Science-based medicine is a concept that is larger than the analysis of any specific topic. It is, essentially, an approach to answering health and medical questions, one that involves careful and thorough analysis of scientific evidence within a framework of understanding of critical thinking, mechanisms of self-deception, and the process of science itself. We feel this creates the best opportunity to arrive at tentative conclusions that are most likely to be reliable.
We often address claims that are the result of a very different process. In fact there seems to be a thriving subculture on the internet that emphasizes the naturalistic fallacy, fear of anything technological (including irrational chemophobia), paranoia about the government, corporations, and mainstream medicine, and embracing anything perceived as being contrarian, exotic, or radical. To this subculture science is either the enemy, or it is used (as Andrew Lang famously quipped) like a drunk uses a lamppost, for support rather than illumination. This approach is simultaneously gullible and cynical.
It is no surprise that those who follow this fatally flawed approach consistently arrive at the wrong conclusion, especially on any controversial scientific topic. The two most prominent netizens following this approach, in my opinion, are Joseph Mercola and Mike Adams. I do believe, however, that there is another hoping to join their ranks – Vani Hari, who blogs under the name Food Babe. (Mark Crislip also blogged about her here.)
The infiltration of pseudoscience and simply bad medicine into mainstream medicine continues. Hospitals are an easy breech point because they are run by administrators who may have more talent and interest in marketing than in science. Many hospitals in my area, for example, proudly display their “integrative” centers, offering nutrition advice and massage alongside more dubious offerings, such as reflexology and reiki.
So-called “alternative” treatments are tempting because they are often not covered by insurance, and so patients will have to pay cash for them, and they are often inexpensive to run – so they are a nice cash cow for hospitals.
The Wall Street Journal reports another, more serious, chapter in this infiltration – the opening of Chinese herbal clinics, specifically in the Cleveland Clinic. The article itself is reasonably balanced, and lacks the gushing anecdotes that most such pieces have, but could certainly have been more hard-hitting in terms of the serious problems with herbal medicine.
The BBC reports that 11 doctors and a GlaxoSmithKline regional manager in Poland have been charged with alleged corruption. The apparent scheme was simple — GSK sales reps are given targets for new prescriptions for whatever drugs they are promoting. In order to meet those targets, it is alleged that one sales rep agreed to pay doctors £100 to give educational lectures to patients. The lectures never took place, and it was understood that in exchange for the payment the doctors would prescribe more of the rep’s drug.
The case is still under investigation but one doctor has already admitted guilt, stating that the £100 was simply too tempting.
Assuming the charges are upheld, such cases are very damaging to public confidence in the system. This is similar to cases of researchers faking their published research — I cringe every time I read about such cases.
What will it take? That is the lingering question, one that has significant implications for the legitimacy and effectiveness of our professional and regulatory institutions.
Homeopathy is 100% pure nonsense. It is one of the so-called “alternative” medical systems that has absolutely no basis in reality. It is magic-based medicine. It is based on two-centuries-old pre-scientific ideas, bad guesses that turned out to be wrong.
The notion behind homeopathy is that illness is caused by a problem with the essence or life energy. Based on the idea of “like cures like” the homeopath must find a substance that is the match for the totality of symptoms, including personality traits and superficial details like eye color, and then give a magic potion which is created by diluting the matched substance out of existence – but the essence remains. (more…)
Antivaxxers spread misinformation. This does not have to be the case – I can envision those who wish to function as watchdogs on the vaccine industry or prioritize personal freedom over government programs (even good ones), but who strive to be logical and evidence-based. The culture within the anti-vaccine movement, however, is not logical and evidence-based. Rather, they spread whatever misinformation supports their rather extreme ideology – that vaccines do not work and are dangerous.
Countering anti-vaccine misinformation can be almost a full time job. It is the proverbial game of whack-a-mole, especially in the social media age where old debunked anti-vaccine memes can resurface over and over again on Facebook or Twitter. The game is also rigged in that it is easier to spread fear with misinformation than to reassure with accurate information. Even if we address every anti-vaccine trope, parts of the public can be left with the vague sense that there is something dangerous about vaccines, or that the government is not playing entirely straight with us.
