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HIV Denial and “Just Asking Questions”

The “just asking questions” maneuver is familiar to many skeptics. The idea is to feign neutrality, to insulate oneself from accountability or being held to answer for any specific position, but meanwhile to sow doubt about a scientific claim by raising (dubious) questions.

Sometimes the “I’m just asking questions” gambit also tries to disguise itself as sincere journalism. That’s what journalists do, right, ask the tough questions, uncover the uncomfortable truth?

I find this approach particularly deceptive. It tries to hide the fact that the journalist is working off of a particular narrative. Asking questions is, in fact, just another narrative style, one that is meant to lead the reader/viewer to a particular conclusion about the subject. The narrative determines what questions are asked and how they are answered.

A perfect example of this deceptive approach is the HIV denialist movie, House of Numbers. Here is the synopsis from the movie’s website:

What is HIV? What is AIDS? What is being done to cure it? These questions sent Canadian filmmaker Brent Leung on a worldwide journey, from the highest echelons of the medical research establishment to the slums of South Africa, where death and disease are the order of the day. In this up-to-the-minute documentary, he observes that although AIDS has been front-page news for over 29 years, it is barely understood. Despite the great effort, time, and money spent, no cure is in sight.

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Doctors Are Not “Only Out to Make Money”

There’s an old joke about the doctor whose son graduates from medical school and joins his practice. After a while the son tells his father, “You know old Mrs. Jones? You’ve been treating her rash for years and she never got better. I prescribed a new steroid cream and her rash is gone!” The father responds, “You idiot! That rash put you through medical school.”

That’s a joke. It doesn’t reflect reality, but it reinforces a common misconception that doctors care more about their own income than about their patient’s outcome. That accusation is demonstrably untrue.

I’m sick and tired of all the doctor-bashing. They accuse us of being shills for Big Pharma. They say “Doctors are only out to make money.” Or “Doctors are greedy bastards only interested in the bottom line.” Or as one of our commenters recently put it: “First do no harm. Second ? Third, profit [sic]” Some have even made the ridiculous accusation that doctors have found the cure for cancer but have suppressed the information so as to keep people sick and increase their business. If profit were really their primary motivation, doctors would have to be astoundingly clueless, because they keep doing things that are guaranteed to reduce their profits. (more…)

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You can’t beat the common cold, and that’s a fact

>> Disclaimer: nothing in this post is meant to be taken as medical advice. Always consult your own provider.

For those of us dedicated to supporting science-based medicine and fighting the ever-widening reach of sCAM, pseudoscience, and health fraud, finding a new woo-filled claim or a dangerous, evidence-lacking trend to write about is relatively easy. Many of us may not realize, however, that some of the most commonly used and recommended treatments, one of which at least is probably sitting in your medicine cabinet as you read this, is equally devoid of evidence to support its use.

Every drug store has row upon row of medicines designed to treat or prevent an acute upper respiratory tract infection, otherwise known as the common cold. Despite this, very few are able to live up to their promise. In most cases, particularly where children are concerned, the side effects of these medicines can be worse than the symptoms they are intended to treat. Because I am a pediatrician, and because the evidence for cough and cold medicines (I will refer to them here as CCMs) for children is particularly absent and because adverse events due to CCMs are most frequently seen in children, I will focus mainly on this population. (more…)

Posted in: General, Pharmaceuticals, Science and Medicine

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How to Talk to People About CAM

Recently a correspondent asked me for advice about his parents. He said they use things like homeopathy, acupuncture, and copper bracelets. They use conventional medicine too, but it seems to be a 50/50 approach that gives each an equal weighting. He has tried to talk to them about things like homeopathy and the placebo effect, but the shutters come down hard and fast. He tries to criticize the alternative treatment itself without offending or attacking the person, but his mother still sees it as a personal attack. He worries that as they get older and in need of more medical care, his parents may not make the best decisions. He asks about how to tactfully have these conversations and perhaps change their point of view.

