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Research, Minus Science, Equals Gossip

“A person is smart. People are stupid.”

- Agent K (Tommy Lee Jones), Men In Black

Regular readers of my blog know how passionate I am about protecting the public from misleading health information. I have witnessed first-hand many well-meaning attempts to “empower consumers” with Web 2.0 tools. Unfortunately, they were designed without a clear understanding of the scientific method, basic statistics, or in some cases, common sense.

Let me first say that I desperately want my patients to be knowledgeable about their disease or condition. The quality of their self-care depends on that, and I regularly point each of them to trusted sources of health information so that they can be fully informed about all aspects of their health. Informed decisions are founded upon good information. But when the foundation is corrupt – consumer empowerment collapses like a house of cards.

There is growing support in the consumer-driven healthcare movement for a phenomenon known as “the wisdom of crowds.” The idea is that the collective input of a large number of consumers can be a driving force for change – and is a powerful avenue for the advancement of science. It was further suggested (in a recent lecture on Health 2.0), that websites that enable patients to “conduct their own clinical trials” are the bold new frontier of research. This assertion betrays a lack of understanding of basic scientific principles. In healthcare we often say, “the plural of anecdote is not data” and I would translate that to “research minus science equals gossip.” Let me give you some examples of Health 2.0 gone wild:

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Posted in: General, Public Health, Science and Medicine, Science and the Media

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The Anniversary

I received a surprising morning call several weeks ago

“Wally?”

“This is he.”

“This is Judy V…. I just wanted to call and thank you again for what you did for me. It’s the 35th anniversary of my cancer…“

Judy V. is a physician’s widow. Her husband, a surgical specialist died in his 40s, 20plus years ago.   She had a Stage II breast cancer; the surgeon had done a modified radical, and I was consulted for possible adjuvant chemotherapy.

Thirty-five years ago the standard was simpler. Same for our knowledge of staging and biological behavior. Genomics was not a word yet. Targeted therapy was not a concept. Tamoxifen was the ony estrogen agonist and had just been introduced.  The standard adjuvant therapy was single agent melphalan or its equivalent. But even then, patients had choices. The surgery had probably cured her, but then… Chemo or none.
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Posted in: Cancer, General, Health Fraud, Herbs & Supplements, Nutrition, Pharmaceuticals, Politics and Regulation

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

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The Many Faces Of Snake Oil

It is my unhappy duty to reveal yet another depressing example of dishonest gain in medicine. This time, however, patients were not the only victims. Many healthcare professionals, including physicians, were prey to what has been called “an intellectual property ponzi scheme.”

In a press release dated January 28, 2009, the HealthCentral Network announced the acquisition of a company called Wellsphere from its young CEO, Ron Gutman. Many of my fellow medical bloggers are familiar with Wellsphere as they’ve received countless email form letters from its CMIO, Dr. Geoffrey Rutledge. The form letters are flattering, and suggest that the company would like to feature the blogger’s writing on their platform.

But what happens next is disturbing – to become a member of Wellsphere, bloggers provide access to their blog’s RSS feed. Hidden in the fine print is the blogger’s consent for Wellsphere to publish the entire feed (in other words, all of the blogger’s written work) and that once it’s published on their site, they own the intellectual property rights to it.

Astonishingly Wellsphere convinced some 1700 bloggers to join their network, and have now sold their site (which is comprised almost entirely of blog post content) to HealthCentral Network for an undisclosed amount, likely in the millions.

How much did the health bloggers get for their writing? As far as I know, zero dollars.

In the reference section below you will see copies of emails sent by Dr. Rutledge and excerpts from the website’s Terms of Use document.

Is this the biggest scam ever pulled on health bloggers? You decide. The Wall Street Journal health blog reports:

As for the thousands of bloggers HealthCentral picks up with the merger, there is already grumbling in the blogosphere that Wellsphere built its business on health bloggers who don’t benefit from the deal. “But most are happy and we hope with all our resources and quality-content background we will really strengthen these engagements,” Schroeder told us.

Interesting statement from Schroeder – “most are happy.” He clearly hasn’t read the comments section of my blog. If there ever were a time for the medical/science/health blogosphere to rise up “Motrin moms-style,” it would be now. You may Tweet in protest by entering your comment with “#wellsphere” on Twitter. Or kick it old-school here in our comment section.

