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SCAMlandia

I quite like Portlandia. I find it funny and it captures a part of Portland. I recognize large swaths of the city’s culture in the show. Other representations of the city I recognize less. Sunset publishes beautiful photographs of the NW, but when I look at the photos I think, that section of the city never looks that good. It is quite wonderful how Photoshop can improve on reality.

Like most major cities, Portland has a monthly magazine, Portland Monthly. The city represented in that magazine is mostly alien to me. I look at the advertisement, the articles, the photographs, and wonder when did Portland become a city with an average 7 figure income? The Portland in which I grew up and currently live is rarely found in the pages of Portland Monthly. If you are extremely well to do, I suppose you are in the demographic Portland Monthly. But when I flip through the pages of the magazine, I see little I recognize, but I have never completely abandoned the hippie/grunge aesthetic of my younger days.

Every January they have the best Doctors issue* and this year, for the first time, they offer The Portland Alternative Medicine Guide. Well, less a guide and more an extended infomercial filled with ‘facts’ that deserve the quotes. (more…)

Posted in: Acupuncture, Chiropractic, Dentistry, Energy Medicine, Homeopathy, Legal, Naturopathy, Politics and Regulation, Science and Medicine, Traditional Chinese Medicine

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Bodytalk: Medical theater

If there were an icon of Science-Based Medicine, I think it should be Sisyphus: pushing a boulder uphill, only to watch it roll down again. Forever. Blogging about pseudoscience in medicine can feel that way at times. There is no end to the variations of nonsense, most health professionals are indifferent at best, and sometimes I wonder if blogging is just preaching to the converted. Compared to the media presence and web traffic of those that promote pseudoscence, I do wonder what to make of SBM. Does it have a bigger impact. Occasionally something comes along to give you some hope that the key concepts of SBM are having some resonance.

To effect meaningful change, we need to teach the concepts of SBM -  the process is the product, not the topics we blog about. This all came to mind as I was reading an open letter from TED organizers. TED talks are now iconic, but if you’re unfamiliar with them, the conferences started as a means of colliding speakers in the technology, entertainment and design fields to talk about big ideas. With a slogan of “ideas worth spreading,” perhaps it’s not surprising that TED talks can be provocative: that’s the point. TED talks are posted online and their success is remarkable: some talks get hundreds of thousands of views. The TED template has become so popular that it spawned TEDx, independent but licensed events that bring TED-like talks to smaller cities and venues. I’ve seen several TED talks and while many are compelling speakers, it’s clear the content is not always grounded in evidence. For all the talks by science advocates like Ben Goldacre, or James Randi, there’s the consciousnessbabble from Deepak Chopra. I’ve never seen TEDx presentations, but recently there’s been some very public criticism of its speaker standards. Anyone, it seems, can be a TEDx speaker including anti-GMO crusaders and naturopaths. Stung by recent criticism that the TED brand is losing credibility with its questionable presenters, TED HQ recently advised TEDx organizers to stop featuring pseudosicence:

It is your job, before any speaker is booked, to check them out, and to reject bad science, pseudoscience and health hoaxes.
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Posted in: Energy Medicine

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Energy Medicine – Noise-Based Pseudoscience

So-called complementary and alternative medicine (CAM) is largely philosophy-based medicine rather than science based. There are a few core concepts that are endlessly recycled in various forms, but it is mythology and culture, not grounded in the rigorous methods of science that allow us to tell the difference between our satisfying fantasies and hard reality. Sometimes proponents of such philosophies try to cloak their beliefs in the appearance of science, resulting in what we simply call pseudoscience.

Harriet Hall coined an excellent term to refer to such pseudoscience -” Tooth Fairy science.” In her metaphor, pseudoscientists sometimes act like scientists by describing the details and statistics of their claimed phenomenon (such as examining all the details of the Tooth Fairy phenomenon) without ever testing the reality of the phenomenon itself. The fundamental concept at the core of their belief is never challenged, or only superficially so, and they proceed prematurely from their faulty premise.

Another term that I find extremely apt is “Cargo Cult science,” a term coined by Richard Feynman. This is a reference to the cargo cults of New Guinea – the pre-industrial tribes were observed building straw mock-ups of control towers, planes, and runways in hopes that the planes they observed flying over head would deliver their cargo to them. In other words – the cargo cults mimicked the superficial appearance of an aviation infrastructure but had none of the real essence or function (because of lack of understanding). This is a perfect analogy to much of what passes for science within the world of CAM.

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Posted in: Energy Medicine, Science and Medicine

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Down the Virtual Rabbit Hole

The interwebs are more than a series of tubes, it has the power of endless distraction and tangents, a series of clickable rabbit holes that can drag you deeper and deeper into the alternative universes that are parallel with our own. One moment you can be on Science Based Medicine, grounded on the terra firma of reality, and then with a click of the mouse you can lose your way in the electronic warren.

It started as an advertisement on a skeptical website, perhaps SBM, perhaps not. The entrances to rabbit holes are Hogwartian in nature, never being in the same place twice. It is how I remember it.

