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“Acupuncture Anesthesia”: a Proclamation from Chairman Mao (Part III)

A Digression: The Politics of Chinese Medicine in the People’s Republic of China (The Early Years)

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A Partial Book Review: Chinese Medicine in Early Communist China, 1945-63: a Medicine of Revolution, by Kim Taylor

Mao’s was a complex personality. He was by nature a control freak, highly secretive, quickly suspicious, ruthless in revenge. These were all personal characteristics that were to determine the flow of politics in early Communist China. (Taylor, p. 4)

We have already seen that attempts to create ‘acupuncture anesthesia’ began in the People’s Republic of China (PRC) in 1958. As suggested by the title of this series, this resulted from neither rigorous research nor the serendipity that occasionally heralds important discoveries. Rather, the apparent prominence of acupuncture in health care in the PRC was a matter of governmental fiat. Even before the Communist victory in 1949, it was clear to Chairman Mao Zedong that there were not enough ‘Western’ trained physicians to handle the massive health problems of the country, which included an infant mortality rate of 1 in 5, an overall death rate of 30 per 1000 per year, and widespread disability. Most of this was due to malnutrition and infectious diseases, including many that sound exotic and ominous to the modern ear:

…schistosomiasis, filariasis, ancyclostomiasis, Kala-azar, encephalitis, plague, malaria, smallpox and venereal disease…measles, dysentery, typhoid, diphtheria, trachoma, tuberculosis, leprosy, goitre, Kaschin-Beck’s disease…(Taylor, p. 103)

Pre-scientific Chinese medicine, acupuncture in particular, was identified by Mao and other Communist leaders as worthy of cultivating:

Our nation’s health work teams are large. They have to concern themselves with over five hundred million people [including the] young, old, and ill. This is a huge enterprise, and one that is extremely important. Thus our responsibility weighs heavily…At present, doctors of Western medicine are few [10,000-20,000], and [thus] the broad masses of the people, and in particular the peasants, rely on Chinese medicine to treat illness. Therefore, we must strive for the complete unification of Chinese medicine. –Mao Zedong, 1950, quoted in Taylor (p. 33)

Taylor writes that there may have been 500,000 doctors of ‘Chinese Medicine’ at the time. It is tempting to conclude that Mao’s call for the ‘unification of Chinese medicine’ was a cynical way to make it appear that the Chinese Communist Party (CCP) could provide adequate health care in a much shorter time than would be required to train sufficient numbers of modern physicians and to build and equip modern facilities. This is undoubtedly true, but Taylor argues that there were additional considerations:

…Mao evidently saw the profession of Chinese medicine not so much as a therapeutic practice, but more as a large, and therefore significant, body of people. Mao’s support of Chinese medicine during this time can be linked to a concern for adequate health care manpower, and by extrapolation, to a concern for social stability. If the Chinese medical practitioners were ignored and not forcibly, as it were, integrated into the new Communist society, and if their medicine was not encouraged, it would mean hundreds of thousands of people would be without a livelihood. Including their dependents, this would mean that there would be hundreds of thousands of people without any means of support. It is likely that Mao interpreted the more serious problem to be one of economics, and the importance of keeping people usefully employed within society, rather than the dangers of supporting a potentially ineffective medicine. (Taylor, p. 35)

Mao also wrote:

Although we should have an all-round and correct understanding of Chinese medicine, Chinese medicine also has to transform itself. We must accept this slice of our old heritage critically. To look down upon Chinese medicine is not correct. To claim that everything about Chinese medicine is good, or too good, this is also not correct. Chinese and Western medicines must unite. (Mao Zedung, 1954, quoted in Taylor, p. 35)

Thus there was, according to Taylor, to be a ‘scientification’ of Chinese medicine. This did not mean ‘scientific’ in the familiar sense:

In Mao’s definition of this ‘new democratic culture’, he was to use three words which were to describe its development. These were ‘new’ (xin), ‘science’ (kexue), and ‘unity’ (tuanjie). The term ‘new’ implied free from superstition and the heavy links to a feudal past. Instead the components of the new culture would have to be forward moving and enterprising. Mao advocated that such a change would be possible through the use of ‘science’. By ‘science’ Mao was not so much referring to the science linked with the Western investigation of nature, but more to the Marxist ideal of science as the criteria for true knowledge. For Mao stated that ‘this type of new democratic culture is scientific. It is opposed to all feudal and superstitious ideas; it stands for seeking truth from facts, it stands for objective truth and for unity between theory and practice’. ‘Unity’ was the third criterion in the building up of a new China. Everybody had to join together and fight for the same cause, and this included all classes of Chinese society, from the upper bourgeoisie to the peasantry, so long as their beliefs were not against those of the Party. It also implied a unity of knowledge, and this had particular implications for the revolutionary intellectual. (Taylor, pp. 15-16)

