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Archive for Public Health

Smoking: The Good News and the Bad News

The principles we espouse on Science-Based Medicine are vitally important, but some of the subjects we address are not so important in the big scheme of things. Homeopathy and electrodermal diagnostic devices don’t actually harm very many people. For today’s post, I’m going to follow the Willie Sutton rule and go where the money is, so to speak.

Smoking is the leading preventable cause of death. No prospective double blind randomized controlled studies have been done, or ever could be done; but a mountain of evidence converging from many avenues has established the health dangers of smoking beyond any doubt. Hill’s criteria of causation have been amply fulfilled.  Smoking causes 90% of all deaths from lung cancer and chronic obstructive pulmonary disease (COPD). It increases the risk of coronary heart disease, stroke, several types of cancer, infertility, stillbirth, sudden infant death syndrome (SIDS), osteoporosis, and premature skin aging (wrinkles). The dangers of second-hand smoke have been amply documented, and where smoke-free laws have been passed there has been a drop in the incidence of heart attacks and of emergency room visits for children with asthma.

Two new studies published in The New England Journal of Medicine reinforce what we already knew and offer both good news and bad news.  (more…)

Posted in: Public Health

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An open letter to Penn & Teller about their appearance on The Dr. Oz Show

An open letter to Penn & Teller about their appearance on <em>The Dr. Oz Show</em>
OzPT

 

Dear Penn & Teller,

I really don’t want to say this, but I feel obligated to. I’m afraid you screwed up. Big time. (Of course, if this weren’t a generally family-friendly blog, where we rarely go beyond PG-13 language, I’d use a term more like one that Penn would use to describe a massive fail, which, as you might guess, also starts with the letter “f”; I think he’d appreciate that.)

I’m referring, of course, to your appearance on The Dr. Oz Show one week ago (video: part 1, part 2, part 3, part 4). Before I begin the criticism, let me just take care of the obligatory but honest statement that I am a fan. I’ve been a fan for a long time. Indeed, I remember seeing you guys perform in Chicago back in the late 1990s when I was doing my fellowship at the University of Chicago. I’ve also seen you in Las Vegas a couple of times, most recently a couple of years ago (see pictures below) at TAM. The two of you have become skeptical icons, through your association with James Randi and over the last several years through your Showtime series Bullshit!, which is advertised with the tagline, “Sacred cows get slaughtered here.” And so they did for the eight seasons Bullshit! was on TV. When you guys were on, it was a thing of beauty to behold, both from the standpoint of entertainment and skepticism.
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Posted in: Faith Healing & Spirituality, Homeopathy, Public Health, Science and the Media

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Legislative Alchemy: Naturopathy 2013

A fresh season of state legislative sessions is upon us and with it comes the ubiquitous attempts by purveyors of so called “complementary and alternative medicine” (or “CAM”) to join the health care provider fraternity. Via the magic of legislative alchemy, state legislatures transform pseudoscientific diagnoses (e.g., “chronic yeast overgrowth”) and treatments (e.g., homeopathy) into faux, but legal, health care. Once the imprimatur of legitimacy is bestowed by the state in the form of a health care practice act tailored to their special brand of quackery, these newly licensed health care providers are free to foist their practices onto an unsuspecting public and charge them for the privilege. All of this is done under the false assumption that such legislation is necessary to protect the public health, safety and welfare.

We might well want to consider how far this whole thing is going. Will practitioners of CAM split into an ever-expanding number of CAM provider guilds, all with their own practice acts? First, chiropractors were the only CAM practitioners who managed to get themselves licensed in all 50 states. Then along came acupuncturists, who are now licensed to practice in over 40 states. A few states license homeopaths. Some states licensed naturopaths early on. Now the naturopaths, licensed in 16 states, are in a full court press to catch up and legitimize themselves with licenses to practice “naturopathic medicine.”

Why? Because, according to Lorilee Schoenback, ND, a Vermont practitioner and American Association of Naturopathic Physicians (AANP) Board member:

If the law [the Affordable Care Act, or ACA] is implemented as intended NDs in 16 states will immediately be covered by insurance.