Google serves up ads based on what their algorithm perceives as the content of the website. The algorithm lacks a certain, shall we say, nuance, and fails to understand that advertisements suggesting training in homeopathy or the promoting the practice of chiropractic may not have a close relationship to the content of Science Based Medicine. Still the ad did intrigue me, as it mentioned that the practitioner was Oregon’s only MD Acupuncturist. So I clicked. (more…)

Posted in: Energy Medicine, Herbs & Supplements, Humor

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Journal of Clinical Oncology editorial: “Compelling” evidence acupuncture “may be” effective for cancer related fatigue

Journal of Clinical Oncology (JCO) is a high impact journal (JIF > 16)  that advertises itself as a “must read” for oncologists. Some cutting edge RCTs evaluating chemo and hormonal therapies have appeared there. But a past blog post gave dramatic examples of pseudoscience and plain nonsense to be found in JCO concerning psychoneuroimmunology (PNI) and, increasingly, integrative medicine and even integrations of integrative medicine and PNI. The prestige of JCO has made it a major focus for efforts to secure respectability and third-party payments for CAM treatments by promoting their scientific status and effectiveness.

Once articles are published in JCO, authors can escape critical commentary by simply refusing to respond, taking advantage of an editorial policy that requires a response in order for critical commentaries to be published. An author’s refusal to respond means criticism cannot be published.

Some of the most outrageous incursions of woo science into JCO are accompanied by editorials that enjoy further relaxation of any editorial restraint  and peer review. Accompanying editorials are a form of privileged access publishing, often written by reviewers who have strongly recommended the article for publication, and having their own PNI and CAM studies to promote with citation in JCO.

Because of strict space limitations, controversial statements can simply be declared, rather than elaborated in arguments in which holes could be poked. A faux authority is created. Once claims make it into JCO, their sources are forgotten and only the appearance a “must read,” high impact journal is remembered. A shoddy form of scholarship becomes possible in which JCO can be cited for statements that would be recognized as ridiculous if accompanied by a citation of the origin in a CAM journal. And what readers track down and examine original sources for numbered citations, anyway?
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Posted in: Acupuncture, Cancer, Clinical Trials, Energy Medicine, Neuroscience/Mental Health, Traditional Chinese Medicine

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Don’t call CAM “cost-effective” unless it’s actually effective

Your health insurance plan probably covers anti-inflammatory drugs. But does it cover acupuncture treatments? Should it? Which health services deliver good value for money? Lest you think the debate is limited to the United States (which is an outlier when it comes to health spending), even countries with publicly-run healthcare systems are scrutinizing spending. Devoting dollars to one area (say, hospitals) is effectively a decision not to spend on something else, (perhaps public health programs). All systems, be they public or private, allocate funds in ways to spend money in the most efficient way possible. Thoughtful decisions require a consideration of both benefits and costs.

One of the consistent positions put forward by contributors to this blog is that all health interventions should be evaluated based on the same evidence standard. From this perspective, there is no distinct basket of products and services which are labelled “alternative”, “complementary” or more recently “integrative”. There are only treatments and interventions which have been evaluated to be effective, and those that have not. The idea that these two categories should both be considered valid approaches is a testament to promoters of complementary and alternative medicine (CAM), who, unable to meet the scientific standard, have argued (largely successfully) for different standards and special consideration — be it product regulation (e.g., supplements) or practitioner regulation.

Yet promoters of CAM seek the imprimatur of legitimacy conferred by the tools of science. And in an environment of economic restraint in health spending, they further recognize that showing economic value of CAM is important. Consequently they use the tools of economics to argue a perspective, rather than answer a question. And that’s the case with a recent paper I noticed was being touted by alternative medicine practitioners. Entitled, Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations, it attempts to summarize economic evaluations conducted on CAM treatments. Why a systematic review? One of the more effective tools for evaluating health outcomes, a systematic review seeks to analyze all published (and unpublished) information on a focused question, using a standardized, transparent approach to evidence analysis. When done well, systematic reviews can sift through thousands of clinical trials to answer focused questions in ways that are less biased than cherry-picking individual studies. The Cochrane Review’s systematic reviews form one of the more respected sources of objective information (with some caveats) on the efficacy of different health interventions. So there’s been interest in applying the techniques of systematic reviews to questions of economics, where both costs and effects must be measured. Economic evaluations at their core seek to measure the “bang for the buck” of different health interventions. The most accurate economic analyses are built into prospective clinical trials. These studies collect real-world costs and patient consequences, and then allow an accurate evaluation of value-for-money. These types of analyses are rare, however. Most economic evaluations involve modelling (a little to a lot) where health effects and related costs are estimated, to arrive at a calculation of value. Then there’s a discussion of whether that value calculation is “cost-effective”. It’s little wonder that many health professionals look suspiciously at economic analyses: the models are complicated and involve so many variables with subjective inputs that it can be difficult to sort out what the real effects are. Not surprisingly, most economic analyses suggest treatments are cost-effective. Before diving into the study, let’s consider the approach:

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Posted in: Acupuncture, Chiropractic, Energy Medicine, Herbs & Supplements, Homeopathy, Naturopathy, Science and Medicine

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Low Level Lasers: N-Rays in action.

