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Probiotics

The Wall Street Journal has an assessment of Probiotics in the Jan 13, 2009 issue entitled Bug Crazy: Assessing the Benefits of Probiotics (1). For some reason when I wander around the hospital on rounds people show me articles such as this and ask, so whatcha think about this?

Probiotics are interesting. They are live bacteria given to treat and prevent diseases. It is one of those overlap areas for scientific medicine and so called alternative medicine. There are good clinical trials to suggest areas where these agents are of benefit, but other aspects of their use are blown out of proportion for the real or imagined benefit probiotics may provide. Much of alternative medicine where it overlaps with real medicine is the art of making therapeutic mountains out of clinical molehills.

The Wall Street Journal article is the kind of reporting that drives. me. nuts. It drive me nuts because the reporting acts as if the underlying assumptions of the therapies are true.

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

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AARP and Alternative Medicine

I know I said the next entry would be about the efficacy of the influenza vaccine. The road to blogging in paved with good intentions. I will eventually write that entry, but the ADD has kicked in and my attention has wandered elsewhere.

I am 51 and one of the benefits of this advanced age is you get to join AARP, the American Association of Retired People. Yes, I know I am not retired, and given the current economic situation I am already practicing for my retirement.

“Do you what paper or plastic?”

“For here or to go?”

“Do you want fries with that?

Piece of cake. Who needs a 401K?

The day I received the AARP application, on my 50th birthday, despite some misgivings (8), I joined.

The purpose of AARP, besides discounts at Denny’s and the right to yell at kids when they are on your lawn, is, according to their mission statement, “AARP is dedicated to enhancing quality of life for all as we age. We lead positive social change and deliver value to members through information, advocacy and service. (1)” AARP is a lobby/special interest group for the elderly. In medicine the elderly are considered a vulnerable/at risk group. The elderly may have have fixed incomes, chronic medical problems, declining cognitive function and social situations that make them particularly susceptible to scams of all kinds. So it was nice to have an organization looking after our interests.

AARP has at least 40 million members. Accompanying the membership is their magazine, somewhat eponymously entitled AARP Magazine. The AARP Magazine has the largest circualtion of any magazine in the US with 24 million copies, each read issue by more than one person (7). It has 3 times the circulation of Readers digest. Only Parade magazine has a wider circulation. These are the publications where people receive casual information about about health care. I would assume that a magazine from my advocacy organization would contain information that I can trust. After all, AARP is looking out for my interests as a senior, and any article they would publish, especially relating to health and finances, I should be confident was reliable.

The January/February had an article “Drug Free Remedies for Chronic Pain” by Loolwa Khazzoom (2).
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Posted in: Energy Medicine, Science and the Media

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Influenza Deaths

“There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know.”- Donald Rumsfeld

How do we know what we know? It is said by some anti-vaccine proponents that vaccines are not needed because the diseases they prevent are either gone or no longer as severe as they were in pre vaccine times. People may have suffered and died in the distant past, but no longer. The risk now is from the vaccines not the diseases they no longer prevent.

36,000 people, more or less, die every year from influenza. That is the number of deaths according to the CDC web site; the NEJM review uses the higher number of 56,000 (7). Which number is correct? Isn’t that why the flu vaccine is recommended: to prevent all those people from dying.

36,000 is a lot of people. That’s about 120 deaths per million people in the US. In Oregon, population about 3 million, that would be about 360 people a year, which is two deaths a day for the six month flu season.

“Death is caused by swallowing small amounts of saliva over a long period of time.”–George Carlin.

2,400,000 people die every year in the US, about 6600 a day. In Oregon, that is about 65 deaths a day. No one outside a epidemiologist is going to notice 2 extra deaths a day during flu season. I have seen a lot of people die of influenza, but I have a biased experience: I am an infectious disease doc, so I am likely to see people with influenza, especially patients with disease severe enough to kill them.

About the same number of people die from car accidents and die from handguns in the US each year as die from influenza. I have never known a person in my real, as opposed to my professional, life to die from influenza or handguns or a car accident. My personal experience suggests no one dies from these causes, but since I take care of patients at one of the Portland trauma hospitals, I know what cars and guns do to people. My professional life confirms that people do indeed die from being shot or car accidents. I would wager that most people reading this blog have not known anyone who has died from influenza, guns or car accidents. The fact that people do die of influenza seems contradicted by experience. Why get the vaccine? I don’t get the flu and and no one I know has ever died from it.

