Perhaps one of the most common questions I receive from those who wish to utilize science-based medicine for their own health is what I think about vitamins. Even among hard-nosed skeptics, this question is often perplexing. On the one hand, vitamins themselves were discovered by medical and biological science, they play a vital role (by definition) in the healthy functioning of our bodies, and deficiencies of vitamins can cause disease. So they seem perfectly legitimate. On the other hand the market is full of exaggerated and even magical claims about the cure-all power of vitamins.
It’s difficult for people to come to a bottom-line conclusion – should they take vitamin supplements or not. Is it woo or not woo?
Well – it’s complicated. But there is large body of research to help inform our decisions about vitamins. Now, the largest study to date has been published (Multivitamin Use and Risk of Cancer and Cardiovascular Disease in the Women’s Health Initiative Cohorts) looking at 161,808 post-menopausal women over 8 years and finding no benefit for heart disease, cancer risk, or overall survival. This study comes on the heels of other recent studies showing no benefit from routine supplementation.
There is a recent trend in UK Universities to close programs offering science degrees for various forms of so-called alternative medicine (CAM), such as homeopathy, crystal healing, and traditional Chinese medicine. This occurs amid growing scientific criticism of these programs.
This is a very good thing, and something I would like to see replicated in the US. The scientific community is appropriately concerned about such programs for a number of reasons. We have also been highly critical of them here at SBM – for example take a look as Wallace Sampson’s excellent analysis of academic medicine here and here, and David Gorski’s summary of Medical Academic Woo here.
Academic institutions have an implied contract with society – they are given resources (donations, scholarships), power (the ability to grant recognized degrees), and respect (the institutions and their members are often given the assumption of credibility and knowledge), and in exchange they agree to follow a code of professional ethics. This contract is similar to many professions, like physicians or lawyers.
The more recent issue of the Journal Pediatrics contains two article providing further evidence for the safety of vaccines and is published amid news reports of recent outbreaks of vaccine-preventable diseases in those who chose not to vaccinate over unwarranted fears. This highlights the need to continue our PR battle against the antivaccinationist movement that seeks to spread pseudoscientific fears about vaccine safety.
Haemophilus influenza type B (Hib) is a bacteria that can cause meningitis, pneumonia, and epiglotitis in young children – all serious illnesses. A Hib vaccine was introduced in 1992 followed by a significant decrease in the number of Hib infections. Last year in Minnesota, however, there were five cases of Hib meningitis, including a 7-month old infant who died. This is a significant spike above the rate we have seen since the Hib vaccine, and occuring in a cluster. Three of the five children who were affected did not have the Hib vaccine by their parent’s choice.
As part of President Obama’s new approach to politics, with the promise of making it more transparent, his transition team solicited ideas from the public at change.gov. On this site anyone could post an idea and everyone could vote proposals up or down. Apparently the most popular ideas will be given some consideration. It’s an interesting blend of democracy and representative government. Whether is has any utility remains to be seen – but it’s just electrons and therefore it’s easy to experiment.
There are numerous suggestions under the health care category, but one in particular that might be of interest to readers of this blog. The author, Professor S, sent me the link to his suggestion that the new Administration defund the National Center for Complementary and Alternative Medicine (NCCAM).
What a great idea.
It is without controversy that the number of autism diagnoses being made is on the rise. In 1991 there were about 6 cases per 10,000 births, and in 2001 there were about 42. This number continues to rise at about the same rate.
The cause of this rise, however, is very controversial. There are basically two schools of thought: 1 – that true autism rates are on the rise, and 2 – that the measured rise is an artifact of increased surveillance and a broadening of the definition. I wrote previously about this very controversy, in which I concluded that the expanded diagnosis hypothesis is much better supported by the evidence.
Now, a new study published last week in the journal Epidemiology is being presented by proponents of the epidemic hypothesis as support for their view. A closer look, however, reveals that this study does not support the epidemic hypothesis and adds little to the overall literature on this question.
Dr. Robert Sears, son of the perhaps more famous Dr. William Sears (both pediatricians), has continued his father’s work of publishing popular books for parents. He wrote The Vaccine Book: Making the right decision for your child, published in October 2007. In it he advocates his Dr. Bob’s Alternative Vaccine Schedule. Much of his claims made in the book are repeated on his Ask Dr. Sears website.
In the latest issue of Pediatrics, Paul Offit, along with Charlotte Moser, write a detailed analysis of Dr. Bob’s alternative vaccine schedule, systematically reviewing Dr. Sears’ claims. It is essential reading for anyone interested in the popular vaccine controversy. Paul Offit also recently published his own book, Autism’s False Prophets, in which he goes into great detail about the history and science behind the claims by anti-vaccination advocates of the risks of vaccines, most famously the claim that vaccines are linked to autism.