If you have any additional information, feel free to post it in the comments section below.

References:

Here is the introductory form email sent out by Dr. Rutledge:
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Posted in: General, Health Fraud, Science and the Media

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More on the Bravewell issue

Being on the West Coast places me (and Harriet?) at disadvantage in responding to recent developments, as I find out about them later in the day, if that day. (Retirement doesn’t help.)

First I had some comments on the WSJ article on “CAM,” the NCCAM by Steve Salerno and the response by the pseudoscince leadership. The 4-author response revealed political tactics used by quacks and sectarian medicine advocates to answer with straw man points and especially to ignore what they cannot answer.

In their response to Salerno’s article they accused him of being unqualified to object to “CAM” because he was only a reporter. Fact was that most of his points were from my writings, which Slerno frankly acknowledged. The several rebutting authors never mentioned my name. Of course not. (That it was lost in the SBM analyses is understandable.)

And that is the frank dishonesty we are dealing with when we face off with these characters, who now have the ears and eyes of the Institute of Medicine, academic deans and professors, and government. They are smiling as they read this.
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Posted in: Basic Science, General, Health Fraud, Medical Academia, Politics and Regulation, Science and Medicine

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Our own slippery grounds

When we were forming the National Council against Health Fraud I wondered aloud to the president, Bill Jarvis, what we would do if society solved the chiropractic problem. Bill laughed and said there would never be an end to quackery claims.

How right he was. But why? Many express surprise that at this time of remarkable intellectual and scientific advance, so many people choose to believe in irrational medical claims. The answer I am used to is the one that explains the difference between the attraction of subjective versus the dryness of the objective; between reflex and conditioned responses and rational thought, and between immediate emotionally gratifying, low-level mid-brain reactions and slow-reacting, cool, higher level intellectual thought. These comparisons are all valid but in trying to answer the question, we can miss the constancy of human nature biology, the dimension of time flow, the changing nature of evidence, and as yet unemphasized, the changes and evolution of measurement.…

Before Evidence Based Medicine (EBM) was devised, and the randomized clinical trial (RCT) accepted as the so-called gold standard, our evidential decisions turned on balances or ratios of science/nonsense, rationality/irrationality, reality/delusion, and an estimate of plausibility/implausibility. We can see now that the concept of EBM introduced a new set of standards to our equations balances – proof by RCT and their derivatives, systematic reviews (SRs). The demand for proof by RCT and and SR relegated the previous standards, the unbalanced ratio concept, to the level of anecdote and “uncontrolled observation.” We had to start over again with a new standard.
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Posted in: Basic Science, Clinical Trials, General, Health Fraud, Science and Medicine

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2008 Medical Weblog Awards

I am pleased to announce that Science-Based Medicine is a finalist for a 2008 Medical Weblog Award in the New Medical Blog category. You can see all the categories and finalists here: http://www.medgadget.com/archives/2009/01/the_2008_medical_weblog_awards_the_polls_are_open.html

Of note, our blogging friend, Orac, is also a finalist for Respectful Insolence in the health policies/ethics category, along with our own Dr. Val Jones for her excellent blog, Better Health.

We would appreciate you taking a look and voting for the blog of your choice.  And thanks to all of our readers for your kind support over our first year, and the active and informative discussions in the comments section. We look forward to more SBM in 2009.

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Influenza Deaths

“There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know.”- Donald Rumsfeld

How do we know what we know? It is said by some anti-vaccine proponents that vaccines are not needed because the diseases they prevent are either gone or no longer as severe as they were in pre vaccine times. People may have suffered and died in the distant past, but no longer. The risk now is from the vaccines not the diseases they no longer prevent.

36,000 people, more or less, die every year from influenza. That is the number of deaths according to the CDC web site; the NEJM review uses the higher number of 56,000 (7). Which number is correct? Isn’t that why the flu vaccine is recommended: to prevent all those people from dying.

36,000 is a lot of people. That’s about 120 deaths per million people in the US. In Oregon, population about 3 million, that would be about 360 people a year, which is two deaths a day for the six month flu season.

“Death is caused by swallowing small amounts of saliva over a long period of time.”–George Carlin.

