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Why People Continue to use SCAMs

Rodin's The Thinker
I remain curious as to why people use, and continue to use, useless pseudo-medicines. I read the literature, but I find the papers unsatisfactory. They seem incomplete, and I suspect there are as many reasons people choose a pseudo-medicine as those use them.

There are numerous surveys on what SCAMs people use. Designing and offering these surveys to every possible medical condition is a growth industry: the old, the young, cancer patients, AIDS patients. All need be asked which SCAM they use. It seems to be a ready way to get a quick entry in your CV, but which SCAM is used does not speak to the why a particular SCAM is being used. Why try acupunctures, say, instead of reflexology?

There are numerous reasons suggested for why people partake of SCAMS as a general concept: dissatisfaction with standard medical care is a common one but is not always supported in the literature. Gullibility, ignorance, and stupidity are often credited, none of them are particularly valid. Dr. Novella covered the topic in 2012. There is some data to suggest that which SCAM and why is a moving target, changing over time. (more…)

Posted in: Basic Science, Critical Thinking

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NY federal court hands triple loss to anti-vaccination ideology

vacccine preventable disease plane ride away

The state of New York allows religious and medical (but not philosophical) exemptions from school vaccination mandates. New York City has a policy of excluding unvaccinated schoolchildren from classes when there is an outbreak of vaccine-preventable disease reported in a particular school. Two sets of parents whose children had religious exemptions sued New York City and the state in federal court when their children were temporarily excluded from school under the policy, in some cases for up to a month. In other words, they were demanding that their unvaccinated children be allowed to attend even though there was an outbreak of vaccine-preventable disease at the school.

These cases were consolidated with another filed by parents, the Checks, who claimed their child had been improperly denied a religious exemption. The parents had applied for a medical exemption, which was denied, as well as a religious exemption, which was granted, but then revoked. (The record is somewhat confusing on this sequence of events, but that sequence is not relevant to our discussion.) The unvaccinated child was ultimately sent to a private school, even though she should have been excluded from admission under New York City law there as well.

Last week, a federal judge dismissed all three cases (they had been consolidated and assigned to one judge) in an opinion holding that neither the students’ nor the parents’ constitutional rights were violated, including their First Amendment right to free exercise of religion. The plaintiffs have filed an appeal. (more…)

Posted in: Critical Thinking, Legal, Politics and Regulation, Public Health, Religion, Vaccines

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More Dialogs

There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. JAMA

Just just because there are flaws in aircraft design that doesn’t mean flying carpets exist. Ben Goldacre

Wiser heads than I have commented on “Invitation to a Dialogue: Alternative Therapies” in The New York Times. So why add my two cents? Partly because The New York Times wanted brief responses and I don’t do brief. Partly because I write for me; nothing focuses the mind like putting electrons to LCD, except, perhaps, a hanging. Partly we do need a dialog, just not of the kind suggested by the writer. And partly, life has been so busy of late I needed a topic that required no research. (more…)

Posted in: Basic Science, Clinical Trials, Critical Thinking, Science and Medicine

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The false dilemma of David Katz: Abandon patients or abandon science

Dr. David L. Katz is apparently unhappy with me. You remember Dr. Katz, don’t you? If you don’t, I’ll remind you momentarily. If you do, you won’t be surprised. Let me explain a bit first how Dr. Katz recently became aware of me again.

Last week, I posted a short (for me) piece about something that disturbed both Steve Novella and myself, namely Traditional Chinese herbalism at the Cleveland Clinic? What happened to science-based medicine? Steve had blogged about it as well a couple of days earlier. In actuality, it was a post that had originally appeared at my not-so-super-secret other blog, and, in my characteristically slightly arrogant way, I thought it was good enough that it deserved to be showcased here at Science-Based Medicine. To my surprise, Maithri Vengala over at The Healthcare Blog noticed and asked me if I would mind letting her post it over there. Never being one to turn down a request to showcase my work to a wider (or at least different) audience, I gave her my permission. The result was that my post ended up being published here, and I thought nothing more of it.

Until yesterday, that is.

Yesterday, thanks to the magic of Google Alerts, I became aware that Dr. David Katz was very unhappy with my post. At the very least, he strongly disagreed with it, so much so that he felt the need to respond. Naturally, he chose as his venue The Huffington Post, which is well known as a bastion of quackery, antivaccine pseudoscience, and Deepak Chopra-inspired magical thinking, to respond. Indeed, so bad is HuffPo (as it’s “nicknamed”) that Steve Novella and I have both referred to it as waging a “war on medical science,” and HuffPo has been a frequent topic of discussion on this very blog for its abysmal record of publishing pseudoscience, a record that goes back to its very beginning in 2005, when antivaccinationists flocked to the fledgling blog and news site. And that doesn’t even count all the nonsense from Deepak Chopra and even promotion of outright cancer quackery.
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Posted in: Critical Thinking, Energy Medicine, Herbs & Supplements, Traditional Chinese Medicine

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Cochrane Reviews: The Food Babe of Medicine?

