As some may know I am infectious disease doctor. Urinary tract infections (UTI) butter my bread. Figuratively speaking. There is an enormous amount known about the pathophysiology of UTI’s. It is both a common and complex problem. But for all our knowledge, chronic and recurrent UTI’s remain a vexing issue for the patient and the doctor.
One reason people develop recurrent UTI’s is not because of altered chi along meridians altered by needles stuck in the skin distant from the bladder. That would be ridiculous. I like reasoning from basic principles. Given what we know about anatomy, physiology and microbiology, how might acupuncture interfere with the development of a urinary tract infection? Would it prevent colonization with pathogenic E. coli? Prevent retrograde travel of bacteria up the urethra into the bladder? Stop E. coli from binding to uroepithelial cells? Have a bactericidal or bacteriostatic effect?
None of the above seem likely. To my mind, postulating any of the above as a potential mechanism for acupuncture as a preventative for UTI’s would be ludicrous. And spare me your Boosting the Immune System, a concept that exists as a marketing tool, not a useful therapeutic intervention. My boss used to say that many an academic career floundered on attempting to prevent and treat UTI’s using an immune system approach. With some exceptions, and there are always exceptions, recurrent UTI’s in normal humans are usually due to anatomic or microbiological anomalies.
Despite its popularity, it is clear that acupuncture is not based on reality and, like all pseudo-medicine, only has demonstrable efficacy in poorly-designed studies. Acupuncture displays the usual progression of all pseudo-medicines. Increasingly-well-done studies show decreasing effect until a study that removes all bias shows it to be no better than placebo. Which one would expect for an intervention based on fantasy. Prior plausibility (the toy boat of SBM, try saying it three times very fast) would predict that acupuncture is worthless. And that should be acupunctures, all 6 styles are an elaborate ritual with no more likelihood of efficacy than the superstitions in a Budweiser commercial. (more…)
Those who cannot remember the past are condemned to repeat it.
- George Santayana
Most people don’t have that willingness to break bad habits. They have a lot of excuses and they continue to produce bad clinical studies.
- Carlos Santana (Well, not the last 4 words.)
One is a guitar player, one is a philosopher. I get them confused.
I think George was in charge of SCAM research at the NIH. It was Dr. Gorski who first used the term Whac-a-Mole to describe what we do. The same badly-done studies are done over and over and misrepresented over and over, with only very minor variations on a theme. This is especially true of acupuncture, the most extensively studied pseudo-medicine in search of something, anything, for which it might be effective. They are still searching.
I loved going mano-a-mano with my kids when they were younger on the Whac-a-Mole machine in the Seaside arcade followed by root beer and elephant ears. It was the last time I beat either of them at any athletic endeavor. So I enjoy Whac-a-Mole, with mechanical rodents or bad research. (more…)
We are proud to announce a new organization: The Society for Science-Based Medicine.
A Society for a community of like-minded individuals, both in and out of health care, who support the goals of Science-Based Medicine.
People should not suffer, die, go bankrupt, and lose time and hope because of complementary and alternative pseudo-medicine.
We received the following letter:
Your blog, the SBM page, has come up for me several times in my research. I’m an RN trying to research cancer treatment, for myself, I am the patient. I’m also a licensed massage practitioner with a 30 year history using “alternative” or “complementary” medicine successfully to treat myself for various things. When your blog has come up I’ve read into it, picking up some useful information.
My question is, why the sarcasm? Why do you and the responders on your site have such disdain and anger? Why do you feel threatened? Your physician status gives you the top of the totem pole, the extensive training, the authority and the privilege. Very doubtful you are going to be knocked off the top of that totem pole in this or any several more lifetimes to come. (more…)
Ed: Doctors say he’s got a 50/50 chance at living.
Frank: Well there’s only a 10% chance of that
There are several motivations for choosing a topic about which to write. One is to educate others about a topic about which I am expert. Another motivation is amusement; some posts I write solely for the glee I experience in deconstructing a particular piece of nonsense. Another motivation, and the one behind this entry, is to educate me.
I hope that the process of writing this entry will help me to better understand a topic with which I have always had difficulties: statistics. I took, and promptly dropped, statistics 4 times a college. Once they got past the bell shaped curve derived from flipping a coin I just could not wrap my head around the concepts presented. I think the odds are against me, but I am going to attempt, and likely fail, in discussing some aspects of statistics that I want to understand better. Or, as is more likely, learn for the umpteenth time, only to be forgotten or confused in the future. (more…)
I have a confession. I have been interested in issues skeptical since high school when I came across a copy of the Zetetic at Powells. In the pre-digital era I had a complete library of Zetetic-Skeptical Inquirers (SI) that a decade ago was tossed in the recycle bin along with a similar collection of MacWorlds. I have been interested in skepticism a long time and, here is my confession, I no longer find much of the subject matter covered by SI all that interesting. Even big ticket topics like the existence of God are uninteresting. It is not that the topics are not important, they are, and each generation has to relearn why Bigfoot or haunted houses or UFO’s are nonsense. But for me it is a large serving of been-there, done-that.
