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Lessons from History of Medical Delusions

A brief reference on the web site The Quackometer recently drew my attention to a very short book (really more of a pamphlet, in the historical sense) by Dr. Worthington Hooker, Lessons from the History of Medical Delusions, which I thought might be of interest to readers of this blog. Though published in 1850, the book contains many eloquent observations that are just as relevant to understanding how pseudoscience and quackery persist and even flourish in what we otherwise assume to be an age of scientific medicine. The book is available online as a Google eBook, and relatively cheap printed facsimiles are available as well.

Dr. Hooker was a physician, a professor at Yale, and an outspoken critic of homeopathy in it’s early days. His critique of homeopathy still resonates today, and has long drawn the ire of Hahneman loyalists, such as this one who makes reference to Dr. Hooker’s, “periodical fulminations for the destruction of Homoeopathy that have appeared like locusts or cholera at certain dates.” Though Dr. Hooker wrote an entire book discussing homeopathy, Homeopathy: An Examination of its Doctrines and Evidences, he does spare a few words here for this less-than-venerated practice:

The error I have been illustrating is carried to an extreme by the Homeopathist. He attributes palpable results to doses of medicine which are so small that they cannot produce any perceptible effect except by miracle.

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Posted in: Book & movie reviews, General, History, Science and Medicine

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A Christmas Card from the SkepDoc

The holiday season is upon us. As a bit of a holiday from science-based writing, I thought I would offer some thoughts inspired by the season and not supported by any scientific evidence.

One of my friends refers to Christmas as “The Feast of St. Dyspepsia.” Holidays are indeed an occasion for over-indulging. People change their routine: they have time off work, they travel, spend too much money, go to parties, skip exercising, eat and drink things they ordinarily avoid, gain weight, and then suffer from post-holiday guilt.

Science and Mom both tell us we will be healthier if we eat our fruits and vegetables, exercise, avoid large quantities of alcohol, get enough rest, avoid stress, and control our weight. I would argue that if we follow that guidance most of the time, an occasional lapse is not likely to matter very much. And the pleasure we experience might even be good for our health.

Now for some heretical words.

Science isn’t everything. Health isn’t everything. Even truth isn’t everything. Humans find value in other things like music and mythology, things that bring great pleasure and help make life worth living.

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Lessons Learned

I just returned from a trip to Montreal where I spoke at the Lorne Trottier Public Science Symposium, an annual event that David Gorski spoke at a year ago. My topic was “Puncturing the Acupuncture Myth” and the other speakers were Paul Offit, Edzard Ernst, and Bob Park. I was honored to be in such august company; and we were wined, dined, and cossetted: overall, an experience that will count among the high points of my career. In addition to speaking at the Symposium, I was interviewed on the radio; participated in a roundtable discussion with other doctors, scientists and journalists; and was invited to speak to a large freshman chemistry class at McGill University. I told the students a bit about how I came to be the SkepDoc and some of the things I’ve written about, with “Vitamin O” as an example, and I provided 3 “lessons I have learned” from my investigations that are general principles applicable to other fields:

  • Roosters don’t make the sun come up.
  • Never believe one study.
  • The SkepDoc’s Rule of Thumb: when encountering a new or questionable claim, always try to find out who disagrees and why.

My presentation was recorded and is available as a webcast. Scroll down to “2011/11/08 HallOffit” near the bottom and click on the appropriate symbol to the far right. That saves me having to write a post this week. I think SBM readers will find it pertinent to all we discuss here.

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Legislative Alchemy I: Naturopathy

Via the magic of “legislative alchemy,” state legislatures transform implausible and unproven diagnostic methods and treatments into perfectly legal health care practices.[1] Without the benefit of legislative alchemy, chiropractors, naturopaths, homeopaths, acupuncturists and other assorted putative healers would be vulnerable to charges of practicing medicine without a license and consumer fraud. Thus, they must seek either their own licensing system or exemption from licensing altogether.

Licensing bestows an undeserved air of legitimacy on “alternative” practitioners. Because a state’s authority to regulate health care lies in its inherent power to protect the public health, safety and welfare, the public understandably assumes licensing actually accomplishes this purpose. In fact, the opposite occurs. Any attempt to impose a science-based standard of health care becomes impossible when vitalism and similarly debunked notions of human functioning are enshrined into law.

Initial licensing is just a beginning. Once the beach head is established other benefits can follow, such as expansion of the scope of practice. If not granted in the initial legislation, “alternative” practitioners can return, seeking more goodies like self-regulation and mandatory insurance coverage.

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Posted in: General, Legal, Naturopathy, Politics and Regulation, Science and Medicine

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Virtual Colonoscopy Can Be Hazardous to Your Health

The US Preventive Services Task Force (USPSTF) recommends that everyone aged 50-75 be screened for colon cancer with any one of three options: colonoscopy every 10 years, flexible sigmoidoscopy every 5 years, or fecal occult blood testing (FOBT) every year. Conventional colonoscopy is considered the “gold standard” since it allows for direct detection and biopsy of early cancers and removal of precancerous polyps. It involves passing a long colonoscope via the rectum through the full length of the colon and is also known as optical or visual colonoscopy. A newer and less invasive alternative, virtual colonoscopy or CT colonography, is being promoted by some as the test of choice. Others disagree. One area of controversy is that CTs frequently find “incidentalomas” that require further investigation. An article in the journal Radiology highlights this problem, describing “the clinical drama that follows screening or diagnostic tests.” (more…)

Posted in: Cancer, General

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The Believing Brain

A common question of skeptics and science-based thinkers is “How could anyone believe that?” People do believe some really weird things and even some obviously false things. The more basic question is how we form all our beliefs, whether false or true.