In any case, here is this week’s edition of whack the anti-vaccine mole. The particular varmint that popped its head up recently is the claim that 2-5% of children who receive the MMR vaccine (mumps-measles-rubella trivalent vaccine) contract measles from the vaccine. This specific claim was made on the realfoodeater blog (another thing you should know about the anti-vaccine community is the broad overlap with the natural, alternative medicine, and conspiracy subcultures). The blogger gave as a reference a conversation she had with an unnamed doctor at DeVos Children’s Hospital. (more…)
Anyone publicly writing about issues of science and medicine from a pro-science perspective likely gets many e-mails similar to the ones I see every week. Here’s just one recent example:
Im sorry the medical community has become decadent and lazy as most that follow your stance could care less to study the real truth. I have also seen it much more deviant as many professionals know the risks and harm vaccination cause but continue to push it through there practices because of pure greed. Many are also scared of loosing there practices for not following the corrupt industry. Im sorry but the medical industry has become drug pushing decadent slobs that only care about there bottom line.
The e-mailer clearly has a particular narrative that he is following (in addition to the amusingly common poor grammar and spelling). He even writes at one point in our exchange, “the details really don’t matter at this point what matters is what the bigger picture…” He is certain of his big picture conspiracy narrative. The details are unimportant.
Oil pulling is a traditional Ayurveda method of oral care. It involves swishing sesame oil or a similar oil, perhaps mixed with other substances, in the mouth for 10-20 minutes as a means of preventing caries (cavities), reducing bacteria, and promoting healthy gums. In our internet-fueled age of misinformation, oil pulling has seen a surge in popularity as it makes the rounds on Facebook and other popular social media sites.
The proliferation of unscientific medical advice also essentially assured that oil pulling would be updated to incorporate the latest marketing memes in the alternative marketplace. It is therefore not surprising that this technique is being presented as a cure-all, treating all sorts of systemic diseases by allegedly pulling toxins from the mouth. The Wellness Mama (the first hit on Google) proclaims:
Oil pulling is an age-old remedy that uses natural substances to clean and detoxify teeth and gums. It has the added effect of whitening teeth naturally and evidence even shows that it is beneficial in improving gums and removing harmful bacteria!
Food Matters also gushes:
It is believed that these oils help the lymphatic system of the body as harmful bacteria are removed and beneficial microflora are given with [sic] a healthy environment to flourish. Because of this holistic perspective, oil pulling has been used as a preventative health measure for many other conditions.
This is followed by a long list of conditions from migraines to bronchitis. (more…)
Affecting public health has a few components. It includes providing a safe environment at home, at work, and in public spaces. It involves protecting the food and water supply from pathogens and toxins. Perhaps the most challenging component, however, is affecting people’s behaviors. Humans are complex psychological animals, and simply providing information to facilitate a rational decision may not always have the intended effect.
Those in power wishing to protect the public from themselves can simply pass laws that coerce people into safer behavior, such as seat belt laws and helmet laws. This approach amounts to outlawing certain unhealthy choices. There is also the “nudge” approach where the unhealthy choice is not outlawed, but the healthier choice is facilitated or made the default choice so that people have to work harder if they still wish to make the unhealthier choice for themselves.
Short of passing laws to force or nudge people in the right direction, the default approach to improving healthy behaviors is to provide information via either public service announcements or warning labels. How effective, however, are such measures? (more…)
PLOS (the Public Library of Science) is a non-profit open access publisher of science articles. Their goal is to make scientific data accessible to everyone, in the name of transparency and open communication. Now they have taken their approach one step further, announcing their policy that all articles published in a PLOS journal must submit their original data so that anyone can access and analyze it for themselves.
In an effort to increase access to this data, we are now revising our data-sharing policy for all PLOS journals: authors must make all data publicly available, without restriction, immediately upon publication of the article. Beginning March 3rd, 2014, all authors who submit to a PLOS journal will be asked to provide a Data Availability Statement, describing where and how others can access each dataset that underlies the findings. This Data Availability Statement will be published on the first page of each article.
They allow for exceptions—when subject confidentiality is an issue, sensitive information related to endangered species, and when the authors do not own the data. In such cases, however, data must be available upon request, and not controlled by the authors. Otherwise the raw data must be made available.
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.