A common theme in alternative medicine is the “One True Cause of All Disease”. Aside from the pitiable naivete, it’s implausible that “acidic diet”, liver flukes, colonic debris, the Lyme spirochete, or any other problem—real or imagined—can cause “all disease” (in addition to the fact that most of these ideas are intrinsically mutually exclusive).
One of the popular new ideas in this category is that of “endocrine disrupting chemicals” (EDCs). These are chemicals in the environment that physiologically or chemically mimic naturally occurring human hormones. That some environmental substances are chemically similar to human hormones is indisputable. That these substances can have a real physiologic effect in vitro seems to hold up. How much of an effect these chemicals may have in real human populations is an open question.
Cannabis has been used recreationally and medically for centuries. Despite long experience, relatively little is known about the risks and benefits of its use as a medication. A considerable portion of our ignorance can be attributed to government discouragement of cannabis research. Searching the NIH website brings up many studies of both cannabis abuse and cannabis as a therapeutic agent, but most of the general information available is about cannabis as a drug of abuse.
And there is no doubt about the abuse potential and withdrawal potential of marijuana except among hard core denialists. The data is clear: marijuana discontinuation is associated with a withdrawal syndrome in many users, with some experts likening it in symptoms and severity to nicotine withdrawal.
As with any pharmacologically active substance, there are no “side effects”, only effects which we desire and those we do not. Given that cannabis is clearly a powerful pharmacologic agent, that there is a great deal of anecdotal evidence supporting its use, and that there is scientific plausibility to these claims, its potential use as a therapeutic drug should be investigated seriously. (more…)
The Atlantic has a monumentally horrible article up about flu vaccination which has been buzzing around our bloggy back channels. There has been some good science reporting out there lately, but this ain’t it. I was hoping one of the best public health blogs would jump on this, and jump on it they did. It is a terrific example of how to approach difficult data in the heat of a pandemic. This is your reading assignment for the weekend, and you can probably finish up before the Michigan game. Go and read (and Go Blue!).
Dr. Weil is often seen as the smiling “mainstream” of alternative medicine. He’s a real doctor (unlike, say, Gary Null), and much of what he advocates is standard and uncontroversial nutritional advice. But Weil illustrates the two biggest problems with so-called alternative medicne: once you’ve decided science is dispensible, the door is open to anything, no matter how insane; and no matter how altruistic you may start, sooner or later you start selling snake oil. Most doctors out there are working hard to help their patients prevent and overcome disease use the available evidence. Others decide that science is too constraining and start practicing at the periphery of knowledge, throwing plausibility and ethics to the wind.
The fact that Weil claims to donate to charity all of his ill-gotten gains does not mitigate the harm he causes.
The flu pandemic has been challenging to all of us who practice medicine. We try to keep up day to day with the latest numbers, evidence, and best practices, while trying not to worry about getting ill. And since the vaccine isn’t widely available yet, we also worry about our family’s health. So we go about our work every day, wearing masks when appropriate and washing hands frequently. If the numbers reach a certain threshold, we will implement sophisticated pandemic plans.
All of that is rather hard, though, so perhaps we should just throw caution to the wind and start selling flu snake oil just like the smiling Dr. Weil.
The FDA and FTC have let Weil know in very clear terms that his fake flu remedies are being marketed illegally. Weil has taken the site down, but here’s a relevant screen shot.
A reader sent me an interesting post from her own blog. It’s well-written, compelling, and betrays an exceptional intelligence. It’s also completely wrong.
The piece is called, “Bias, Racism, and Alternative Medicine”, an intriguing title. The first part tries to establish that “Western medicine” in one of many ways of understanding health and disease. She starts with some personal anecdotes—always interesting, rarely generalizable:
While receiving Western biomedical treatment for ADD, the side effects of my therapy convinced me that western medication alone would not provide a solution to my problems.
One of the author’s fundamental misunderstandings is that the failure of a particular treatment to make her feel better does not invalidate all of medical science, and more important, it does not validate “other ways of thinking”. Still, I can understand how this happens. Personal experience is powerful; unfortunately, it is also misleading. I like this writer. She seems very kind. She goes on to describe her enlightenment further, but this is where a pleasant anecdote goes terribly wrong: (more…)
It’s tempting to think that the practice of medicine should be simple and intuitive. Unlike other sciences, we all have access to the basic materials—ourselves. We feel that because we are intimately familiar with our bodies, we know a lot about how they work. Unfortunately, it’s a little more complicated than that. The biochemical processes walking around in this sack of meat are pretty complicated. Learning these processes is important, but in medicine, it’s not enough. If we have a hypothesis that some change in biochemistry will affect some disease, we must test this in groups of real people in well-designed clinical trials. Or, we can use the Huffington Post method and just make it all up.
The latest abomination is an article on diabetes, by Kathy Freston. Bad information on diabetes is particularly dangerous. The longer diabetes goes untreated, the higher the likelihood of complications. When reading medical writing it’s important to evaluate the source. The author of this article wrote a book called, The Quantum Wellness Cleanse which pretty much says it all. But is it really fair to judge someone on a crappy book title?
