I’ve been a big Star Trek fan ever since I first discovered reruns of the original Star Trek episodes in the 1970s, having been too young (but not by much!) to have caught the show during its original 1966-1969 run. True, my interest waxed and waned through the years—for instance, I loved Star Trek: The Next Generation, while Star Trek: Enterprise and Star Trek: Voyager pretty much left me cold—but even now I still find myself liking the rebooted movie series. In the original series, my favorite characters tended to alternate between Spock, the Vulcan first officer and science officer on the Enterprise, and Dr. Leonard “Bones” McCoy, the ship’s chief medical officer. I sometimes wonder if my love of these two characters had anything to do with my becoming a doctor and researcher myself. It probably did.
One aspect of all the Trek shows that always interested me was its portrayal of medicine in the 23rd and 24th centuries. After all, what doctor wouldn’t like to have a device like the tricorder that he could wave over the patient and come up with an instant diagnosis and course of treatment? Who knew, of course, that nearly 50 years after the first Trek episode first aired, we would have technology that makes the communicators on the original series (TOS, for those Trek non-fans) look primitive and large by comparison and that we’d be well on the way to developing devices that can do some of what tricorders did on the show. Throughout all the shows and movies, the medical technology of a few hundred years in the future is portrayed as vastly superior to what we have now, with 20th century medicine at times denigrated by “Bones” McCoy and other Star Fleet medical personnel as barbaric quackery.
A confluence of events and media led me to want to explore a couple of questions. First, which procedures that we consider state-of-the-art science-based medicine will be considered “barbaric” 50 or 100 years from now? Second, is the contempt expressed for the medicine of the past (e.g., by “Bones” McCoy) justified? These are questions that I’ll explore a bit with the help of the Star Trek universe, a recent new cable television drama series, and a couple of articles that appeared on medical sites as a result of the premier of that series.
Thirty years in Moukden
A mythology has grown up around traditional Chinese medicine (TCM). The ancient wisdom of the inscrutable Orient supposedly helped patients in ways that modern science-based medicine fails to understand or appreciate. A typical claim found on the Internet: “The ancient beliefs and practice of traditional Chinese medicine have been healing people for thousands of years.”
As Steven Novella has said, “TCM is a pre-scientific superstitious view of biology and illness, similar to the humoral theory of Galen, or the notions of any pre-scientific culture”. TCM really hasn’t been doing a creditable job of healing people for thousands of years. A book that was brought to my attention by one of our readers (thank you!) provides a unique insight into what Chinese medicine was really like circa 1900. I wish everyone who believes in ancient Chinese medical wisdom would read the chapter on Chinese medicine in this book. It provides a much-needed reality check. (more…)
When Forbes.com published Steven Salzberg’s article “New Medicare Data Reveal Startling $496 million wasted on Chiropractors” (April 20, 2014), a flood of mail (more than 300 comments) from chiropractors and their patients provided a wealth of evidence that subluxation-based chiropractic is alive and well despite rejection by the scientific community. Pro-chiropractic comments laced with anti-medical rhetoric and ad hominem attacks, expressed with religious fervor, failed to distinguish between generic spinal manipulation (that can be useful in the treatment of mechanical-type back and spinal problems) and chiropractic adjustments used in an attempt to restore and maintain health by correcting vertebral subluxations. No distinction was made between a real, symptomatic orthopedic subluxation and an imaginary, asymptomatic chiropractic “vertebral subluxation complex,” neither of which has been shown to be a cause of bad health. While the chiropractic profession may have some justification for objecting to any suggestion that chiropractic treatment has no value whatsoever, especially in the case of mechanical-type back pain and other musculoskeletal problems, the tone and content of many of the comments by chiropractors provide good examples of why chiropractic is so often criticized by the scientific community.
A quote in the Forbes article, from my Science-Based Medicine article “Chiropractic: A Summary of Concerns,” brought this comment from a prominent chiropractor:
…Harriet Hall, Edzard Ernst, Jann Bellamy, and other current renowned medical bigots who attack all CAM providers but turn a blind eye to the dangers of the medical profession….Steven, your chiro critics are invalid—none of them are researchers or educators, but they are just disgruntled practitioners from yesteryear. Don’t get me started on the Science-Based guys who are just haters like you—Harriet Hall, Edzard Ernst, Jann Bellamy are renown medical bigots.
Ngram is a Google analytic tool/way to waste lots of time on the internet, a byproduct of Google’s scanning millions of books into its database. In a matter of seconds, Ngram scans words from about 7.5 million books, an estimated 6 percent of all books ever published. Type a word or phrase in the Ngram Viewer search box and in seconds a chart of its yearly frequency will appear. You can also search for a series of words or phrases and the Viewer will provide a color-coded chart comparing frequency of use. More sophisticated searches (e.g., making the search case sensitive, or not) are also possible.
