magic lies at the heart of many SCAMs. (more…)

Posted in: Acupuncture, Traditional Chinese Medicine

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Astrology, Alchemy, ESP and Reiki. One Of These Is Not Like The Other

reiki-hands-pic

I knew that Jann was thinking of writing about reiki and fraud, but did not know the details of her most excellent discussion from yesterday until I had finished my penultimate draft for today. Think of them as a match set, two perspectives on the same elephant.

Fraud: a person or thing intended to deceive others, typically by unjustifiably claiming or being credited with accomplishments or qualities.

There are numerous activities that one human will offer another in exchange for money that are completely divorced from reality.

Astrology. Total bunkum.

There is no force, known or unknown, that could possibly affect us here on Earth the way astrologers claim. Known forces weaken too fast, letting one source utterly dominate (the Moon for gravity, the Sun for electromagnetism). An unknown force would allow asteroids and extrasolar planets to totally overwhelm the nearby planets…
Study after study has shown that claims and predictions made by astrologers have no merit. They are indistinguishable from chance, which means astrologers cannot claim to have some ability to predict your life’s path.

Although 48% of Americans think astrology is a science, as best I can tell astrology is not part of the curriculum at any astronomy division or program. Astronomers know it is bunkum and avoid it . (more…)

Posted in: Energy Medicine, Health Fraud

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