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Alternative Microbiology

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…)

Posted in: Epidemiology, Evolution, Science and Medicine

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Scam Stud

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…)

Posted in: Science and the Media, Vaccines

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Pump it up: osteopathic manipulation and influenza

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…)

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

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You Get What You Pay For

I will be giving a free talk entitled Acupuncture: A Science-Based Evaluation of a Popular SCAM to the Bay Area Skeptics on Wednesday, October 2 at 7:30 pm.

Information at the Bay Area Skeptics site on how to get to the La Peña Cultural Center, 3105 Shattuck Avenue, Berkeley.

A wonderful time will be had by all. Well, those who drink first.

Posted in: Announcements

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What are words for?

Do you hear me

Do you care

Do you hear me

Do you care

My lips are moving and the sound’s coming out

The words are audible but I have my doubts

That you realize what has been said

You look at me as if you’re in a daze

It’s like the feeling at the end of the page

When you realize you don’t know what you just read

What are words for when no one listens anymore

What are words for when no one listens

What are words for when no one listens it’s no use talking at all

I might as well go up and talk to a wall

‘Cause all the words are having no effect at all

Missing Persons on blogging. Or so I thought. I was surprised to learn the song was written by the brothers Gibb.

Words are important. I try and choose my words carefully when writing so that they accurately reflect not only my thoughts but reality. When I speak, not so much. My frontal lobe filters often fail if I think might I might get a laugh.

I tell housestaff, precision of writing reflects precision of thought. It is one of the reasons I write; the act of writing forces some coherence into what can be muddled and inchoate thoughts. Even though I have residents who write notes, I always write my own. Often I do not make a final decision as to a plan until I put pen to paper, or electrons to screen. Writing crystallizes thought.

Not, evidently, for everyone, as 10 Facts About the Flu Vaccine and the Flu nicely demonstrates. (more…)

Posted in: Epidemiology, Vaccines

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I refute it thus

Reality is one honey badger. It don’t care. About you, about your thoughts, about your needs, about your beliefs. You can reject reality and substitute your own, but reality will roll on, eventually crushing you even as you refuse to dodge it. The best you can hope for is to play by reality’s rules and use them to your benefit. Combined with a little luck (nothing quite as beneficial as being a white, middle class male in the US) you might have a reasonably healthy health.

The most reliable way to understand reality is science and the scientific method. Used wisely you may have a shot at minimizing morbidity and mortality. Deny or ignore it and reality don’t care. Reality will get us all.

We all have our biases, recognized and unrecognized. I often see the world in terms of infectious diseases. When I read Team of Rivals: The Political Genius of Abraham Lincoln I enjoyed the politics and personalities but I was struck by how people constantly died young of infectious diseases. We don’t see mortality in the young anymore for a variety of reasons: better nutrition, an understanding of the pathogenesis of disease, clean water, flush toilets and vaccines.
(more…)

Posted in: Epidemiology, Public Health, Science and Medicine, Vaccines

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Survey Says…

Surveys are evidently a popular way to get a paper published. Put “complementary alternative medicine survey” into Pubmed and get 2,353 hits. I would have trouble coming up with a hundred groups about whom I would be interested in their use of SCAMs, but I tend to be a lumper rather than a splitter. But if you want to know about SCAM use in chronic pain patients in one Singapore hospital, the information is available.

I am a survey magnet and a remarkable number of people send me dead tree and electronic surveys which I generally ignore. So people like me, those who ignore surveys (but support public television), are underrepresented in surveys. But evidently there is no group whose attitudes about SCAM are not amenable to analysis including my medical brethren, Infectious Disease doctors.

So I was understandably curious when I was sent a link to “Infectious Diseases Physicians’ Attitudes and Practices Related to Complementary and Integrative Medicine: Results of a National Survey“. The abstract makes it sound like my colleagues are a bunch of ignorant rubes who just fell off the turnip truck: (more…)

Posted in: Acupuncture, Clinical Trials, Critical Thinking, Homeopathy, Science and Medicine

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A Different Perspective: Placebo, SCAM, and Advertising

Summertime, time, time

Child, the living’s easy.