As explained in the New York Times, researchers “have used this system to analyze centuries of word use, examining the spread of scientific concepts, technological innovations, political repression, and even celebrity fame.” Erez Aiden, a computer scientist who helped create the word frequency tool, says he and his co-researcher, Jean-Baptiste Michel, wanted “to create a scientific measuring instrument, something like a telescope, but instead of pointing it at a star, you point it at human culture.” In fact, the title of their new book is Uncharted: Big Data as a Lens on Human Culture. Still, they caution that, like other scientific tools, Ngram’s results can be misinterpreted. An example: the fax machine. If you query that term, it looks as if the fax appears almost instantaneously in the 1980s. In reality, the machine was invented in the 1840s but was then called the “telefax.”
If Ngram can search for scientific concepts, how about unscientific concepts? What might a search of unscientific concepts tell us about our human culture? Let’s find out. (more…)
If there’s one medical treatment that proponents of “alternative medicine” love to hate, it’s chemotherapy. Rants against “poisoning” are a regular staple on “alternative health” websites, usually coupled with insinuations or outright accusations that the only reason oncologists administer chemotherapy is because of the “cancer industrial complex” in which big pharma profits massively from selling chemotherapeutic agents and oncologists and hospitals profit massively from administering them. Indeed, I’ve lost track of the number of such rants I’ve deconstructed over the years. Usually, they boil down to two claims: (1) that chemotherapy doesn’t work against cancer (or, as I’ve called it before, the “2% gambit“) and (2) that the only reason it’s given is because doctors are brainwashed in medical school or because of the profit motive or, of course, because of a combination of the two. Of course, the 2% gambit is based on a fallacious cherry picking of data and confusing primary versus adjuvant chemotherapy, and chemotherapy does actually work rather well for many malignancies, but none of this stops the flow of misinformation.
Misinformation and demonization aside, it is also important to realize that the term “chemotherapy,” which was originally coined by German chemist Paul Ehrlich, was originally intended to mean the use of chemicals to treat disease. By this definition, virtually any drug is “chemotherapy,” including antibiotics. Indeed, one could argue that by this expansive definition, even the herbal remedies that some alternative medicine practitioners like to use to treat cancer would be chemotherapy for the simple reason that they contain chemicals and are being used to treat disease. Granted, the expansive definition evolved over the years, and these days the term “chemotherapy” is rarely used to describe anything other than the cytotoxic chemotherapy of cancer that in the popular mind causes so many horrific side effects. But in reality virtually any drug used to treat cancer is chemotherapy, which is why I like to point out to fans of Stanislaw Burzynski that his antineoplastons, if they actually worked against cancer, would be rightly considered chemotherapy, every bit as much as cyclophosphamide, 5-fluorouracil, and other common chemotherapeutics.
First, my bias. I work in Portland and we have medical students, residents, and faculty who are DOs (Doctor of Osteopathy). Before he moved on to be a hospitalist my primary physician was a DO. From my experience there is no difference between an MD and a DO. In my world they are interchangeable. There are many more qualified applicants for medical education than positions in MD programs and some opt for a DO education. Osteopathy has a dark side.
As best I can determine from my colleagues, learning osteopathic manipulation (OM) is the price they pay to obtain an otherwise standard medical education. I have yet to see OM offered by any of my DO colleagues. It may be they know better than to offer such a modality around me given my ranty propensity for all things SCAM.
The literature would suggest that OM is left behind by most DOs upon graduation. DOs are not proud of their OM, and rarely invite them ‘round to dinner. It will be interesting to see if OM fades over time in DO school as the old time true believers die off and are supplanted by a generation of DOs trained with more traditional medical education.
OM, the small pseudoscientific aspect of DO medical school education, is a form of massage and manipulation invented in the 19th century with no basis in reality. OM postulates
the existence of a myofascial continuity – a tissue layer that interlinks all parts of the body. By manipulating the bones and muscles of a patient a practitioner is supposed to be able to diagnose and treat and variety of systemic human ailments.
Studies into the efficacy of OM find it to be ineffective for any process aside from low back pain (is there anything that does not help low back pain?), not surprising for a therapeutic intervention detached from reality. My purpose with this entry is not to review OM per se, which may be a good topic someday, but to focus on a specific application of OM. (more…)
How do you like your coffee? Rectally.