There are two topics about which I know a fair amount. The first is Infectious Disease. I am expert in ID, Board Certified and certified bored, by the ABIM. The other, although to a lesser extent, is SCAMs.

When I read the literature on these topics, I do so with extensive knowledge and, in the case of ID, 30 years of clinical experience. The extensive knowledge, and, one hopes, understanding, has led me to read meta-analyses with a grain of salt substitute. They average meta-analysis and systematic review is good for gaining a general understanding of the topic within, as well as, and here is the key phrase, the limitations of the included studies.

And like all the published literature, when writing a meta-analysis, those with an axe to grind will grind it. Even, or perhaps especially, the Cochrane reviews.

Just because something is labelled as a systematic review does not mean it is any good. We have to be just as vigilant now as ever. Even a review with a Cochrane label does not make its true. Four out of 12 Cochrane reviews on acupuncture were wrong. Caveat lector rules, OK? (more…)

Posted in: Basic Science, Clinical Trials, Critical Thinking, Pharmaceuticals, Science and Medicine

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How “they” view “us”

Over the weekend, I was perusing my Google Alerts, along with various blogs and news websites, looking for my weekly topic, when I noticed a disturbance in the pseudoscience Force. It’s a phenomenon I’ve noticed many times before, but, as far as I can tell, I haven’t actually blogged about it here, at least not specifically, although I have mentioned it, particularly in posts about Stanislaw Burzynski. I have, however, blogged about it over at my not-so-super-secret other blog, which means that some of the thoughts (if you can call them that) that I plan to lay down in this post will likely seem familiar to some of you, but I think this is an important enough topic that I should cover it here, too. As arrogant as I might sometimes seem, even I’m not so deluded as to think that the fraction of SBM readers who are regulars at my not-so-super-secret other blog is anything greater than a clear minority, and even for those of you for whom there’s overlap I’ll try to make things different enough to be interesting.

On Friday, Sharon Hill published a post over at Doubtful News entitled Chiropractors get their spine out of place over critique. It’s about how chiropractors have reacted to a post by Steve Salzberg over at Forbes entitled New Medicare Data Reveal Startling $496 Million Wasted On Chiropractors. Salzberg’s blog post was basically about just that, namely the amount of money billed Medicare by chiropractors, information that’s possible to obtain since the government released Medicare billing data for individual practitioners. Salzberg pointed out that half a billion dollars is a lot of money, more than twice as much as what is wasted every year on the National Center for Complementary and Alternative Medicine (NCCAM) and the National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine (OCCAM). The result was rapid. Chiropractors swarmed, complaining to Forbes.com, and making the usual threats to sue, much as they actually did sue Simon Singh and, fortunately, saw their lawsuit blow up in their faces.

This, of course, can be looked upon as a purely mercenary protection of turf and livelihood not unlike how Daniel Kopans attacks any study that finds mammography to be less effective than thought (or even ineffective) in decreasing deaths from breast cancer. There is, however, a form of backlash against criticism of pseudoscience that is different and, when I first encountered it, more disturbing to deal with. It’s a level of pure, visceral hatred that is difficult to understand; that is, until you try to put yourself into your “enemy’s” shoes. Consider this post an exercise in doing just that, an exercise that will no doubt shock at least one of our readers.
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Posted in: Cancer, Chiropractic, Critical Thinking, Genetically modified organisms (GMOs), Science and the Media, Vaccines

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What Whole Foods Markets Doesn’t Tell You

Whole Foods Market is a relentlessly hip American supermarket chain which prides itself on organic fruits and vegetables, gluten-free just-about-everything, and high-end touches like wine bars and exotic take out items (roasted yucca, anyone?). The health products aisle is stocked with Bach Flower and homeopathic remedies. For example, in-house brand Flu Ease: “an established homeopathic formula that should be taken at the first sign of flu for temporary relief of symptoms including fever chills and body aches.”

Selling Flu Ease and like products certainly exhibits a lack of appreciation for scientific evidence, not to mention basic science. But I recently saw a product in the checkout line that was so filled with over-the-top quackery and so shocking in its disregard for the public’s health that I haven’t been back to Whole Foods since. And I won’t be going back.

