The word “paradigm” is over misused and overused, diluting its utility. Thomas Kuhn coined the term in The Structure of Scientific Revolutions to refer to an overarching explanatory system in science. Scientists, according to Kuhn, work within a paradigm during periods of “normal science,” punctuated by occasional “paradigm shifts” when the old explanatory model no longer sufficed, and a radically new explanatory system was required. The term has since come into colloquial use to mean any scientific breakthrough, which marketers quickly overused to refer to just about any new product.
I am therefore cautious about using the term, but I think it is appropriate in this case. In medicine I would consider a new paradigm to be an entirely new approach to some forms of illness. Common treatment paradigms include nutrition, physical therapy, surgery, and pharmacology. A new paradigm is emerging in my field of neurology – directly affecting brain function through electromagnetic stimulation.
The brain is a chemical organ, with many receptors for specific neurotransmitters. This has allowed us to use a pharmacological approach in treating brain disorders – using drugs that are agonists (activators) or antagonists (blockers) of various neurotransmitter receptors, or that affect the production or inactivation of the neurotransmitters themselves. There are limits to this approach, however. First, neurotransmitters are not the only factor affecting brain function. The brain is also a biological organ like any other, and so all the normal physiological factors are in play. Further, there is only so much evolved specificity to the neurotransmitters and their receptors.
The “just asking questions” maneuver is familiar to many skeptics. The idea is to feign neutrality, to insulate oneself from accountability or being held to answer for any specific position, but meanwhile to sow doubt about a scientific claim by raising (dubious) questions.
Sometimes the “I’m just asking questions” gambit also tries to disguise itself as sincere journalism. That’s what journalists do, right, ask the tough questions, uncover the uncomfortable truth?
I find this approach particularly deceptive. It tries to hide the fact that the journalist is working off of a particular narrative. Asking questions is, in fact, just another narrative style, one that is meant to lead the reader/viewer to a particular conclusion about the subject. The narrative determines what questions are asked and how they are answered.
A perfect example of this deceptive approach is the HIV denialist movie, House of Numbers. Here is the synopsis from the movie’s website:
What is HIV? What is AIDS? What is being done to cure it? These questions sent Canadian filmmaker Brent Leung on a worldwide journey, from the highest echelons of the medical research establishment to the slums of South Africa, where death and disease are the order of the day. In this up-to-the-minute documentary, he observes that although AIDS has been front-page news for over 29 years, it is barely understood. Despite the great effort, time, and money spent, no cure is in sight.
One of the goals of rigorous science is to disentangle various causes so we can establish exactly where the lines of cause and effect are. In medicine this allows us to then optimize the real causes (what aspect of treatments actually work) and eliminate anything unnecessary.
Eliminating the unnecessary is more than just about efficiency – every intervention in medicine has a potential risk, so this is also about risk reduction.
It often seems to me that the goal of “alternative” medicine is to blur the lines of cause and effect, to exploit non-specific effects in order to promote a useless but profitable ritual (acupuncture comes to mind).
For the past 17 years Edge magazine has put an interesting question to a group of people they consider to be smart public intellectuals. This year’s question is: What Scientific Idea is Ready for Retirement? Several of the answers display, in my opinion, a hostility toward science itself. Two in particular aim their sights at science in medicine, the first by Dean Ornish, who takes issue with large randomized controlled clinical trials, and the second by Gary Klein, who has a beef with evidence-based medicine.
These responses do not come out of nowhere. The “alternative medicine” meme that has taken hold in the last few decades (a triumph of slick marketing over reason) is all about creating a double standard. There is regular medicine which needs to justify itself with rigorous science, and then there is alternative medicine, where the rules of evidence bend to the needs of the guru or snake oil salesperson.
We have been hearing arguments from alternative medicine proponents for years now for why the strict rules of science need to be relaxed or expanded. Andrew Weil has advocated for the use of “uncontrolled clinical observations,” (also known as anecdotes). David Katz advocates for a “more fluid concept of evidence.” Dr. Oz went as far as advocating outright medical relativism, saying. “You find the arguments that support your data, and it’s my fact versus your fact.” (more…)
Poorly done acupuncture studies are published every week, so I can’t write about every one that comes out. I probably would have passed this one by, except for the New York Times article using it to tout the effectiveness of acupuncture.
The headline reads: “Acupuncture, Real or Not, Eases Side Effects of Cancer Drugs.”