I do not want to get all angsty and omphaloskeptic, but I have been thinking more of late about the purpose of the blog and my role in it.  Blogs,and the people who write them,  are ephemeral.  It takes a unique personality and commitment to churn out these essays and commit them to the ether.  Especially since Michelson and Morley.

I have never given much thought as to who our readers are, at least as a composite.  I read most of the comments on every entry and have certainly developed a mental picture of some of our regular commenters, although I suspect I probably do not have even the gender correct most of the time.  The commenters represent a tiny fraction of the regular readers and an even smaller fraction of occasional readers.  It occurs to me I haven’t a clue who the real audience of this blog is.

I write  first for my own education and entertainment, then for the slightly bored and overwhelmed medicine resident, since that is who I spend most of my time educating at work.  Someone educated with an understanding of basic medicine but has more important things on their mind than a need for a detailed understanding of why homeopathy is complete nonsense.  I doubt the majority of my readers are health care workers and I suspect  continuing medical education is not a major part of the blog.

I never considered SBM to be a consumer protection group, but this week my wife showed me a half page advertisement in the local paper, and I realized that not only was the advertisement a good topic for blogging, but consumer protection is a fundamental result of this blog.  There really is no site on the interweb that looks at both SCAM and real medicine with quite the same skeptical eye.  Here is the headline:

A Special Wellness Report

New Medicine Based On An 88- Year Old Theory By Albert Einstein Can Help Almost Everyone Who Is Sick Or Injured! (more…)

Posted in: Basic Science, Energy Medicine, Health Fraud, Science and Medicine, Science and the Media

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Vital Signs

As I have mentioned in the past, almost all of my practice is inpatient medicine, doing infectious disease consults in acute care hospitals. I only spend three hours a week in the outpatient clinic, so I have a skewed perception of medicine and disease. The patients I see are sick, really sick, often trying to die and are a complicated collection of abnormal labs and deranged physiology.

I remember finishing residency thinking that a potassium of 2.8, a hemoglobin of 9.8 or a bilirubin of 4.5 wasn’t all that bad, losing track of normal physiology amongst all the medical pathology. I never did lose track of normal vital signs (VS): pulse, respiration, blood pressure and temperature. Like trying to be the fifth Beatle, over the years other values have vied to become the fifth vital sign: pain level or O2 saturation, but none have the importance of the fab four. I can live without pain*, but I can’t live long if the other vital signs are abnormal for extended periods of time. Watching the vital signs return to normal is often an important variable that signifies the patient is improving. (more…)

Posted in: Energy Medicine, Faith Healing & Spirituality, Science and Medicine

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What Would It Take?

I recently wrote a SkepDoc column on fantasy physics in Skeptic magazine in which I mentioned a study that had allegedly measured 2 milligauss emanations from a healer’s hands. A reader inquired about it and went on to ask “what criteria is [sic] necessary for gaining acceptance in the scientific community in regards to purported healing processes using energy fields generated in the human hand, specifically the palm area.”

What would it take to prove this implausible claim to the satisfaction of the scientific community? That is an excellent question with a complicated answer. It’s worth looking at because there is only one science and the same standards apply to how science evaluates any claim. I’ll take a stab at it, and perhaps our commenters can add words of wisdom.

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Posted in: Energy Medicine

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There’s an app for that ?!?

There is no shortage of technology in my household: computers, smart phones and tablets of one kind or another. The nice thing about being a blogger and an app developer is I can justify it all. Well, mostly. The “It’s probably tax deductible” gambit can only be used so many times. It is remarkable how much of my life is filtered through the digital lens. I think if google glasses ever become a reality, my kids and I will be the first up to be permanently wired into the world. To my way of thinking, the Daemon haunted world looks like hog heaven.

There is an app for just about anything, many of which feed into my OCD. I keep track of my daily walk and I have walked over 1500 miles since July 1, 2011. When I developed my middle aged bloat I had the option of medications to control the metabolic results or lose some damn weight. Losing weight is simple in concept, hard in execution. Take in fewer calories than you expend and the weight will slowly, ever so maple bar free slowly, come off. It took 9 months to drop the 45 pounds needed, and I must say I feel just as old and creaky as I did before, but my labs are better. The opposite of the placebo effect: I am subjectively the same but am objectively better. I’ll take it.  One of the cool features of the app I used, and still use, for calorie management is that it will take a picture of the bar code of food and give you the nutritional information for entry in the program. Amazing.

A fellow bugdoc sent me a link to story about Chinese Tongue diagnosis. The journal article has been accepted for publication as Automated Tongue Feature Extraction for ZHENG Classification in Traditional Chinese Medicine 

It is as fine a piece of tooth fairy science and tooth fairy engineering as I have ever encountered. (more…)

Posted in: Energy Medicine, Science and Medicine, Traditional Chinese Medicine

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