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Posted in: Herbs & Supplements, Homeopathy, Legal, Naturopathy, Pharmaceuticals, Politics and Regulation, Public Health

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One Flu Into the Cuckoo’s Nest*

“I don’t seem able to get it straight in my mind….”
― Ken Kesey, One Flew Over the Cuckoo’s Nest

Influenza is going gangbusters at the moment. I like going to Google Flu trends as well as the CDC flu site to see what flu is doing. Using Google searches as a surrogate for infections is an interesting technique that public health officials have tried with less success in other illnesses but is not without utility. Behaviors of populations can presage a problem, my favorite example is the first hint of the 1993 massive Cryptosporidia diarrhea outbreak in Milwaukee was a sudden shortage of Kaopectate and Peptobismol. It appears there are more patients with flu like symptoms this year than  at the height of the H1N1 epidemic of 2009. We have lots of flu like illness, and per the CDC there are buckets of confirmed influenzaflu, but so far the season, while probably having more cases than 2009, the outbreak is clinically not the same.

Compare and contrast, the two words that defined undergraduate liberal arts essay assignments. Get out your blue books and compare and contrast influenza outbreaks from 2009 and 2013. You have one hour. (more…)

Posted in: Clinical Trials, Epidemiology, Public Health, Science and Medicine, Science and the Media, Vaccines

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Nonsense about the Health Effects of Electromagnetic Radiation

Helke Ferrie has written an article for The CCPA Monitor, a monthly journal published by the Canadian Centre for Policy Alternatives, entitled “Dirty electricity, EMF radiation can be removed or reduced.” It is in the June 2012 issue, and is not available online. She calls herself a science writer, but this is not the writing of a person who understands science. There is hardly a word of truth in it. It’s a classic example of pseudoscientific propaganda, an appalling farrago of false statements and fallacious arguments. The nonsense starts with the very first sentence:

The symptoms of electropollution-induced sickness involve all organs with many debilitating symptoms, from skin rashes to cancer; they are part of the Multiple Chemical Sensitivity (MCS) spectrum.

The diagnoses of “electromagnetic hypersensitivity” and “multiple chemical sensitivity” are not recognized by the medical and scientific communities. Up to 5% of the population has come to attribute a large variety of nonspecific symptoms to non-ionizing electromagnetic fields from cell phones and other common electrical devices or to the chemicals in their environment. Their complaints have been thoroughly evaluated. Numerous studies and systematic reviews have been done; they are summarized in a Wikipedia article.  Just to give one example, a systematic review published in Psychosomatic Medicine in 2006 analyzed 31 double blind studies comparing real radiation to sham radiation. Patients couldn’t tell the difference. 24 of the studies found no effect, 7 reported “some” supporting evidence (2 of which could not be replicated on subsequent trials by the same researchers), 3 were false positives attributed to statistical artefacts, and the final 2 had mutually incompatible results. They concluded:

The symptoms described by “electromagnetic hypersensitivity” sufferers can be severe and are sometimes disabling. However, it has proved difficult to show under blind conditions that exposure to EMF can trigger these symptoms. This suggests that “electromagnetic hypersensitivity” is unrelated to the presence of EMF.

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Posted in: Public Health, Science and the Media

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Anti-psychiatry and anti-vaccine activists shamelessly taking advantage of the Sandy Hook Elementary School shootings

Quacks detest science-based medicine (SBM) in general, but there are certain specialties that they detest more than others. For instance, you won’t find too many quacks attacking trauma surgery because even they know that when a person’s body has been on the losing end of a confrontation with a bullet or a car, no amount of laying on of hands, homeopathic nostrums, “energy healing,” or herbal remedies are going to stop the hemorrhage, mend broken bones, or repair holes in various internal organs. That’s why even homeopaths will concede that “allopathic medicine” is good for emergencies. It’s also why sketches like this one resonate:

However, from there the distrust of promoters of unscientific and pseudoscientific medical systems and treatment modalities for SBM appears to increase in direct proportion to the urgency and need for direct physical repair of damaged organs, with the possible exception of cancer, for which the standard physical treatment (surgery) is attacked nearly as much as chemotherapy.