2,400,000 people die every year in the US, about 6600 a day. In Oregon, that is about 65 deaths a day. No one outside a epidemiologist is going to notice 2 extra deaths a day during flu season. I have seen a lot of people die of influenza, but I have a biased experience: I am an infectious disease doc, so I am likely to see people with influenza, especially patients with disease severe enough to kill them.

About the same number of people die from car accidents and die from handguns in the US each year as die from influenza. I have never known a person in my real, as opposed to my professional, life to die from influenza or handguns or a car accident. My personal experience suggests no one dies from these causes, but since I take care of patients at one of the Portland trauma hospitals, I know what cars and guns do to people. My professional life confirms that people do indeed die from being shot or car accidents. I would wager that most people reading this blog have not known anyone who has died from influenza, guns or car accidents. The fact that people do die of influenza seems contradicted by experience. Why get the vaccine? I don’t get the flu and and no one I know has ever died from it.

As an illustrative example, a relative of mine, a retired physician, mentioned that he thought the shingles vaccine was a waste of time and money as he had never known anyone to get shingles. Using personal experience to judge disease prevalence is unreliable. If I applied the same rationale to driving, I would not wear a seat belt as I have never been in a high speed crash.

36,000 people die of influenza each year. What is the source of that statistic? From “Mortality associated with influenza and respiratory syncytial virus in the United States”. JAMA 2003. Is that really how many deaths are there from influenza? It depends on what you mean by ‘death’ and what you mean by ‘influenza’ and what you mean by ‘from’.

“It depends on what the meaning of the words ‘is’ is.” – Bill Clinton

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Posted in: Basic Science, General, Public Health, Vaccines

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Quackery tolerance – a learned response

Academic politeness turns to the vicious  This is more on the theme of academic and postmodern roots of sectarianism-quackery’s advance on medicine. I illustrate through the personal experience of a noted combatant – Mary Lefkowitz - in the front lines of the war with intellectual and academic buffoonery passing as scholarship. The joke is not in the buffoonery, though. The joke is turning on us.

Some of you are familiar with Prof.Lefkowitz’s academic dispute from publicity last spring. Prof. Lefkowitz is on the list of academic opponents to relativism and postmodernism. Lefkowitz’s travail began in 1993 when another Wellesley faculty member who led a department or course of Africana Studies claimed in lectures that ancient Greek and Roman intellectual advances were lifted from libraries and other sources of ancient Egypt, and that furthermore, those Egyptians were black Africans.

You recognize this as Afrocentrism, one of relativism and postmodernism’s multi-pronged attack on intellectualism and Western civilization. I attended a session on the problem in 1992 (or so) at the AAAS in San Francisco, and did not appreciate or understand what was going on, or why the raised rhetoric and voices. I do now, especially having read excerpts from Lefkowitz’s book, History Lesson, published earlier this year.
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Posted in: Basic Science, General, Medical Academia, Science and Medicine

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“I Reject Your Reality” – Germ Theory Denial and Other Curiosities

Note: This article was originally published in Skeptic magazine. Space limitations resulted in omitting some of what I wanted to say. I’m taking advantage of having a blog to publish the entire article as originally submitted.

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On an episode of Mythbusters, Adam Savage was shown a video clip that contradicted his memory of something he had said. He responded, “I reject your reality… and substitute my own.” He was joking. Unfortunately, the world is full of people who reject reality and who are not joking.

James Randi tells a story about a TV program that featured Uri Geller doing his standard trick of bending a key. Afterwards, the program’s host said it couldn’t possibly have been a trick because Uri had “never touched” the key. The host was then shown the recorded program, which proved that Geller clearly had the key in his hands, for two-and-a-half minutes. Instead of admitting having been wrong, the host exclaimed, “Well, that’s not how it happened.”

One of my own ancestors was a pro at this kind of thing. I’ll call her Aunt S (for stubborn). She had once tried tinned sardines, hated them, and refused to ever touch sardines again. One day she came into my grandmother’s kitchen when she was frying up some large fresh sardines a friend had brought her. Aunt S ate some, proclaimed them tasty, then asked, “What kind of fish were those, Mary?” My grandmother told her they were sardines. She protested, “No they weren’t! I don’t eat sardines!”

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Posted in: General, Nutrition, Vaccines

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