I know that authors, in this case Nicholas Bakalar, often do not write their own headlines, but in this case the article itself is just as bad. It begins:
Both acupuncture and sham acupuncture were effective in reducing menopausal symptoms in women being treated with aromatase inhibitors for breast cancer, a small randomized trial found.
Let’s conduct a little thought experiment. First, for the sake of this thought experiment let’s assume that you have no morals, ethics, or conscience. You are comfortable lying to people, even if they are sick, and even if it will harm their health.
Your task is to get as many people as possible to believe that small bits of plastic can improve their health and treat their symptoms. This is not as difficult as it may at first appear, and the payout can be huge. Small plastic stickers can be mass produced for pennies. The primary investment will be creating and maintaining a website. Then, if you can get people to believe that the plastic stickers are magical, the money will come rolling in.
What claims should we make for the stickers? Let’s stay away from anything that has an objective outcome, so we won’t claim that they can be used as an antibiotic to treat pneumonia, or as a way to treat heart attacks. I also understand that in the US and other countries, they take a close look at claims made to treat specific diseases, but you can make vague “structure function” claims with abandon, so let’s go with those. We can always imply that they are effective for diseases, even serious ones like cancer. (more…)
I am daily annoyed by overhyped headlines reporting medical and other science news. I think news outlets and the public would be better served if they fired all their headline writers and let the authors and editors craft headlines that actually reflect the story. Of course, often the story is overhyped as well, so this would not be a panacea to annoying science reporting.
Take this headline from The Week (please): “This pill could give your brain the learning powers of a 7-year-old“. The article discusses a recent study (full article here) looking at the effects of a drug, valproic acid, on the ability of young adult male subjects to learn pitch. It might be a good exercise for regular SBM readers to take a look at the full article now and analyze the strengths and weaknesses of the study.
The study found that those subjects taking valproic acid, which is a drug used to treat seizures, migraines, and mood disorders, did slightly better overall in learning to identify the pitch of various tones. The main limitation of the study is that it is very small – 24 participants enrolled, 18 completed. Further, they did not establish a good baseline performance, as the subjects were practicing as they went along. (more…)
There are a number of annoying clichés of science reporting, prime among them being the need to make a connection from any research to a specific application. It must be deeply embedded in the journalism culture, or written in a handbook somewhere.
In medicine this means that any study that involves viruses or the immune system’s ability to fight off infection might lead to a cure for the common cold. Any study that has anything to do with cell function might lead to a cure for cancer. Almost any study of the brain might one day cure Alzheimer’s disease.
Add to this – any study that alters a metabolic parameter that changes with age might, of course, reverse the ageing process.
Such were the headlines about a recent study in Cell looking at mitrochondrial function in mice. Here is the summary: (more…)
We (the authors and editors) at SBM get accused of many nefarious things. Because we deliberately engage with the public over controversial medical questions, we expect nothing less. It goes with the territory. In fact, if there were a lack of critical pushback we would worry that we were not doing our job.
Still, it is disconcerting to see the frequently-repeated ideological accusations in response to simply evaluating and reporting the evidence. That is what we do here – follow the science and evidence. When that trail leads to a conclusion that some people do not like (usually for ideological reasons) a common response is to accuse us of ideology, malfeasance, being part of a conspiracy, or having conflicts of interest or ulterior motives. That is easier, I suppose, than engaging with us on the science.
One common accusation is that we are shills for the pharmaceutical industry, and downplay or ignore the benefits of diet and “natural” treatments. A search through the SBM archives demonstrates that this accusation is false – we criticize bad science and poor-quality control, regardless of who is committing it. Sometimes pseudoscience is used to promote a drug, sometimes a nutritional supplement, and sometimes pure magic. (more…)
The Centers for Disease Control (CDC) announced in a recent press release the data for 2013 so far shows 175 confirmed cases of measles in the US. This is about three times the usual rate of 60 per year since endemic measles was eradicated in the US, and is the most in the last decade other than 2011, which saw 222 cases.
Measles is a highly contagious virus that primarily causes a respiratory infection. It is not benign. According to the CDC:
About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. About one out of 1,000 gets encephalitis, and one or two out of 1,000 die.
About 500 Americans died each year of measles prior to the introduction of the vaccine. Measles is still endemic in Europe and many other parts of the world, causing about 20 million infections and 164,000 deaths each year. (more…)