Be that as it may, arguably the specialty most attacked by quacks is psychiatry. Many are the reasons, some legitimate, many not. For example, the Church of Scientology in particular despises psychiatry, even going so far as to maintain through its anti-psychiatry front group the Citizens’ Commission on Human Rights (CCHR) a risibly nonsensical “museum” in Hollywood dedicated to psychiatry that they charmingly call Psychiatry: An Industry of Death. It’s so ridiculously, painfully over-the-top, a veritable self-parody of anti-psychiatry hyperbole, that it inadvertently undermines the very attacks on psychiatry frequently leveled by Scientologists and quacks that it’s meant to reinforce. Indeed, not having visited its website for several years, I notice that the CCHR has totally revamped it, now including a virtual 3D tour of the museum, along with video clips from its many “exhibits” available online. I’ll have to file that away for later blog fodder, because the misinformation, cherry picking, and pseudoscience flow freely, as one would expect from a Scientology propaganda project. In the meantime, suffice to say that it’s not just the Church of Scientology that despises psychiatry. It’s founder L. Ron Hubbard and his disciples merely represent the most ridiculously over-the-top and vociferous anti-psychiatry group that I’m currently aware of.

Let’s face it, psychiatry hasn’t always had the best history. It’s a very hard to study human behavior and disorders of human behavior in a rigorous fashion, but to my mind that didn’t excuse the the widespread acceptance for many decades of the ideas of Sigmund Freud, which were little removed from pseudoscience in many respects. Also, psychiatry has not always had the best history, particularly in the early part of this century. Too often, psychiatry has been used as a tool of control rather than a means of helping people who are suffering. Perhaps the worst example is the misuse of psychiatry by various totalitarian regimes, be it the Nazis using it as a primary tool of its T4 euthanasia program or the Soviet Union declaring enemies of the state to be mentally ill and shipping them off to Gulags.

Although there is a ways to go, however, psychiatry in 2012 is much better than psychiatry, say, 50 or 75 years ago. It wasn’t so long ago that, popularized by Walter Freeman, thousands of “ice pick lobotomies” were performed for all manner of indications, few of which had what we would consider to be compelling scientific support to back them up. Over the last half-century, better psychiatric drugs to treat different conditions have been developed, leading to their widespread use for a number of indications.
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Posted in: Neuroscience/Mental Health, Politics and Regulation, Public Health, Vaccines

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Another blow to the anti-vaccine movement as legislation change forces a name change

Earlier this year, Australia’s anti-vaccine lobby, the Australian Vaccination Network (AVN), took the NSW Government to the Supreme Court. In dispute was their license to fundraise which had been revoked and a public warning, issued because they refused to put a Quack Miranda on their website.

The public warning was posted after the NSW government investigated their website following two complaints, one from a concerned citizen and one from the parents of a 4 week old girl who had died of pertussis.

The complaints accused the AVN of peddling dangerous health misinformation including that vaccines were linked to autism and that pertussis was “nothing more than a bad cough”.

The AVN had always insisted that the HCCC did not have jurisdiction over them because they were not health care providers or educators in the “traditional sense”. It is true that health legislation in NSW is very much out of date in the Internet age. The rules say you can complain only if you can demonstrate direct harm as a result of taking someone’s dodgy advice. For example you had a stroke because of a chiropractor’s adjustments or a punctured lung from acupuncture. Just having a website full of woo-woo wasn’t really covered.

So the AVN challenged the HCCC on these grounds and, to the surprise of many of us, they won. Those who were present in the court that day recall the Judge urging the HCCC Barrister to present evidence for direct harm. And the worst thing was the HCCC apparently had this information, but for reasons unknown to us, did not present it. Those who were there said the HCCC Barrister dropped the ball big time that day. And they were right.