Dr. Sears does not come off as a hard core anti-vaccinationist. I am still trying to figure out his perspective from reading his articles. It seems as if he is trying to be popular by straddling the fence, and offering what he thinks might be a reasonable compromise. For example, he writes on his site:
The bottom line is that more and more parents want options. If we don’t provide them with options they are comfortable with, more parents will opt out of vaccines altogether. We will then see more and more disease fatalities and complications.
Unfortunately, this is like trying to compromise between mutually exclusive positions, like young-earth creationism and evolution. It doesn’t work. Dr. Sears is left giving his readers, who will likely be comprised of many parents trying to decide whether or not to vaccinate their children, with partial information or misinformation. Offit and Moser do a great job of exposing this deception through misinformation.
I am pleased to announce that Science-Based Medicine is a finalist for a 2008 Medical Weblog Award in the New Medical Blog category. You can see all the categories and finalists here: http://www.medgadget.com/archives/2009/01/the_2008_medical_weblog_awards_the_polls_are_open.html
Of note, our blogging friend, Orac, is also a finalist for Respectful Insolence in the health policies/ethics category, along with our own Dr. Val Jones for her excellent blog, Better Health.
We would appreciate you taking a look and voting for the blog of your choice. And thanks to all of our readers for your kind support over our first year, and the active and informative discussions in the comments section. We look forward to more SBM in 2009.
On January 1, 2008 I wrote the first blog entry on Science-Based Medicine introducing the new blog. Now, by coincidence, I have the privilege of writing the last entry of 2008. It seems like a good time to look back over the last year and reflect on our little project.
I am happy to write that by all measures SBM has been a satisfying success. Most blogs end after a few months. We not only kept up our schedule for the entire year, we expanding our writing about midway through the year. Given that there are millions of blogs, by necessity most blogs are relatively obscure. SBM rather quickly garnered a respectable readership and gained the attention of the some in the media as well as those with oppossing views.
I am very proud of the quality of the articles we have published here. Of course I have to thank all of my co-bloggers – David Gorski, Kim Atwood, Harriet Hall, Wally Sampson, and Mark Crislip who were with me from the beginning and Val Jones, David Kroll, Peter Lipson, and David Ramey who joined us part way through the year. Every week they each contributed a magazine-quality article, and then hung around to discuss their articles and others in the comments section. They all do this without any compensation, out of a pure desire to have a positive effect on the world.
Science-based medicine is more than a website. It is a philosophy of medicine that is actively vying with other philosophies for dominance in the world of medicine. We believe that medicine should be based upon the best science available, according to a single universal standard of rigorous methodology and valid logic and reason. Others desire a double-standard, so that they can be free to practice or market whatever they wish without having to meet strict scientific standards. Still others have a non-scientific ideological world-view and want public policy to accord to, or at least admit, their personal beliefs.
I therefore expect that we will be attacked by proponents of unscientific medicine in all its forms. Yesterday, however, we were attacked on the Evolution News & Views website of the Discovery Institute by creationist neurosurgeon, Michael Egnor. This may seem incongruous at first, but honestly I suspected that just such an attack was inevitable.
Many science bloggers, David Gorski and me prominent among them, have taken on both the DI and Dr. Egnor specifically over many anti-scientific arguments he has put forward over the last couple of years. We have sparred mostly about evolution in medicine, neuroscience and consciousness, and the materialist underpinnings of modern science. Dr Egnor’s day job, however, is that of a (from what I can tell) respected neurosurgeon, so I always wondered what he thought of his sparring partners’ writings about science-based medicine.
His entry yesterday ends any speculation – he wrote an incoherent, logical fallacy-ridden screed that would make any snake-oil peddler proud. This reinforces a point I have made in other contexts – all anti-scientific philosophies have science as a common enemy, and will tend to band together in an “unholy alliance” against those advocating for scientific rigor or defending science from ideological attack. That is why a website that is ostensibly about the “misreporting of the evolution issue” would post a blog attacking science-based medicine as an “arrogant medical priesthood.”
Have you ever heard of heavy leg syndrome? I hadn’t, until I read this BBC article about it – the British are apparently amused at this peculiarly French medical malady. Heavy leg syndrome is a common diagnosis in France, which alone consumes one third of the world’s drugs for this diagnosis.
Diseases certainly vary from population to population based upon genetics, environment, and lifestyle. But can it also vary just based upon the culture of diagnosis? It seems so.
Ever since it was recognized that there exists diseases – that different people can suffer from the same entity, rather than everyone having their own unique illness, the medical profession has described certain clinical presentations as syndromes. This is legitimate, but it must be recognized that this use of the term syndrome is purely descriptive. (As an aside, the term “syndrome” has a different and very specific use in describing certain genetic diseases.)