That’s a very tough question that gets asked a lot, and I don’t have any good answers; but I do have some thoughts and untested ideas that could serve as the starting point for a discussion, and I hope readers will pipe up in the comments and tell us what has or hasn’t worked for them. (more…)

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Candida and Fake Illnesses

Savvy consumers have learned over the years that the primary goal of marketing is to create demand for a product or service. This has risen to the point of inventing problems that do not really exist just to sell a product that addresses the fake problem. Who knew that my social status could be destroyed by spotty glassware.

Better yet, if you can make people worry about a nonexistent problem, something that they were not previously aware of and don’t understand, they might buy your solution just to relieve their worry.

This type of “artificial demand” marketing can be very insidious when it occurs with medical products and services. The pharmaceutical industry has been accused of generating artificial demand for some of their drugs. For example, osteopenia is a relative decrease in bone density, but not enough to qualify for osteoporosis. Osteopenia is not really a disease, or even necessarily a mild version of osteoporosis, although it is a risk factor. Merck, however, was happy to broaden the market for its drug for osteoporosis and argue that patients with osteopenia should be treated also, even though the evidence really did not support this.

Sometimes the accusations are flat-out wrong. GSK has been accused of inventing restless leg syndrome (RLS) to sell a failed Parkinson’s drug. In fact the drugs used for RLS are successful Parkinson’s drugs. Further, I found references to RLS in neurology texts going back over 50 years, and there were even older references although not using the same name.

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A Skeptical Look at Screening Tests

I’m going to follow Mark Crislip’s example and recycle my presentation from The Amazing Meeting last week, not because I’m lazy or short on time (although I am both), but because I think the information is worth sharing with a larger audience.

We’ve all had screening tests and we’re all likely to have more of them, but there is a lot of misinformation and misunderstanding about what screening tests can and can’t do. Screening tests are done on populations of asymptomatic people and must be distinguished from diagnostic tests done on individual patients who have symptoms. Some tests are excellent for diagnostic purposes but are not appropriate for screening purposes.

We’re constantly being admonished to get tested for one thing or another. A typical example was a recent Dear Abby column. She got a letter from a woman who had been screened for kidney disease and learned that she had a mild decrease in kidney function. Abby was shocked to learn that 26 million Americans have chronic kidney disease, and she advised her readers to get their kidneys checked. This was terrible advice. It superficially seems like good advice, because if you have something wrong with your kidneys, you’d want to know about it, right? In fact, if there was anything wrong anywhere in your body, you’d want to know about it. By that logic, it might seem advisable to test everyone for everything. But that would be stupid. It would find lots of false positives, it would create anxiety by picking up harmless variants and anomalies that never would have caused problems, it would be expensive, and it would do more harm than good.
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Posted in: Cancer, General

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Kombucha: A symbiotic mix of yeast, bacteria and the naturalistic fallacy

Kombucha

 

If you grew up in the seventies, you may remember the same food fads as I do. There was the oat bran buzz that was replaced by the wheat germ movement, the family fondue set and the homemade yogurt maker. And for a while I remember my father making what I called “aquarium water” – a foul-looking jug sitting on the kitchen counter with a gelatinous white mass floating on top. Despite the assurances it was good for me, I declined the taste tests. They didn’t push it and I never volunteered to drink this “cure all”. I thought kombucha had gone the way of gelatin-based salads and entrees, until a friend told me she was drinking it. Not only is it still a home-brew darling, kombucha isn’t just for hippies: There’s probably some for sale at your local organic grocery. Yet after a bit of digging, kombucha culture still seems mired in the 1970′s. It’s still touted as a panacea, and it’s still one of the more questionable folk remedies out there. (more…)

Posted in: General, Nutrition

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Patient Participation in Decision-Making

“Patient-Centered” decision-making is a new buzz-word in medicine. It is a metaphor for a general approach to care that puts the patient’s experience and needs at the center, as opposed to the needs of the physician or the system.