Fish are jumping out

And the handicap, Lord

Handicaps high, Lord so high

~ Janis Joplin

It is summer. Time for the kids and the outside, not the computer. What follows is a summertime blog entry, for which I admit to feeling guilty for the comparatively little time I have spent on it, but as I have said before, no dying patient has ever told me “Doc, I wish I had spent more time at work.”

Mt. Hood has been a constant feature to the east my entire life. The mountain, on a clear day at least, is Portland’s most impressive geologic feature. If you are in the right part of the city, you may see Mt. St. Helens or the tips of Jefferson, Adams and even Rainier, but Mt. Hood dominates. It is solitary mass of rock, (diminishing) ice and snow only 50 miles from where I live. I have spent uncountable hours hiking in the Mt. Hood wilderness. When I think of Mt. Hood, in my mind’s eye it is from the perspective of west Portland looking east.

Last week was our yearly summer vacation in Sunriver, just south of Bend Oregon on the eastern side of the cascades in the Oregon High Desert. Driving north/south on highway 97 puts Mt. Hood in a different perspective. From the high desert you can see the huge swaths of the Cascades: calderas, mountains, lava fields and cinder cones. You see Mt. Hood differently. Not a single mountain to the east, but part of a chain of recent and distant historical volcanic activity along the Rim of Fire. Photographs do not do the view of the Cascades justice from this vantage point.

The eastern view puts Mt. Hood in a broader geologic and time perspective. It is still the same Mt. Hood, but in a different context. Like running into a nurse outside of the hospital, you have to recalibrate the context in which you understand and know the person.

I have written on placebo, the placebo effect, and its relationship to SCAM. To my understanding the preponderance of literature indicates there is no placebo effect upon any objective medical problem, only a change in the patients perspective of the problem. (more…)

Posted in: Basic Science, Clinical Trials, Science and Medicine

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Religion and SCAM

I do not worry much about being dead although the process of getting there gives me pause. I have witnessed a few unpleasant deaths and I hope to never see the Grim Reaper coming my way.

One of the more awful and pointless deaths occurred early in my career. I had a patient with hepatitis C and cirrhosis. He had low platelets, low clotting factors (many of which are made by the liver), a previously undiagnosed clotting disorder, and a mouth full of bad teeth that were removed all at once when he acquired dental insurance.

Then he started to ooze blood from his extractions. An ooze that did not stop, it was a constant trickle of blood that would not clot. After several visits to his dentist he almost passed out and came to the emergency room. After 4 days he had bled out about half his blood volume, his haemoglobin had gone from 12 to 6. At this point we geared up for transfusions of red cells and clotting factors and he let us know that he was a Jehovah’s Witness and, no thank you, he would not accept any blood or blood products.

For the next week he continued to ooze despite all the interventions we could come up with to stop the bleeding and he remained adamant in his refusal of transfusions of any kind, despite the risk of death. At about a hemoglobin of 2 he had a large stroke and severe muscle pain from ischemia. At 1 he had a large heart attack and died. If you could rank deaths as pointless and horrific, this would be in my top 10. And I was struck at how nonplussed the family was, accepting this completely preventable death matter-of-factly. (more…)

Posted in: Science and Medicine

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Who you gonna believe, me or you own eyes?

Mrs. Teasdale: Your Excellency, I thought you’d left!

Chicolini: Oh no, I no leave.

Mrs. Teasdale: But I saw you with my own eyes!

Chicolini: Well, who you gonna believe, me or your own eyes?

Duck Soup. Funniest movie ever.

If I could choose a super power, it would be neither flight nor invisibility, but the ability, like Triad, to separate into multiple people so I could accomplish more. I find that my multiple personality disorder is not all that efficient at getting things done. The Goth cowgirl? Lazy.

So sometimes I have to cut corners. As this post goes live I am at TAM helping with panel discussions and workshops and the only way I can get a post up is to cannibalize my lecture. Dr. Gorski will not let me post the slides and be done with it; those managing editors can be so unreasonable. Full sentences. Proper spelling. Good grammar. Sheesh. Some people.

The topic of my presentation is the cognitive errors that lead people to believe in nonsense and is, or was, a brief tour of the flawed ways in which we think and how the brain allows everyone to be under the false impression that fictions are real. (more…)

Posted in: Critical Thinking, Science and Medicine

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