In other words, as Mao later asserted,

In the future there will be only one medicine; that is to say a [single] medicine guided by the laws of dialectical materialism, and not two [separate] medicines. (Quoted in Taylor, p. 35)

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Posted in: Acupuncture, Book & movie reviews, Medical Academia, Science and Medicine

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Another Kind of Evolutionary Medicine

Last month I wrote about a book on evolutionary medicine that I could not recommend. Now I’ve found one I can recommend. Marlene Zuk, an evolutionary biologist at the University of California, Riverside, has written a delightful book entitled Riddled with Life: Friendly Worms, Ladybug Sex, and the Parasites That Make Us Who We Are. She describes how our parasites and diseases co-evolved with us: as we developed better defenses, they developed better weapons. “We do not choose to have them, but our lives are unimaginable without them, and for better or worse, they have made us who we are.” Parasites have altered our bodies in ways that science fiction filmmakers could never have imagined. She even suggests that we can thank parasites for the fact that we reproduce sexually rather than asexually.

She advocates an evolutionary medicine that “places diseases and defects in an evolutionary framework to make sense of the apparent mismatch between the way our bodies often work and the way we would like them to.” Evolution did not design our bodies for health, but to maximize reproduction.

“Just because our species evolved in a different environment does not mean …that following the ways of the past is automatically going to free us from the illnesses of modern life.” She incisively debunks the myth of the Paleolithic diet and points out that if we wanted to copy our hunter-gatherer ancestors we would have no way of deciding which ones to copy – the ones from 10,000 years ago or the ones from 100,000 years ago; the Inuits or the Kalahari Bushmen. She also points out that evolution explains why humans vary and why one diet won’t suit everyone. (more…)

Posted in: Book & movie reviews, Evolution

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Evolutionary Medicine

I have been asked to review a pre-publication proof of a book that will be published in May 2009: Evolution Rx: A Physician’s Guide to Harnessing Our Innate Capacity for Health and Healing by William Meller, MD. It offers “a primal yet radical new view of why we act and feel the way we do, why we get sick and how we heal. This new perspective, known as evolutionary medicine, looks at how our Stone Age ancestors lived, loved, got sick and got well over millions of years, which leads to guidelines for living longer healthier and happier lives today.”

He says we are the way we are because that’s what it took to adapt and survive throughout our evolutionary history. To some extent, that’s true, but that’s not the whole story. Sometimes we are the way we are because of an accident of evolutionary history that had no bearing on survival. Sometimes we are the way we are because a useless trait was linked to a useful one and came along for the ride – what Stephen Jay Gould referred to as “spandrels.”

The problem with evolutionary explanations is that we can never know for sure if they are true. We may be inventing “Just So Stories” like Rudyard Kipling’s “How the Camel Got His Hump.” Our explanation may seem perfectly reasonable but we may not have all the information and there may be a better explanation that simply doesn’t occur to us. (more…)

Posted in: Book & movie reviews, Evolution

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Book Review: Triumph Of The Heart, The Story Of Statins

Triumph of the Heart, as its name does not suggest, is about science. The book’s author, Jie Jack Li, is a medicinal chemist who meticulously reviews the history relevant to the discovery of lipid-lowering drugs. He spares no details, even recounting the amusing quarrels and quirks of the scientists engaged in the “apocryphal showdowns” leading to the manufacture of cholesterol in a laboratory.

The personalities of the various scientists and Nobel laureates described in the book are highly entertaining. From beating one another with umbrellas, to insisting on wearing blue clothing only, to egos so large and unappealing as to empty an entire academic center of all its promising young recruits, one has the distinct impression that brilliance does not go hand-in-hand with grace.

That being said, each of these scientists did seem to share a common approach to research: carefully testing hypotheses, repeating peer study results to confirm them, and patiently exploring complex biochemical pathways over periods of decades. The physicians, physicists, and chemists showed an incredible ability to doggedly pursue answers to specific questions – understanding that the results might influence human health. But even more importantly, they were each willing to invest their careers in analysis that may never lead to anything more than a dead end. In fact, the book is full of examples of great ideas, developed over decades, that did not lead to a marketable drug. In some cases the research was halted due to lack of efficacy, in others political forces or personal whims influenced the course.
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Posted in: Book & movie reviews, Pharmaceuticals

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Hyping Health Risks

Three kids on the same block were diagnosed with leukemia last year. That couldn’t happen just by chance, could it? There MUST be something in the environment that caused it (power lines, the chemical plant down the street, asbestos in their school, iPods, Twinkies?). Quick, let’s measure everything we can think of and compare exposures to other blocks and find an explanation.