While this is an effective marketing term, and a useful principle as far as it goes, as a guide to medical practice it is a bit simplistic. It needs to be viewed in the context of the overall medical infrastructure and the net effect specific practices have on the cost and effectiveness of medical care.

A 2012 NEJM editorial by Charles Bardes nicely summarizes the issues. He notes that patient-centered care represents the next step in a general trend (a good trend) in the medical profession over the last half-century:

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A Final Word: On T-Shirts and Teapot Tempests

I wore a T-shirt at The Amazing Meeting 2012 that generated a lot of controversy. You can see a picture of it on my Wikipedia article.  I didn’t want to talk about the T-shirt, but I’ve been repeatedly challenged to explain myself, and I’m afraid I can no longer avoid it. Steven Novella has recommended that we try to give other people’s arguments the most charitable interpretation. I hope my critics will do that, but I’m not optimistic. If past experience is any guide, they will misinterpret my explanation and put it in the worst possible light, which is why I haven’t offered it before. So be it; I have a tough skin. Once this T-shirt explanation is out of the way, I will have done my duty and had my say and will feel free to ignore all these divisive and nonproductive arguments. I don’t plan to write about gender or feminism or the squabbles in the skeptic movement again.

First, a brief digression about charitable interpretations and the whole “queer” discussion. I said “most” people in the LGBT community find the term offensive. Instead of attacking me as totally clueless, a charitable reader might have gently corrected me by providing quantitative evidence that the majority of people in the LGBT community do not find the word offensive (so far, no one has provided such evidence). When shown quantitative evidence, I would gladly have changed the word “most” to “many” or “some” or even “a few,” depending on the actual numbers, and we would all have learned something. What actually happened served as a perfect illustration of the points I made in my “Enemies” article. The ensuing discussion was bizarre, nit-picking, surreal, divisive, unproductive, and failed to emphasize the one thing we ought to all agree on: we don’t want to use labels that others find offensive.  The silly quibbling about my use of the one word “most” just derailed the discussion from the more important issues, and from all the other words in my post.

To set the scene for the T-shirt incident, there was a complex backstory involving Elevatorgate, Richards Dawkins, insults and threats directed at women, a perception that TAM’s anti-harassment policy was not being enforced, objections to a statement JREF President DJ Grothe made, accusations that Grothe had lied about reports of harassment, and numerous other incidents, many of which were blown way out of proportion. All this had left big chips firmly glued to shoulders. (more…)

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I Am Not Your Enemy: An Open Letter to My Feminist Critics

Note: The previous post is my usual weekly contribution to SBM. I am taking the liberty of posting this additional entry today on an issue that is peripheral to Science Based Medicine. If you are not interested in the recent squabbles within the skeptical movement, you will probably want to skip it. But it does respond to a detailed critique of an article I posted here two weeks ago, and some might find that of interest. We have seen the same kind of behavior on this blog, where commenters have responded not to what we said, but to what they wanted to believe we said.

 


 

I have been falsely identified as an enemy of feminism (not in so many words, but the intent is clear). My words have been misrepresented as sexist and misinterpreted beyond recognition. I find this particularly disturbing and hard to understand, because I’m convinced that my harshest critics and I are basically arguing for exactly the same things. I wish my critics could set aside their resentments and realize that I am not the enemy.

Two weeks ago I published an article on gender differences and the recent divisions in the skeptical community.  Ophelia Benson showed up in the comments. Not unsurprisingly, she disagreed with me about the Shermer incident, but then she said “I like the rest of this article a lot. I particularly like the point about averages and individuals, which is one I make all the time.”

I took that as a hopeful sign that friendly communication might be achieved, but my bubble was quickly burst by a hostile takedown of my article on Skepchick by “Will.”  His critique is demonstrably unfair. He attacks me for things I never said and tries to make it look like I believe the exact opposite of what I believe.

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