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Welcome back, my friends, to the show that never ends: The Jenny and Jim antivaccine propaganda tour has begun

As hard as it is to believe, 2009 started out very promising from the perspective of actually countering the misinformation of the antivaccine movement. Antivaccine hero Andrew Wakefield, who with the help of the credulous and sensationalistic media started the entire MMR-autism scare in the U.K. a decade ago, was revealed as not just having been in the pocket of trial lawyers suing vaccine manufacturers and having been an incompetent scientist but as a scientific fraud, thanks to the investigative tenacity of Brian Deer. Thanks to Wakfield, the measles, once declared conquered in the U.K. in the mid-1990s, has come roaring back to the point where it has been declared endemic again by the ealth Protection Agency (HPA), the public health body of England and Wales. This was rapidly followed by the rejection by the Special Masters of the Vaccine Court of the claims of all the test cases in the Autism Omnibus case. It was a one-two body blow to the antivaccine movement.

Unfortunately, the antivaccine movement is nothing if not resilient. After all, the science has consistently been against each of its favorite claims, namely that the mercury in the thimerosal used as a preservative in vaccines or that the MMR vaccine causes autism. They simply move the goalposts and pivoted effortlessly to much harder to falsify ideas, such as blaming “toxins” in vaccines or proclaiming that our current vaccine schedule is “too many too soon.” After scientific setback after scientific setback that have revealed the antivaccine movement to be nothing more than the 2009 equivalent of creationists or the flat Earth movement, why would it matter to them that Andrew Wakefield has been thoroughly discredited and their signature legal action, the Autism Omnibus, has gone donw in flames? It doesn’t. Certainly it didn’t stop David Kirby from duping Keith Olbermann into chastising Brian Deer for nonexistent conflicts of interest; a group proclaiming loudly “We Support Dr. Andrew Wakefield” with a petition; David Kirby, Generation Rescue, and Robert F. Kennedy, Jr. from trying to distract attention from the defeat of the antivaccine movement in the Autism Omnibus ruling; or Andrew Wakefield himself from “complaining” to a press board about Brian Deer’s alleged misbehavior and errors. After all, science doesn’t matter to the antivaccine movement.
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Posted in: Neuroscience/Mental Health, Public Health, Science and the Media, Vaccines

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Involuntary Treatment – Civil Rights or Civil Wrongs?

In the 1950s, 558,000 people were in mental institutions in the U.S. Many were there against their will and were being warehoused or treated badly. Deinstitutionalization was intended to restore their civil rights and improve their lot. Did it? By 2006, there were only 40,000 people in institutions. What happened to the other 518,000?

Some of them are living in the community with supportive family members, taking their medications, and contributing to society. Some of them have been ghettoized in halfway houses or group homes in crime-ridden and run-down neighborhoods. Some of them are homeless, living on the streets and eating out of garbage cans. Some of them are in jail. Some of them have killed family members or have killed multiple people in “rampage” murders provoked by their psychotic delusions.

Accurate numbers are difficult to obtain. By some estimates, as many as 30-50% of the homeless (and even more of the hard-core homeless) and as many as 40-50% of the jail population are mentally ill. There are more mentally ill people in jails than in hospitals. The mentally ill are more likely to be victims of violence and rape and are more likely to be shot by the police in “justifiable homicide” incidents.

Mentally ill people who are adequately treated are no more violent than the non-mentally ill, but a disproportionate number of murders are committed by the mentally ill. The risk of violence increases with past history of violence, substance abuse, anosognosia with medication noncompliance, antisocial personality disorder, paranoid symptoms, and male sex. (more…)

Posted in: Neuroscience/Mental Health, Politics and Regulation

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Train Your Brain

I’m a big fan of video games, puzzles, and brain teasers. So the notion that so-called “brain training” games can help improve mental function and stave off dementia has some appeal to me. It also makes a certain amount of sense – exercise your brain and its function will improve.