Michael Shermer’s book Why People Believe Weird Things has become a classic. Now he has a new book out: The Believing Brain: From Ghosts and Gods to Politics and Conspiracies: How We Construct Beliefs and Reinforce Them as Truths It synthesizes 30 years of research into the question of how and why we believe what we do in all aspects of our lives.

Some of the content is repetitious for those of us who have read Shermer’s previous books and heard him speak, but the value of the new book is that it incorporates new research and it puts everything together in a handy package with a new focus.

Shermer says

I’m a skeptic not because I do not want to believe, but because I want to know. How can we tell the difference between what we would like to be true and what is actually true? The answer is science.

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Cognitive Traps

In my recent review of Peter Palmieri’s book Suffer the Children I said I would later try to cover some of the many other important issues he brings up. One of the themes in the book is the process of critical thinking and the various cognitive traps doctors fall into. I will address some of them here. This is not meant to be systematic or comprehensive, but rather a miscellany of things to think about. Some of these overlap.

Diagnostic fetishes

Everything is attributed to a pet diagnosis. Palmieri gives the example of a colleague of his who thinks everything from septic shock to behavior disorders are due to low levels of HDL, which he treats with high doses of niacin. There is a tendency to widen the criteria so that any collection of symptoms can be seen as evidence of the condition. If the hole is big enough, pegs of any shape will fit through. Some doctors attribute everything to food allergies,  depression, environmental sensitivities,  hormone imbalances, and other favorite diagnoses.  CAM is notorious for claiming to have found the one true cause of all disease (subluxations, an imbalance of qi, etc.).

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Conflicts of Interest

When an article is published in a medical journal, the authors must disclose any conflicts of interest. This is important, because even if they think owning stock in the drug company won’t influence their scientific judgment, we know that subtle biases can creep in to somehow affect the findings of studies. It has been shown that studies funded by drug companies are more likely to get positive results for their drug than studies funded by independent sources. Andrew Wakefield, author of the infamous retracted Lancet study suggesting a relationship between MMR vaccine and autism, was severely chastised for not disclosing that he received money from autism litigators and expected to earn a fortune from his own patented products if the MMR vaccine could be discredited.

I was recently contacted by an acupuncturist who plans to critique an article I wrote. It was a commentary in the journal Pain that accompanied a systematic review of systematic reviews of acupuncture by Ernst et al. For details of Ernst’s and my articles, see my previous post. He challenged my statement that I had no conflicts of interest to report. He apparently thinks I should have said I have a conflict of interest in that I am anti-CAM and anti-acupuncture. When he writes about my article, he plans to attack me for not declaring this alleged conflict of interest and he plans to set a good example with a conflict of interest statement of his own, divulging that he makes his living practicing acupuncture, has financial investments in it and many personal relationships, that his self-identity and prestige are dependent on his belief in acupuncture’s efficacy, and that he is biased towards constructivism and away from positivism. (I think this is a fancy way of saying he favors experience over the scientific method.) I agree that he has conflicts of interest, but was I wrong to say I had no conflicts of interest? I don’t think so. (more…)

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Suffer the Children

Some of our readers have complained that we pick on alternative medicine while ignoring the problems in conventional medicine. That criticism is unjustified: we oppose non-science-based medicine wherever we find it. We find it regularly in alternative medicine; we find it less frequently in conventional medicine, but when we do, we speak out.   A new book by Dr. Peter Palmieri is aimed squarely at failure to use science-based medicine in conventional practice.

Dr. Palmieri is a pediatrician who strives to provide the best compassionate, cost-effective, science-based care to all his patients. Over 15 years of practice in various settings, he observed that many of his colleagues were practicing substandard medicine.  He tried to understand what led to that situation and how it might be remedied. The result is a gem of a book: Suffer the Children: Flaws, Foibles, Fallacies and the Grave Shortcomings of Pediatric Care. Its lessons are important and are not limited to pediatrics: every health care provider and every patient could benefit from reading this book.

The chapters cover these subjects:

  • How doctors mishandle the most common childhood illnesses
  • How doctors succumb to parental demands
  • How they embrace superstition and magical beliefs
  • How they fall prey to cognitive errors
  • How they order the wrong test at the wrong time on the wrong patient
  • How financial conflicts of interest defile the medical profession
  • How doctors undermine parents’ confidence by labeling their children as ill
  • A prescription for change

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Posted in: Book & movie reviews, General

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The Role of Experience in Science-Based Medicine

Before we had EBM (evidence-based medicine) we had another kind of EBM: experience-based medicine. Mark Crislip has said that the three most dangerous words in medicine are “In my experience.” I agree wholeheartedly. On the other hand, it would be a mistake to discount experience entirely. Dynamite is dangerous too, but when handled with proper safety precautions it can be very useful in mining, road-building, and other endeavors.

When I was in med school, the professor would say “In my experience, drug A works better than drug B.” and we would take careful notes, follow his lead, and prescribe drug A unquestioningly. That is no longer acceptable. Today we ask for controlled studies that objectively compare drug A to drug B. That doesn’t mean the professor’s observations were entirely useless: experience, like anecdotes, can draw attention to things that are worth evaluating with the scientific method.

We don’t always have the pertinent scientific studies needed to make a clinical decision. When there is no hard evidence, a clinician’s experience may be all we have to go on. Knowing that a patient with disease X got better following treatment Y is a step above having no knowledge at all about X or Y. A small step, but arguably better than no step at all. (more…)

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