That may be the common reaction, and it may seem plausible to the general public, but it’s not good science.

I have just read a book that does a great job of elucidating the pitfalls of epidemiologic studies, the problematic interface between science and emotion-laden public concerns, and the way environmental hazards have been hyped far beyond the evidence. Hyping Health Risks: Environmental Hazards in Daily Life and the Science of Epidemiology by Geoffrey C. Kabat.

He covers the uses, strengths and limitations of epidemiology, discusses the pros and cons of different study designs, and explains how to judge whether an association is causal.
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Posted in: Book & movie reviews, Science and the Media

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The China Study

One of our readers asked that we evaluate a book I had not previously heard of: The China Study: Startling Implications for Diet, Weight Loss and Long-Term Health, by nutrition researcher T. Colin Campbell, PhD, with his non-scientist son Thomas M. Campbell II. The China Study was an epidemiologic survey of diet and health conducted in villages throughout China and is touted as “the most comprehensive study of nutrition ever conducted.” The book’s major thesis is that we could prevent or cure most disease (heart disease, cancer, diabetes, autoimmune diseases, bone, kidney, eye and other diseases) by eating a whole foods plant-based diet, drastically reducing our protein intake, and avoiding meat and dairy products entirely.

Opinions of the book

There’s a lot of praise for this book on the Internet. It was named VegNews Book of the Year. PETA loves it (not surprisingly). Heather Mills McCartney calls it inspirational. It was featured on Oprah.com and endorsed by two of her favorite doctors: Mehmet Oz and Dean Ornish. Its author was even interviewed on Coast to Coast AM.

But I also found this critical review which makes some excellent points and accuses the authors of misrepresenting the findings of the study. And this commenter on an Amazon.com forum also charges Campbell with misrepresenting the data from the study and points out numerous flaws in his reasoning.

Problematic references

I didn’t look at the praise or criticism of others until after I read the book, and the following represents my independent impressions. I approached the book as I do any book with scientific references: I read until I come across a statement of fact that strikes me as questionable and then I check the references given for the statement. This immediately got me off on the wrong foot with this book. In the first chapter I found the statement:

Heart disease can be prevented and even reversed by a healthy diet. (more…)

Posted in: Book & movie reviews, Cancer, Nutrition

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Bad Books

In the interests of fairness and intellectual honesty, I’ve forced myself to read a lot of really bad books. The True Believer tells me his guru’s book is the Real Stuff. He tells me I have a closed mind and won’t look at anything outside establishment dogma, and if I only read the book and understood Dr. Quack’s evidence and arguments, I would be a True Believer too. I have tried, really I have. I’ve given the Dr. Quacks every chance to convert me, and I’ve hoped to learn something new, but I’m always disappointed. I’ve come to the point that I feel like I’m reading the same book over and over: it is always a mixture of real science, pseudoscience, and speculation, based on cherry-picked evidence and argued with the same logical fallacies.

I recently got hooked into reading another one by a correspondent who had called me an “ignorant relic” for writing a “grossly ignorant article” about alternative medicine. I suggested he read R. Barker Bausell’s book Snake Oil Science and a couple of others, which he promised to do. Then he said, “If I am willing to buy three books that you have suggested and read them and you are not willing to read what I have suggested, then that pretty much says all that needs to be said.”

I was willing, even though the very title of the book suggested that its message was incompatible with the scientific evidence as I know it: How to Prevent and Treat Cancer with Natural Medicine. The authors are big names in naturopathic and herbal medicine: Michael Murray, Tim Birdsall, Joseph Pizzorno, and Paul Riley. It’s nowhere near as bad as some of the bad books I’ve read, but it is a good example of the genre and I’ll use it to illustrate why I call them bad.

It offers “an arsenal of disease-fighting tools for prevention, treatment, and coping with side effects” (Yes, it offers tools; but do those tools work?) And it promises to “change your internal environment so cancer can’t survive.” (Wow! If it could really do that, every oncologist in the world would enthusiastically adopt these methods and the authors would be eligible for a Nobel prize.)
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Posted in: Book & movie reviews, Herbs & Supplements, Science and Medicine

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Edzard Ernst Does It Again

Publishing one excellent book is an accomplishment; publishing two in one year is a truly outstanding achievement. In 2008 Edzard Ernst and Simon Singh published a landmark book Trick or Treatment: The Undeniable Facts About Alternative Medicine. I reviewed it on this blog last summer.  It is particularly important since Ernst is a former advocate for CAM (complementary and alternative medicine) who was able to objectively look at the scientific evidence and realize that it doesn’t support most CAM methods.