And yet, as a skeptic, I have always been bothered by the specific claims made by marketers of games, websites, devices and programs. The formula is probably familiar to you, a specifically designed program is optimized to stimulate brain function, improve integration of information, and improve global function.

The website promotion for Brain Age, for example, claims:

Everyone knows you can prevent muscle loss with exercise, and use such activities to improve your body over time. And the same could be said for your brain. The design of Brain Age is based on the premise that cognitive exercise can improve blood flow to the brain. All it takes is as little as a few minutes of play time a day. For everyone who spends all their play time at the gym working out the major muscle groups, don’t forget – your brain is like a muscle, too. And it craves exercise.

The blood flow argument is pure hand-waving. The muscle analogy is perhaps more apt than intended – do muscles respond to a specific exercise or to any exercise?

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Psychiatry-Bashing

Psychiatry is arguably the least science-based of the medical specialties. Because of that, it comes in for a lot of criticism. Much of the criticism is justified, but some critics make the mistake of dismissing even the possibility that psychiatry could be scientific. They throw the baby out with the bathwater. I agree that psychiatry has a lot of very dirty bathwater, but there is also a very healthy baby in there that should be kept, cherished, nourished, and helped to grow – scientifically.

Common criticisms in the media

  • We are over-medicating our children, producing a generation of drugged zombies.
  • We are using medication indiscriminately for people who don’t fit the diagnosis (i.e. antidepressants for people who only have normal mood fluctuations and life problems).
  • Antidepressants lead to violence and suicide.
  • Psychotropic medications all have terrible side effects.
  • Antidepressants are no better than placebo.
  • Psychotherapies are no better than talking to a friend.
  • Electroconvulsive therapy (ECT) is a barbaric, damaging assault with no redeeming value.
  • And we all remember how Tom Cruise attacked Brooke Shields on the issue of postpartum depression.

Thomas Szasz: Mental Illness is a Myth

Thomas Szasz goes even further: he rejects the whole concept of mental illness and considers it a plot to interfere with people’s human rights. He says:

  • Psychiatric diagnoses are not valid because they are based on symptoms rather than on objective tests. (Steve Novella has pointed out that there are other well-established diagnoses like migraine that cannot be verified by any objective tests.)
  • Mental illness is a myth: unusual behavior does not constitute a disease.
  • Psychiatric diagnoses are an arbitrary construct of society to facilitate control of individuals whose behavior does not conform.
  • Involuntary commitment is never justified even for the protection of the patient: patients always have the right to refuse treatment even if that means they will die. (more…)

Posted in: Neuroscience/Mental Health, Science and Medicine, Science and the Media

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The Alleged Autism Epidemic

It is without controversy that the number of autism diagnoses being made is on the rise. In 1991 there were about 6 cases per 10,000 births, and in 2001 there were about 42. This number continues to rise at about the same rate.

The cause of this rise, however, is very controversial. There are basically two schools of thought: 1 – that true autism rates are on the rise, and 2 – that the measured rise is an artifact of increased surveillance and a broadening of the definition. I wrote previously about this very controversy, in which I concluded that the expanded diagnosis hypothesis is much better supported by the evidence.

Now, a new study published last week in the journal Epidemiology is being presented by proponents of the epidemic hypothesis as support for their view. A closer look, however, reveals that this study does not support the epidemic hypothesis and adds little to the overall literature on this question.
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Posted in: Neuroscience/Mental Health, Vaccines

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Dr. Jay Gordon – “Anti-Vaccination”

Dr. Jay Gordon is a pediatrician and one of the stars of the anti-vaccinationist movement. (Dr. Gorski wrote an exellent criticism of many of his claims recently on SBM.) He is, in fact, the pediatrician to Jenny McCarthy’s son, Evan (who she claims was injured by vaccines). Several months ago he published an “open letter on vaccinations” which is now making the rounds on anti-vaccine websites. The letter is a work of pure arrogant pseudoscience – a crafted piece of anti-vaccine propaganda. He begins:

I don’t give a lot of vaccines.