It might not occur to you, sipping your morning coffee, that you could derive tremendous health benefits by simply shooting that coffee directly into your rectum. Yet many people believe this. Suzy Cohen, who calls herself, “America’s Pharmacist™” and also “America’s Most Trusted Pharmacist®” is a proponent. Her syndicated column Ask the Pharmacist recently contained this question and response: (more…)
Ever heard of George Augustus Scott? Probably not. Although he was once touted as “Man of the Century,” he was actually a charlatan who sold electric hairbrushes. (No, an electric hairbrush isn’t a device that will brush your hair for you; it’s a hairbrush that supposedly produces a “permanent electric current” to cure everything from baldness to headaches.) He went on to sell magnetic corsets, electric rings for rheumatism, and sarsaparilla, advertised as the “GREATEST MEDICAL DISCOVERY of the AGE.” (You probably haven’t heard about that greatest discovery either.)
He and his many comrades in crime are profiled in a new book, The Medical Electricians: Dr. Scott and his Victorian Cohorts in Quackery by Robert K. Waits. You will find more quacks in this book than in any duck pond. It provides historical insights and reminds us that there is nothing new under the sun; similar charlatans continue to sell similar quack devices today, facilitated by the Internet and other media.
Electricity and magnetism sounded exciting to Victorian ears, but their properties were poorly understood. Great hopes were raised for medical applications. The opinions of experts varied. Priestly reported experiments from Italy and Germany in 1747-8 showing that a patient who held a vial of medicine while being electrified would get the same benefit as if he took the medicine by mouth. Benjamin Franklin, on the other hand, was persuaded that these reports were not true. (more…)
Sometimes blogging topics arise from the strangest places. It’s true. For instance, although references to how tobacco causes cancer and the decades long denialist campaign by tobacco companies are not infrequently referenced in my blogging (particularly from supporters of highly dubious studies alleging a link between cell phone radiation and cancer and the ham-handed misuse of the analogy by antivaccinationists, who seem to think that vaccine companies engage in deceit on a scale similar to the deceptive practices of tobacco companies in “denying” that vaccines cause autism and all the other conditions, diseases, and horrors their fevered imaginations attribute to them), I’ve never really delved particularly deeply into one of the most useful repositories of documents on the topic that exists, namely the UCSF Legacy Tobacco Documents Library. Actually, the reason I started poking around there is not due to tobacco science, but because a fellow blogger mentioned to me that there were some articles and documents about Stanislaw Burzynski there dating back to the late 1970s. My curiosity was piqued.
As I explored, however, I learned that the documents there were not so much about Stanislaw Burzynski per se. In fact, they were more about the state of the underground “alternative cancer cures” industry in the late 1970s, which interested me greatly. The reason is that, when it comes to having delved so deeply into cancer quackery, I’m a relative newbie. Compared to, for example, Wally Sampson, Stephen Barrett, Peter Moran, or even Kimball Atwood, I’m inexperienced, having only noticed this phenomenon in a big way in the Usenet newsgroup misc.health.alternative back around 2001 or so, give or take a year. As a result, I don’t have the shared historical perspective that they do, mainly because I can only learn about that era from reading, studying, and talking to people who were active then. After all, in the late 1970s I was still in high school, and in the 1980s I was in college and medical school. There was no Internet (at least none that I had access to and that contained the wealth of easily accessible information to which we have become accustomed). In any case, in high school I had other interests, and throughout the 1980s I was too focused on getting an education and training to be a surgeon and researcher, a process that extended into the late 1990s. (Yes, it takes that long sometimes, particularly if you are masochistic enough to want to get a PhD, complete a general surgery residency, and do a fellowship in surgical oncology.)
Infectious diseases (ID), as those who read my not-so-secret other blog know, is without a doubt the most interesting speciality of medicine. Every interesting disease is infectious in etiology. What is cool about ID is that it has connections into almost every facet of human culture and history.
I note that at some point I have gone from being the young whippersnapper to the Grandpa Simpson at my hospitals and am one of the few who has been around long enough to be a repository of institutional memory. I remember what it was like 20 plus years ago, when no one consistently washed their hands, when all S. aureus (S. aureui?) were sensitive to beta-lactams and we wore an onion on our belt, as was the style of the day. Oh the changes I have seen.
Besides remembering the not so good old days of my professional career, ID keeps me reminded of how the world used to be in the past. Medicine used to be about the epidemics that would routinely sweep across the world. Polio, measles, mumps, scarlet fever, rheumatic fever, tuberculosis and on and on. I occasionally see TB but thanks to modern medicine many of these scourges have mostly faded from medical practice in the US. Not a one, I might add, has faded due to the efforts of alt med practitioners.
Influenza still gives me pause. It is, as infections go, quite the tricky virus and it remains a difficult beast to treat and prevent. Which is a drag as it remains one of the more consistent causes of infectious morbidity and mortality. (more…)