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Homotoxicology

What you’ve just said is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul.
—James Downey, Billy Madison

Pictured: Toxins coming out.  Or cancer.  Whatever it is, it's your fault.

Pictured: Toxins coming out. Or cancer. Whatever it is, it’s your fault.

My first experience with SCAM was as a first year medical student. I was on the bus to school when the person next to me asked, after looking at my reading material, if I was a medical student. Yes, I am. Why so was he, enrolled at the local naturopathic school. I knew nothing about naturopathy, or medicine for that matter, at the time, so when he told me that warts were not caused by a virus but in fact due to the body walling off toxins and expelling them through the skin, I did not have much to say. I suspected it was nuts, but lacked the education or understanding of disease to know for sure, and who knew, maybe he was on to something.

When we got to cutaneous diseases I learned that warts were indeed caused by the papilloma virus, not toxins, and the best therapy remained swinging a dead cat in a graveyard at midnight. So I filed that curious incident away as a fluke, even though it is part of standard naturopathic teaching, which is often separated from reality.

It should not have surprised me that there is a whole field of pseudo-medicine devoted to the pseudo-treatment of pseudo-toxins that goes by the nom de scam of Homotoxicology. Yet another One True Cause of all disease. Being a splitter, I think Harriet missed this one. All diseases in this particular SCAM are due the toxins and the bodies attempt to remove them. (more…)

Posted in: Homeopathy

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In the Spirit of Choosing Wisely

Oh, loneliness and cheeseburgers are a dangerous mix.
- Comic Book Guy

Same can be said of viral syndromes and Thanksgiving. My brain has been in an interferon-induced haze for the last week that is not lifting anytime soon. Tell me about the rabbits, George. But no excuses. I have been reading the works of Chuck Wendig over at Terrible Minds. (Really, really like the Miriam Black books). Writers write and finish what they start and only posers use excuses for not completing their work.

Recently I attended an excellent Grand Rounds on some of the reasons doctors do what they do. Partly it is habit. We learn to a certain way of practice early in our training and it carries on into practice and it is not always best practice. Patients also learn from us and have expectations on what diagnostics or treatments they should receive, and that too it is not always the best practice.

So to educate physicians and patients, the American Board of Internal Medicine (ABIM) started the Choosing Wisely initiative. (more…)

Posted in: Acupuncture, Chiropractic, Critical Thinking, Energy Medicine, Homeopathy, Science and Medicine

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Why Get A Flu Shot?

Banner_-FLU_Be_Aware_and_Be_Prepared-

Actual discussion:

Parent “I want vaccine for my child”

Doc “There isn’t one, but we have

Parent “We don’t believe in that”

So much of what we are for at Science-Based Medicine is reflected in what we oppose: all the pseudo-medical interventions and SCAMs. It is not always a positive message, forever noting why you should not be participating in a given bit of fantasy-based medicine. We are often the nay-saying curmudgeons of the medical world. Even for medical topics about for which I am in strongly in favor, vaccines, much of my prose is devoted to countering myths and lies about influenza vaccines, from why the Cochrane review is messed up to why health care workers are dumb asses for not being vaccinated.

Well no Debbie Downer or Crotchety Crislip today. Nope. We are going to ride our Rainbow Unicorn to the land of Happiness and Immunity and discuss some of the reasons why you and yours should get the influenza vaccine. (more…)

Posted in: Vaccines

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Infinite Variety?

Age cannot wither her, nor custom stale. Her infinite variety.
- William Shakespeare

This is not a typical post for me, but something I have been meaning to do to satisfy my own curiosity. I have wondered, how many variations of acupuncture are there? I suspected a lot, but I thought I would go looking and make a list. Since acupuncture is not based in reality but is instead a collection of pseudo-knowledge, there is no reason for acupuncture to have fidelity to fundamental concepts. I suspect in the US that in the future acupuncture will become less heterogenous as schools start teaching to the test that allows for acupuncture licensure. For now variation rules.

Acupuncture needling

So this will be a list, with description and commentary. If a missed form of acupuncture is noted by others, and I am sure I have, I will expand the list in an addendum. (more…)

Posted in: Acupuncture

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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

Dr. Oz, one half of the You Doctors.  And a professor.  A professor.

Dr. Oz, one half of the You Doctors. And a professor. A professor.

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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