I still give DPT vaccinations to some children, chicken pox shots to kids who haven’t been able to acquire natural immunity by age ten years or so, and I give polio vaccines very infrequently. The polio vaccines are given for what I call “emotional” reasons because my exposition of the “numbers” (2000 cases of polio out of six or seven billion people) doesn’t counteract the very strong memory of a beloved aunt or uncle who had polio in fifties or sixties. And many parents feel much more comfortable traveling to India or parts of Africa with updated polio immunity for their children and themselves. By the way, 2007-2008 statistics don’t support that discomfort, but I don’t argue much.
In 2007, there were 1314 cases of polio on the planet and 127 of them were in “endemic” countries: 873 in India, 285 in Nigeria, 41 in the Congo, 32 in Pakistan and 17 in Afghanistan.

As of July 1, 2008, halfway through the year, we’re running a similar pace with 714 cases of polio reported worldwide. Nigeria has had 353 cases, India 287.

His argument is that because the risk of catching polio is so low, the benefits to the individual child are not balanced by the risks of the vaccine. His argument, however, is bogus on many levels. First, the benefits of the vaccine to the individual child do outweigh the risks. That is largely due to the fact that the polio vaccine is very safe. Serious complications are extremely rare.

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Posted in: Neuroscience/Mental Health, Vaccines

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Bee Venom Therapy – Grassroots Medicine

Pat Wagner (or “The Bee Lady,” as she likes to be called) treats herself for multiple sclerosis (MS) by allowing bees to sting her. She calls this bee-venom therapy (BVT) and believes it has saved her from MS.

There are now thousands of people who administer BVT to themselves or others, mostly in private homes by unlicensed practitioners. BVT is not prescribed by a doctor, yet it is used like any other drug, given in regular doses at regular intervals. There is no scientific evidence to support its use, and yet thousands of multiple sclerosis sufferers and others tout its effectiveness.

BVT, which is one modality within Apitherapy, or the use of various bee products as a medical treatment, is still a relatively small phenomenon. It is largely an unrecognized grassroots or folk medicine treatment – but like all such phenomena has been given a huge boost recently by the easy spread of information via the internet. It has also been adopted by many so-called alternative medicine (CAM) practitioners, and has been increasingly wrapped in the typical marketing jargon of CAM. So, in a way, this grassroots treatment has been corporatized by the CAM industry.

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Posted in: Herbs & Supplements, Neuroscience/Mental Health, Science and Medicine

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Rainman – Link Between Precipitation and Autism

A new study published in the Archives of Pediatrics and Adolescent Medicine shows a positive correlation between counties in California, Oregon, and Washington with greater precipitation and a higher incidence of autism. While the results of this study are interesting, it needs to be put into proper context. Also of note, the authors had presented early results from this data previously.

Correlation is not Causation

This type of study is a correlational study, which means it asks whether or not there is a statistical correlation between two variables – in this case the rate of autism and the amount of precipitation.  This type of data is extremely useful to medical science, but it has known limitations, which can be summarized by the statement that correlation is not causation.

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Dr. Jay Gordon and me: Random encounters with an apologist for the antivaccine movement

27452983Although he doesn’t detest me nearly as much as antivaccine honcho and founder of Generation Rescue J. B. Handley does, Santa Monica celebrity pediatrician Dr. Jay Gordon doesn’t like me very much at all.