Before the year was out, Ernst had published another book, Healing, Hype or Harm? A Critical Analysis of Complementary or Alternative Medicine. It is a compilation of essays on various general and specific topics in CAM. Ernst is the editor; he and 15 other authors have contributed, mostly from the UK but also including Asbjorn Hrobjartsson from the Nordic Cochrane Centre in Denmark (the author of a landmark paper on placebos), Canadian health activist Terry Polevoy, and our own inimitable James (The Amaz!ng) Randi.

In the preface, Ernst says,

Our book tries to look behind the various smoke screens that tend to obstruct our vision and often prevent us from understanding the truth. The authors of this volume have very different backgrounds and views but they are all well-informed critics who do not dismiss CAM lightly. If they disapprove of certain aspects, they do so for well-argued reasons. (more…)

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Where Does Sanjay Gupta Register On The Quackometer?

Four weeks ago I wrote a blog post about Sanjay Gupta’s nomination by the Obama administration as our potential new Surgeon General. Many of you voiced concerns about Sanjay’s nomination, specifically because of his poor handling of the Raelians’ Clonaid fiasco, his inability to counter Michael Moore’s health statistics as presented in Sicko and his relationship to the pharmaceutical industry.

As I wondered about what Sanjay Gupta might be like as Surgeon General – and specifically how he might assist in “restoring science to its rightful place” – I decided to educate myself about his thought processes by purchasing his recent book “Chasing Life.” The question I sought to answer was, “is Sanjay Gupta a crank?”

The short answer is: I’m not sure.  Although I wouldn’t go so far as to say that he is a crank, I think he’s more likely to be a shruggie. For those of you who haven’t read my post on shruggies, here’s the definition:

Shruggie (noun): a person who doesn’t care about the science versus pseudoscience debate. When presented with descriptions of exaggerated or fraudulent health claims or practices, their response is to shrug. Shruggies are fairly inert, they will not argue the merits (or lack thereof) of complementary and alternative medicine (CAM) or pseudoscience in general. They simply aren’t all that interested in the discussion, and are somewhat puzzled by those who are.

The longer answer involves an exploration of Gupta’s disturbing insistence on flirting with cranks, if it gets him publicity. The back cover of Chasing Life caries an endorsement from Deepak Chopra – and the inside page a favorable review from Andrew Weil. Normally, I would assume that the author of any book endorsed by those two would contain an intolerable blend of science and pseudoscience and refuse to read it. But for the sake of the readers of Science Based Medicine, I stifled my gag reflex and purchased the book. I hope that my sacrifice will benefit you all.
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Posted in: Book & movie reviews, Public Health, Science and the Media

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Reality Deniers

“You have an irrational belief in rational thought.” ~Dr David Scholes, directed towards me.

“Humankind cannot bear very much reality.” ~T.S. Eliot

I just finished the book Mathematical Cranks by Underwood Dudley, part of a trifecta of skeptical mathematics books.

Doctor Dudley is a professor of mathematics at Depau University and a connoisseur of cranks with a mathematical bent.

What is a mathematical crank?

Mathematics is a peculiar field. Whether or not some aspects of mathematics exist independent of humans is an ongoing debate, but within its axioms and proofs is a consistent body of well defined, internally consistent knowledge.

Within that knowledge, ideas can, under the rules of mathematics and logic, can be proved or disproved, to be absolutely true or false or to be impossible.

No prior plausibility that pester the world of scientific medicine and the evaluation of woo. No borderline p values that hint at effects. No biologic variability. No placebo effect. No investigator or patient bias. No placebo effect. No N rays. No unproven water memory or meridians or subluxations.

Just clean, beautiful, mathematics. True or false. Possible or impossible. I simplify a bit, but mathematics, especially at the lower levels, is an internally consistent field of study. What happens in the math of 11 dimension string theory is beyond my puny intellect.

In mathematics there are things that are impossible. Absolutely impossible. No ifs, ands, or buts. Impossible. Can’t be done no how no way. In the world of mathematics, things are not only impossible, they are proven truly impossible within the boundaries of the mathematical discipline.

An example of mathematical impossibility is the quadrature of the circle, also called squaring the circle.

It is impossible, using only a straight edge ruler and a compass, to construct a square with the same area as a given circle. It was proved to be impossible in 1882 by Lindeman. Not improbable or unlikely or very, very, very difficult. With in mathematical reality, it is impossible.

Just because it is impossible does not prevent people from attempting to square the circle. They send these ‘proofs’ to mathematicians for comment.
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