The product? A glossy, slickly-produced magazine with the conspiracy-minded title What Doctors Don’t Tell You. The April 2014 issue promises, in banner-headline font size, a “New Light on Cancer.” It features the well-known symbol of fighting breast cancer, a loop of pink ribbon, but with a tear in the middle of the loop. We’ll look into this “new light” in a bit.

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Posted in: Cancer, Critical Thinking, Faith Healing & Spirituality, Health Fraud, Herbs & Supplements, Homeopathy, Nutrition, Science and the Media

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Amber Waves of Woo

As a pediatrician I have an opportunity to observe a wide variety of unusual and sometimes alarming parental efforts meant to help children through illness or keep them well. I have recently noticed one particular intervention that seems to be becoming more prevalent, at least in my practice. I’ve begun to see more and more infants sporting Baltic amber teething necklaces. These consist of multiple small beads of amber on a string that is worn around a baby’s neck, and are supposed to relieve the discomfort of teething. Before I had any idea what these necklaces were for or how they were supposed to work, my first reaction was to inform these parents of the dangers of necklaces or anything placed around an infant’s or young child’s neck. Strangulation is a known cause of accidental injury and death in children, and pediatricians are trained to discuss this as part of the routine anticipatory guidance we give to parents. In addition, we strongly advise against giving infants or young children any small items that could be accidentally aspirated, such as the beads found in a necklace of this sort. But I was equally surprised to learn that these necklaces are not intended for babies to chew or gum. Instead, they are supposed to ease a baby’s teething discomfort simply by lying against the skin.

I will not discuss teething here, or the many myths that surround it; that was well covered in a previous post. I will reiterate that there is little-to-no evidence that the majority of concerns parents have about teething are actually due to teething, including fever and diarrhea. The irritability associated with teething also tends to wax and wane for only several days before and after the emergence of a tooth. But let’s assume for the moment that these necklaces actually work to ease the discomfort of teething, and whatever other problems parents tend to associate with the long period of time during which infants and young children develop their teeth. Assuming these necklaces work as recounted in the glowing testimonials on countless websites and parent blogs, how do they produce their dramatic results?
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Posted in: Critical Thinking, Energy Medicine, Health Fraud, Herbs & Supplements, Pharmaceuticals

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Agnotology: The Study of Ignorance

A comment from the blog:

Every single time – bar none – I have had a conversation with someone about CAM and its modalities, they are absolutely astonished when I explain to them what the modality really is. One story I love telling comes from my friend in the year behind me. His parents are professional chemists and he came home one day and saw his mother had a bottle of homeopathic medicine. He asked why and she gave the typical non-committal response of “well, I thought it may help and I saw it on the shelf at the pharmacy.” He explained what homeopathy actually is and they were absolutely dumbfounded. They are well aware of Avogadro’s number, after all. People generally don’t study what the CAM in question actually is – merely the fluff PR garbage that gets touted around and without direct and clear demonstration of harm, give it a pass as a result. After all, the business of real medicine is time consuming and difficult enough.

Participating in activities that have a permanent record gives one the fortunate, or unfortunate, opportunity to revisit the past and see just how you worked early in a career. (more…)

Posted in: Critical Thinking, Naturopathy, Science and Medicine

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How to Think

Robert Todd Carroll, the author of The Skeptic’s Dictionary, has a new book out: The Critical Thinker’s Dictionary: Biases, Fallacies, and Illusion and what you can do about them. Since some of our commenters and most of the CAM advocates we critique are constantly committing logical fallacies, a survey of logical fallacies is a good idea both for us and for them, and this book fits the bill.

When I received the book in the mail, I set it aside, thinking it would be a somewhat boring listing of things I already knew. When I finally got around to reading it, I was surprised and delighted. It held my interest, reminded me of things I had forgotten, explained other things I had never heard of, and provided entertaining stories to illustrate each point. Best of all, the bulk of his examples are taken from medicine and relate directly to the topics we discuss on SBM.

Carroll is well-qualified to write about logical fallacies: he is a retired professor of philosophy who has long promoted skepticism and taught classes in critical thinking, and he writes in an entertaining, accessible style. He started The Skeptic’s Dictionary website in 1994 with 50 articles and it has now grown to several hundred articles. It attracts more than a million visitors a month, and some of its entries have been translated into more than a dozen languages. It has become a go-to reference for anyone seeking the facts on questionable claims about everything from crop circles to homeopathy. Its articles are thorough and well documented with lots of references and links. (more…)

Posted in: Book & movie reviews, Critical Thinking

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