Within hours the public warning was expunged and shortly after that the authority to fundraise was returned. As if nothing ever happened.
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Posted in: Politics and Regulation, Public Health, Vaccines

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Disingenuous: Deconstruction of a naturopathic white paper

Science is the Concept by which
we measure our reality
I don’t believe in magic
I don’t believe in I-ching…
I just believe in science…and that reality.

John Lennon. Sort of.

As regular readers of the blog are aware, I am science/reality based.  I think the physical and basic sciences provide an excellent understanding of reality at the level of human experience.  Physics, chemistry, biology, anatomy, biochemistry, physiology, evolution etc. provide a reliable and reproducible framework within which to understand health and disease.  My pesky science may not know everything about reality, but day to day it works well.

“There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy. – Hamlet (1.5.166-7).”  

Perhaps, but all the medical advances in my lifetime have been not yielded new science, just (amazing) variations and extensions of known processes.  I sometimes think the blog should have been called reality based medicine, but science is the tool by which we understand reality, and while the tool is constant, our understanding of reality is prone to changing.  An understanding of the rules of the universe combined with an awareness of the innumerable ways whereby we can fool ourselves into believing that those rules do not apply to us is part of what makes a science and reality based doctor.

We are often told of the need to keep an open mind, but I like to keep it open to reality.  Not that I do not like fantasy and magic, it is a common category for my reading.  I just finished Red Country by Joe Abercrombie, and while I love the world he has created, I would not want to apply the rules of that imaginary world to my patients.   Well, one exception.  As Logen Ninefingers  would say, “You have to realistic about these things.” Fictional worlds should be limited to the practice of art, not the practice of medicine.
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Posted in: Humor, Naturopathy, Politics and Regulation, Public Health, Science and Medicine

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A holiday round in the mammography debate

There are times when the best-laid blogging plans of mice and men often go awry, and this isn’t always a bad thing. As the day on which so many Americans indulge in mass consumption of tryptophan-laden meat in order to give thanks approached, I had tentatively planned on doing an update on Stanislaw Burzynski, given that he appears to have slithered away from justice yet again. Then what to my wondering eyes should appear in my e-mail in box but news of a study that practically grabbed me by my collars, shook me, and demanded that I blog about it. As if to emphasize the point, suddenly e-mails started appearing by people who had seen stories about the study and, for reasons that I still can’t figure out after all these years, were interested on my take on the study. Yes, I realize that I’m a breast cancer surgeon and therefore considered an expert on the topic of the study, mammography. I also realize that I’ve written about it a few times before. Even so, it never ceases to amaze me, even after all these years, that anyone gives a rodential posterior about what I think. Then I started getting a couple of e-mails from people at work, and I knew that Burzynski had to wait or that he would be relegated to my not-so-secret other blog (I haven’t decided yet).

As is my usual habit, I’ll set the study up by citing how it’s being spun in the press. My local home town paper seems as good a place to begin as any, even though the story was reprinted from USA Today. The title of its coverage was Many women receiving unnecessary breast cancer treatment, study shows, with the article released the day before the study came out in the New England Journal of Medicine:
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Posted in: Cancer, Diagnostic tests & procedures, Public Health

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Scaremongering to Sell Water Filters

There is an obvious survival advantage to the emotion of disgust – we should fear putting unhealthy, tainted, contaminated, or poisonous substances into our bodies. Emotions, however, are a double-edged sword. They are an effective evolutionary mechanism for motivating creatures to engage in certain behavior, but they also tend to be crude and undiscriminating – inadequate to deal with our complex modern society.

A dispassionate consideration of objective scientific evidence is the optimal strategy for deciding on which foods and substances are safe to consume, but it is far easier to scare people about toxins than to reassure them with data. We see this frequently with the anti-vaccine movement, and also with anti-fluoridation attitudes. It is easy to scare people with the idea that there are “chemicals” in our drinking water.

One company, San Diego Pure Water, seems to have made such scaremongering into a marketing strategy. Their website is full of articles and videos claiming that fluoride is the “the greatest fraud that has ever been perpetrated.”

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Posted in: Public Health

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