Well, yes, but more important is the crappy interview she conducts with Dr. Neal Barnard. I have no way of knowing with absolute certainty whether Barnard is as dangerous a fool as he sounds, but I suspect so. He and Freston promulgate a dangerously over-simplified view of diabetes. (more…)
The flu pandemic of 1918 was horrific. Millions of people died (by some estimates 4% of the world’s population), and the medical establishment worked feverishly to find a cause and a treatment. There were many dead-ends in the search for the cause of the flu. One of the most enduring errors was the attribution of the pandemic to a bacterium called Haemophilus influenzae (H flu). It turned out that the flu was actually caused by a virus rather than a bacterium, but H. flu is still an important discovery. The fight against influenza was in many ways successful (although too late for the 1918 pandemic)—it led to the discovery of influenza and many other viruses, and the development of effective influenza vaccines. It is analogous to the discovery of HIV and the advances in science and medicine pioneered by HIV researchers. Influenza birthed the field of virology.
But what if we had stopped at one of our dead ends? What if we had held to the belief that H flu caused influenza, or that HTLV-1 caused AIDS? In science, dead-ends usually reveal themselves—eventually. As new discoveries fail to appear, scientists re-examine their underlying assumptions. H flu was found in many flu victims, but not all. Other researchers found that fluids that were run through filters that stopped bacteria were still infectious (in human volunteers!), leading them to conclude that there must be an infectious particle smaller than a bacterium. A quarter of a century after the Great Influenza pandemic, effective vaccines against influenza were in production.
While the world was torn by the first “modern” war, and influenza destroyed military and civilian populations, doctors were trying everything that might help. In the U.S., sera and vaccines against various agents such as pneumococcus were produced and used with some efficacy, but many other immunologic treatments were dead-ends. One of these dead-ends was named Oscillococcinum.
As many of our readers know, there are plenty of websites devoted entirely to fake medicine. Sites such as whale.to and NatrualNews are repositories of paranoid, unscientific thinking and promotion of dangerous health practices. Thankfully, they are rather fringe (but not fringe enough). More mainstream outlets print some pretty bad stuff, but it’s usually just lazy reporting and not a concerted, organized effort to promote implausible medical claims. As many of us have written, both hear and at our other blogs, the Huffington Post is the exception. It actively and in an organized way promotes dangerous, implausible pseudo-medicine. This starts at the top with Arianna, and is actively encouraged by medical and health editors like Patricia Fitzgerald and Dean Ornish. In the spring, our complaints were picked up briefly by the larger blogosphere and for a while, HuffPo appeared to have toned it down. Some of that may have been due to our critique of their flu coverage, much of which was mere infomercials for patent medicine.
As the old joke goes, “Break’s over—back on your knees.” HuffPo has jumped back into the quakery pond with full abandon. Venues like HuffPo are one of the reasons a site like this one are necessary. So let’s take a look at the latest abominations from “the other side”.
One of the common themes regarding alternative medicine is the reversal of normal scientific thinking. In science, we must generally accept that we will fail to validate many of our hypotheses. Each of these failures moves us closer to the truth. In alternative medicine, hypotheses function more as fixed beliefs, and there is no study that can invalidate them. No matter how many times a hypothesis fails, the worst that happens is a call for more research.
Sometimes this is the sinister and cynical intent of an alternative practitioner—refuse to let go of a belief or risk having to learn real medicine. Often, though, there are flaws in our way of thinking about data that interfere with our ability to understand them.
This week, the New York Times had a piece on alternative therapies for fibromyalgia. First a little background.
Doug Bremner has a blog. That blog stinks.
Bremner is an apparently well-regarded psychiatrist, and takes a refreshing look at the influence of industry not just on pharmaceuticals but on the conduct of science itself. His outspoken views have led to attempts to squelch his academic freedoms. But his sometimes-heroic record does not excuse dangerous idiocy.
I can understand how wading into the cesspool that is conflict of interest can leave one cynical. But cynicism and suspicion turned up to “11″ is no longer bravery—it’s crankery. It’s not his snarkiness that burns—it’s his inability to separate his biases from the facts.
It’s not like the pharmaceutical industry doesn’t deserve to be taken to the wood shed. Examples of unethical and downright immoral practices abound, such as ghost-writing, fake journals, and a host of other sins. But the industry has also helped develop a most remarkable pharmacopeia which saves and improves countless lives. There is good, and there is bad. And telling the two apart, well, that makes all the difference.
He tends to go for headlines that hit hard, but miss the point entirely. Examples:
- Angioplasty Found to be Useless Waste of Money: he cites a journal article which he says concluded that “not useful for patients with stable coronary artery disease (CAD). ” His title would be accurate if angioplasty were used only in stable CAD—it is not.
- Should I Take Aspirin or Put a Gun To My Head?: here, he sort of gets the difference between primary and secondary prevention, but not really. He also likes to admit that the data contradict his conclusion but he’s nice enough to say, “screw the data”:
Although technically the risk of stomach bleeding is outweighed by the heart benefits of aspirin (which can only be shown when large numbers of patients are studied), in terms of what that means to you the differences are clinically meaningless.
- This Just In: Breast Cancer Screening Essentially Useless: yes, Doug, breast cancer screening doesn’t benefit everyone equally. For example, the prevalence of breast cancers in men is low enough that recommending it for you would be stupid—like your article.