As an illustrative example, a relative of mine, a retired physician, mentioned that he thought the shingles vaccine was a waste of time and money as he had never known anyone to get shingles. Using personal experience to judge disease prevalence is unreliable. If I applied the same rationale to driving, I would not wear a seat belt as I have never been in a high speed crash.

36,000 people die of influenza each year. What is the source of that statistic? From “Mortality associated with influenza and respiratory syncytial virus in the United States”. JAMA 2003. Is that really how many deaths are there from influenza? It depends on what you mean by ‘death’ and what you mean by ‘influenza’ and what you mean by ‘from’.

“It depends on what the meaning of the words ‘is’ is.” – Bill Clinton

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Posted in: Basic Science, Public Health, Vaccines

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Google Trends and the Interest in Alternative Medicine

USA Today has come out with a new survey – apparently, three out of every four people make up 75% of the population.

–David Letterman

How popular is alternative medicine? One way is to survey people and ask them. Like all surveys, the nature of the question determines the answer. The first, and probably most referenced, and misquoted, article on ‘alternative’ medicine to address the question was “Unconventional Medicine in the United States — Prevalence, Costs, and Patterns of Use” from the NEJM .

‘Alternative’ proponents quote this article, often as the opening sentence of the paper. “One in three respondents (34 percent) reported using at least one unconventional therapy in the past year.” No one, it appears, ever reads past the abstract. As is so often the case, the substance of the article may not reflect the spin found in the abstract.

There are many issues with this paper (see http://www.quackwatch.org/11Ind/eisenberg.html for a detailed critique) , not the least of which is the definition of unconventional therapy. To get to this huge percentage of users they had to include exercise (26%), prayer (25%) and relaxation techniques (13%) as unconventional therapies. Little did I know that I participate in unconventional therapies every day.

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Posted in: Science and Medicine

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The Infection Schedule versus the Vaccination Schedule

A baby’s body is bombarded with immunologic challenges—from bacteria in food to the dust they breathe. Compared to what they typically encounter and manage during the day, vaccines are literally a drop in the ocean”, and Dr. Offits studies theoretically show an infant could handle up to 100,000 vaccines at one time … safely (6).

It is not the mercury in vaccines, its the vaccine schedule that is the problem. Too many shots, too many antigens, too close together. Our children need to be exposed to fewer antigens, less often, so they don’t get complications from the vaccine like autism and autoimmune diseases. It is all part of greening our vaccines.

That is part of propaganda on vaccines from the More Infectious Diseases for Children, a.k.a. antivaccine groups.

What is the vaccine schedule? How much exposure do children receive from organisms and antigens as part of the vaccination schedule? The entire schedule is at CDC.

In summary there are 5 live attenuated or altered organisms and 21 different antigens by age 6. A couple of vaccines are added from age 7 to 18, but by then it is too late, your child already has autism and autoimmune diseases from the immunologic and toxic scourging of vaccines. BTW. Sarcasm.

Is the vaccine schedule a lot of virus and a lot of antigens? Is this an enormous load on the immune system, sending it spiraling out of control to damage the child? Lets find out.
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Posted in: Public Health, Science and the Media, Vaccines

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“It’s just a theory”

I am afraid that the experiments you quote, M. Pasteur, will turn against you. The world into which you wish to take us is really too fantastic.

La Presse, 1860

It’s just a theory. Not evolution. Germ theory. Just a theory, one of many that account for the etiology of diseases.

I should mention my bias up front. I am, as some of you are aware, an Infectious Disease doctor. My job is simple: me find germ, me kill germ, me go home. I think there are three causes of disease: wear and tear, genetic, and germs. Perhaps a bit of an exaggeration, but not much. My professional life for the last 22 years has been spent preventing, diagnosing, and treating the multitudinous germs that a continually trying to kill or injure us. It is a fundamentally futile job, as in the end I will be consumed by the organisms I have spend a lifetime trying to kill.

I would have though that the germ theory of disease was a concept that was so grounded in history, science and reality that there would be little opposition to the idea that germs (a broad term for viruses, bacteremia, fungi, parasite etc) cause infections and some other diseases.

Wrong. There are people who deny the validity of germ theory. Add there are people who deny gravity. And evolution.

Opponents of germ theory come in two flavors:

  1. Germ theory deniers.
  2. Those who propose alternative mechanisms of disease.

There is great overlap between the two categories, and the division serves more as a literary device for the sake of exposition than a true description of reality.
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Posted in: Acupuncture, Chiropractic, Homeopathy, Science and Medicine, Vaccines

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51 “Facts” About Homeopathy

Get your facts first, and then you can distort them as much as you please.