So while I subscribe to SI, it is more from a sense of obligation to support institutions I think are important than from an expectation that I will be either educated by the content or entertained by the style of the writers. I usually skim the magazine while accomplishing tasks that do not require my full attention probably because SI is the only magazine I still receive in dead tree format, the rest of my life being digital.
So I ran across “Taking our medicine: What hope for skepticism in healthcare?” by Kenneth W. Krause and after skimming it I was irritated. So I read it again and I was more irritated, which is often a good sign. But I could not quite put a finger on what it was. So I read it again and then went for a walk and thought about it.
All the facts were fine. I had no issue with the content of the article. It was the adjectives that irritated me. And the essay was, from my perspective, incomplete. It was like reading a relationship/birth control article by the Pope. Sure, he knows the facts of the situation, but not being an active participant in the process and with an agenda to promote, vital information will be missing or distorted. (more…)
Should anyone be in Ashland, Oregon the afternoon of Sunday the 10th of November, and is sober after an afternoon of watching the NFL, I will be giving a talk on Supplementary, Complementary and Alternative Medicine Myths. Sponsored by the Jefferson Center, details on their website.
For those in the Portland, Oregon area, I will be giving same talk on Monday November 18th.
Portland State University
Science Bld. 1 – Room 107
Although the Patriots-Panthers game may be more exciting.
Sponsored by Oregonians for Science and Reason and the PSU Department of Physics.
Both talks are free.
A man of science rises ever, in seeking truth; and if he never finds it in its wholeness, he discovers nevertheless very significant fragments; and these fragments of universal truth are precisely what constitutes science.
~ Claude Bernard.
I almost never have to search for material for this blog. The Secret always seems to provide topics. Subject matter appears unbidden out of the ether. But not this week. I enjoy deconstructing the nonsense of SCAM papers or blog entries more than any other type of blog entry. Perhaps the glee that last week’s entry provided had to be countered by some kind of cosmic balancing mechanism. Although the rational part of my mind objects to the personification of random existence, I suppose the Universe just does not want me to have that much fun two entries in a row. Probably explains why I have a viral URI and my brain has slowed almost to the point of functional inactivity. There is no shortage of SCAMs to write about, they are just not created equal in their ability to generate a passionate rant. (more…)
We have evolved in order to survive reality, not to understand it. And it is a good thing that understanding and survival are not tightly linked as many people are apparently totally disconnected from the reality I inhabit, the one described by the natural sciences. When I started writing and podcasting about the SCAMverse I was under the impression that people who used SCAMs were simply misinformed. If people were made aware of the facts of the matter, they would see the error of their ways and put away their SCAMs as the childish thoughts they are.
Silly me. Reality, as I understand it, is often if little interest to proponents of SCAM. This was brought home by the Food Babe with an essay Should I get the Flu Shot? Spoiler alert. Her answer is “No, I’m not taking the Flu Shot. Ever.”
It is how she reaches that conclusion that is amazing. There are nouns and adjectives and adverbs and verbs and article and prepositions. They are strung together to form sentences and paragraphs, but somehow, though an almost magical alchemy, all that writing transmutes into content that is completely divorced from reality as I understand it. It is a tour de farce that reaches the definition of the Pauli Principle, where “It is not only not right, it is not even wrong.” (more…)
First, my bias. I work in Portland and we have medical students, residents, and faculty who are DOs (Doctor of Osteopathy). Before he moved on to be a hospitalist my primary physician was a DO. From my experience there is no difference between an MD and a DO. In my world they are interchangeable. There are many more qualified applicants for medical education than positions in MD programs and some opt for a DO education. Osteopathy has a dark side.
As best I can determine from my colleagues, learning osteopathic manipulation (OM) is the price they pay to obtain an otherwise standard medical education. I have yet to see OM offered by any of my DO colleagues. It may be they know better than to offer such a modality around me given my ranty propensity for all things SCAM.
The literature would suggest that OM is left behind by most DOs upon graduation. DOs are not proud of their OM, and rarely invite them ‘round to dinner. It will be interesting to see if OM fades over time in DO school as the old time true believers die off and are supplanted by a generation of DOs trained with more traditional medical education.
OM, the small pseudoscientific aspect of DO medical school education, is a form of massage and manipulation invented in the 19th century with no basis in reality. OM postulates
the existence of a myofascial continuity – a tissue layer that interlinks all parts of the body. By manipulating the bones and muscles of a patient a practitioner is supposed to be able to diagnose and treat and variety of systemic human ailments.
Studies into the efficacy of OM find it to be ineffective for any process aside from low back pain (is there anything that does not help low back pain?), not surprising for a therapeutic intervention detached from reality. My purpose with this entry is not to review OM per se, which may be a good topic someday, but to focus on a specific application of OM. (more…)