Actually, I’m not sure whether that’s entirely true or not, but Dr. Gordon sure doesn’t like it when I criticize him for his antivaccine rhetoric. He affects an oh-so-wounded posture and self-righteously assures me that he is not “anti-vaccine” and that it is “beneath me” to use such rhetoric against him. Whether such rhetoric is “beneath me” or not, however, I’ve never quite understood why Dr. Gordon gets so upset at when I describe him as “anti-vaccine.” After all, his words are frequently apologetics for the anti-vaccine movement, and his actions frequently give it aid and comfort. After all, he is Jenny McCarthy‘s son Evan’s pediatrician, and as a result of that connection he has been giving speeches to antivaccine rallies, such as the “Green Our Vaccines” rally in Washington, D.C. in June. (He is the man in the sunglasses behind Jim Carrey in the picture at the top of this post by me.) After all, he has been palling around with luminaries of the antivaccine movement, such as Jenny McCarthy and her boyfriend Jim Carrey, the aforementioned J. B. Handley, Robert F. Kennedy, Jr., Boyd Haley, and numerous others at events like the “Green Our Vaccines” rally.

But, above all, over the last three or four years, Dr. Gordon has become the go-to pediatrician that the media seemingly always wants to interview when a vaccine “skeptic” with an MD after his name is required to provide the “balance” that journalists worship above all else, even when that “balance” gives undue credence to pseudoscientific nonsense. He clearly relishes that role, too, most infamously on his appearance with Jenny McCarthy on Larry King Live!, in which McCarthy shouted down pro-vaccine physicians and yelled “Bullshit!” (as if she who yells the loudest and is the most foul-mouthed wins the debate) and as evidenced by his appearances on certain antivaccination mailing lists, from which messages are occasionally forwarded to me.

What else am I supposed to think, except that Dr. Jay is at the very least an apologist for the antivaccine fringe, if not a card-carrying member himself?

Unfortunately, Dr. Gordon strikes me as being mostly a nice guy. I say “unfortunately” because it would be much easier to be as harsh on him as his promotion of antivaccine pseudoscience deserves if he were not. He also clearly believes that he is right based on the evidence. Based on science and clinical evidence, he most definitely is not. Recently, I had decided more or less to lay off him for a while, so as to avoid the wounded cries that invariably accompany valid charges that he is an apologist for the antivaccine fringe. Also, I felt kind of bad beating up on him so regularly and thought that perhaps a respite was in order. Then I found out that Dr. Gordon wrote the foreword to Jenny McCarthy’s new antivaccine and pro-autism quackery book, Mother Warriors: A Nation of Parents Healing Autism Against All Odds. Then, one of my readers actually took the time to transcribe Dr. Gordon’s foreword and e-mail it to me.

I read it, and I was appalled.
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Is there no end to unscientific treatments for autism?

OK, it’s true that I’m only scheduled to post every other week or so, but I couldn’t resist sharing this one with you (which I’ve cross-posted over at denialism blog).  I promise to get back to my assigned schedule after this one.  Thanks for your indulgence.  –PalMD

If you’ve been a regular reader of SBM or denialism blog, you know that plausibility plays an important part in science-based medicine.  If plausibility is discounted, clinical studies of improbable medical claims can show apparently positive results.  But once pre-test probability is factored in, the truth is revealed—magic water can’t treat disease, no matter what a particular study may say.  So it was with great dismay that I read an email from a reader telling me about parents buying hyperbaric chambers for their autistic children.  Let’s review some science.

In Breathing 101, we talked about how the oxygen delivered to your lungs depends on both the percentage of oxygen in the air, and the air pressure.  We looked at how diminishing atmospheric pressure, for example at altitude, makes it harder to breathe.

Of course it is also possible to expose people to increased atmospheric pressure, which has therapeutic uses in the form of hyperbaric oxygen therapy (HBOT).

Oxygen delivery to tissue depends on several factors.  We already talked about the air itself.  Once air gets enters the lungs, most of the oxygen transported to your tissues is carried by the hemoglobin molecules in your red blood cells (under normal conditions).  A small amount is directly dissolved in the blood.  The amount dissolved in the blood is dependent on (no surprise) the percentage of oxygen and the atmospheric pressure.  By increasing the atmospheric pressure from 1 atm (760 torr) to 3 atm, the amount of oxygen dissolved in the blood is enough to meet your body’s needs independent of heme-associated oxygen.

This is a good thing.
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