—- Mark Twain

I use a Mac, so I know I think different. I also coexist on an alternative parallel world where people live on the same planet as me, but have such a radically different way of thinking that I wonder if we have the same ability to evaluate reality (1).

The best example of different ways of seeing the same thing is homeopathy. Homeopathy is utterly and completely ridiculous with zero plausibility or efficacy. Only therapeutic touch is its rival. Yet homeopath Louise Mclean can suggest there are 50 facts that validate homeopathy (2). These facts were presented as an attempt to counter criticism that homeopathy is only water with no therapeutic effects.

Lets evaluate each fact. There are two parts to the evaluations: whether the fact is true and what, if any, logical fallacy is being used. Deciding on which logical fallacy is being used is not my strong point, feel free to correct me in the comments, and I will add to the text later.
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Posted in: Health Fraud, Homeopathy

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I No Longer Love a Parade

Parade magazine is the most widely read periodical in the US, with a circulation of 32 million and a readership of 71 million (1). They get that readership by placing it, free for readers, in over 400 newspapers.

The column in question is “Ease The Aches Of Arthritis” By Dr. Vijay Vad, published 09/28/2008. Dr. Vad is a physiatrist (a rehabilitation doctor) who has published several books on arthritis for the the public.

In the article, Dr. Vad discusses ways to decrease arthritis pain. Like most popular summaries, it is without references, so I used Pubmed and Google for each of his suggestions to look for the evidence to support the advice he offers. I tried to use both narrow and broad search terms in Pubmed, but I do not doubt I missed key articles. I have confidence that the readers of the blog will show me the error of my ways.
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Posted in: Herbs & Supplements, Nutrition, Science and the Media

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A Budget of Anecdotes

Anecdotal evidence. An oxymoron? Or a valid approach to understanding data?

The problem is there are different kinds of anecdotes, used for different purposes, but the purpose of anecdotes is rarely if ever defined explicitly. Anecdotes are used for one purpose by one speaker/writer but interpreted in a different context by the listener/reader. People love anecdotes, especially if the anecdotes are about them or their beliefs. Anecdotes are how patients transmit the particulars of their disease to their health care providers. The medical history, as taken from the patient, is an extended anecdote, from which the particulars of the disease have to be extracted. Anecdotes are how physicians explain disease and treatments. Anecdotes are a tool with which teachers instruct their students. Anecdotes are how CAM proponents validate their particular system, and how skeptics invalidate them.

Anecdotes are useful tools for presenting yourself and your ideas. The convention season is over and is was striking how the candidates attempted to win over voters with anecdotes about their lives rather than the particulars of their policies. Using variations of ‘anecdote’ as a pubmed search term yields little of substance. The predominant theme on medline is to contrast anecdotes with evidence, always to the detriment of anecdotes. Anecdotes have power to influence far greater than evidence.

On The Skeptics Guide to the Universe #165 there was an interview with Ben Goldacre, who noted that there was the popular misbelief that the MMR vaccine was a cause of autism. The belief waned not when the voluminous data on the safety and lack of association with autism and the MMR was released, but when it was discovered that the primary proponent of the MMR/autism link received large sums of money to testify about that MMR/autism link. It was the anecdote about his conflict of interest that invalidated the idea, not the science.

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Posted in: Science and Medicine

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A Budget of Anecdotes

“If you’ve done six impossible things this morning, why not round it off with breakfast at Milliway’s—the Restaurant at the End of the Universe!”–Douglas Adams

I recently finished reading the book “The Joy of Pi” by David Blatner. There is a chapter about the concept of squaring a circle, also called the quadrature of a circle. The idea is that, with just a ruler and a compass, you construct a square of equal area to a given circle.

It turns out it cannot be done. It is, in this iteration of the multiverse, impossible. Not difficult, or implausible or really hard. Impossible. You cannot square a circle in a finite number of steps given the conditions of using only a ruler and a compass.

That it is impossible does not prevent people from trying. Individuals do derive solutions to squaring the circle, and sometimes the derivation is erroneous, and sometimes they have a solution that requires a new value for pi.

Pi is the ratio of the circumference of a circle to its diameter. Take the circumference of a circle, divide it by its diameter and get the endless, or transcendental, number 3.141592654….(1) That number is part of the fabric of this universe. It is a fundamental part of how life, the universe, and everything is put together (2). It is a curious psychopathology that some people feel that all of known mathematics is wrong, and that they have a solution to an impossible problem and that they have discovered the hither to unknown, one true value of pi as a result.

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Posted in: Science and Medicine

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