This is not for kids?
Last month I wrote a post on the causes of poor sleep in adolescents, as well as the myriad problems that can result in this high-risk population. Fortunately there is a system-wide public health measure proven to work, and now groups like the American Academy of Pediatrics are fully endorsing it. In that post, I briefly mentioned the increasing popularity of energy drinks and shots as caffeine delivery devices, and their role as both a potential cause of sleep deprivation and a means of temporarily ameliorating the effects.
I have been planning on addressing in greater detail the intentional, and unfortunately often accidental, ingestion of energy drinks in the pediatric population and the various associated risks for quite a while. What finally motivated me to get to work on this topic was the recent spate of media coverage regarding the results of a study presented this week at the American Heart Association’s Scientific Sessions 2014. The research, which involved the analysis of data obtained from the National Poison Data System for October 2010 through September 2013, supports concerns that pediatricians and other pediatric healthcare professionals have had for a very long time. Energy drinks are dangerous, particularly in young children, and a large part of the blame falls on the shoulders of manufacturers as well as the 1994 Dietary Supplement Health and Education Act (DSHEA) so frequently discussed on SBM.
Before I break down the scary numbers from the study, first a little background on energy drinks. (more…)
One of my early forays into the world of pseudoscience was an investigation of “Vitamin O” (the O stands for oxygen). The story is hilarious; please click and read; I guarantee you won’t be able to read it without at least a chuckle. Vitamin O is still for sale; it’s even available on Amazon.com. You can read the manufacturer’s ridiculous rationalizations about the FTC’s and FDA’s regulatory actions against them and their bogus “research” here. In my article, I mentioned oxygen bars, which were popular at the time. I was under the impression that they had gone out of fashion since then. Alas, no.
Dr. Stephen Barrett of Quackwatch e-mailed me to suggest that I might want to write about the O2 Planet website. It calls itself “the largest oxygen bar and oxygen spa source on the planet.” I can’t decide whether to thank Dr. Barrett for steering me to a source of entertainment and making me laugh or curse him for making me suffer through a disgusting collection of pseudoscientific rubbish. Some of the company’s claims are listed on the graphic above. (more…)
Low body temperature! Do you have Wilson’s Temperature Syndrome?
This is another in an irregular series of posts that puts the statements of naturopaths up against the scientific evidence
How are you feeling today? Tired? Lethargic? Chilled? Lacking energy? Is it the nature of life – or is it something more serious? If you consult with a naturopath, you could walk out diagnosed with something called Wilson’s Temperature Syndrome. But the naturopath would be wrong, because Wilson’s Temperature Syndrome is a fake disease.
One of the hallmarks of alternative medicine is the “fake disease”. Fake diseases don’t actually exist – they are invented without any objective evidence showing that they are real. Fake diseases tend to emerge from vague symptoms which can’t be attributed to a specific medical diagnosis. This is not to say what patients are experiencing isn’t real – the issue is the diagnosis, and the practitioner making the call. As has been pointed out by other SBM contributors, it’s understandable to want reasons and answers when you have debilitating symptoms. But symptoms need to be studied in rational and objective ways in order to understand the underlying illness – call it the “root cause” if you prefer. The diagnosis guides the treatment plan, so getting a diagnosis right is essential. While a group of vague symptoms might lead a medical doctor to run tests to rule out serious illness, alternative medicine providers already know the underlying problem. It’s your Chi. Your energy fields. Your diet. Whatever it is, it’s usually your fault. Adrenal fatigue is a fake disease. So is multiple chemical sensitivity, and Morgellons (delusional parsitosis). “Chronic” Lyme disease is another fake disease. Rather than offer a guide to proper care, a fake disease is a distraction from the truth. (more…)
One of the most interesting aspects of living through the second half of the 20th century and into the first half of the 21st century is the profound change in access to information. I remember in the 1980s there was a buzz (at least among technophiles and science fiction nerds) about how computers were going to be connected in a worldwide network and it would transform the way we access information and communicate. The reality we are living in now exceeds even the most fevered predictions being made at that time.
What was difficult to anticipate was how rapid access to almost any information would affect our day-to-day lives. Now, during a discussion, if a fact is in dispute we can simply look it up and resolve the dispute. I can no longer imagine doing research in a pre-internet age, promoting science-based medicine without social media, or collaborating without the virtual-time communication of e-mail.
The internet is rapidly becoming humanity’s collective culture and body of knowledge. For that reason it is important to nurture that body of knowledge to ensure that it is complete, accurate, and fair. That goal is frustrated, however, by the fact that the World Wide Web is not simply being used for scholarly information. It is also a tool to promote ideology and commercial interests. Therefore any efforts to provide scientifically accurate and unbiased information are likely to be swamped by well-funded and highly-motivated misinformation. Search on any medical topic and you will quickly see what I mean.
I have a new term to add to the English language, ebolasmacked, a derivative of the British term gobsmacked. Ebolasmacked defines my life the last few weeks since Ebola, or at last preparations for Ebola, have taken a huge bite out of my time with many interesting twists and turns. I think this is maybe the 9th outbreak (HIV, MERS, SARS, Legionella, H1N1, Avian flu, West Nile, MRSA) of my career and it has certainly generated more hysteria relative to the risk than any to date. Many of my usual pastimes, like SBM (as this essay will no doubt demonstrate), have had to take a back seat to preparing for what should be a very unlikely, but very disruptive, event. We do not want to get caught with our hazmats down should a case of Ebola come through the door.
What makes life interesting, among other things, is the constant realization that the more you know the more there is to know. I like Richard Dawkins’ metaphor in Climbing Mount Improbable where he pictures scientific progress as a series of false summits extending into infinity. It sure seems that way. Every time I think I understand a topic, I find there is still more to learn.
My Dad told me when I graduated from medical school that half of everything I had just learned was probably not true, the only problem is that you didn’t know which half. It was partially true. There have been ideas that have been abandoned since I was an intern, the most famous being that ulcers were due to stress and diet. But a new paradigm has been the exception, not the rule.
The last thirty years have been more about refining knowledge about the complexity of disease and its treatment and, perhaps equally importantly, having a better understanding of the all slings and arrows of outrageous fortune that can make the results of a clinical trial suspect. (more…)
In August of this year, a new policy statement from the American Academy of Pediatrics was published which tackled the widespread problem of insufficient sleep in our adolescent population. They even went so far as to label insufficient sleep as “one of the most common, important, and potentially remediable health risks in children.” The statement, which gave a number of recommendations on how to address the problem, made the news rounds primarily because of the call for schools to delay start times until at least 8:30 AM.
I wrote about pediatric sleep in March for a post on the potential link between some sleep disorders in children, specifically nightmares and night terrors, and the development of psychosis. Those claims are suspect but please read that post for a review of what sleep is, why we need it, and what can go wrong with it in children of all ages. For this post, my focus will be on adolescent sleep specifically, and on the role of delaying school start times in improving a variety of health parameters.
What are the common adolescent sleep challenges?
The typical modern teenager faces a variety of challenges to consistently obtaining a full night’s sleep, which is considered by most sleep experts to be in the 8.5 to 9.5 hours per night range. This doesn’t mean that every teenager will fall apart if they only get 7 hours of sleep each night, but sub-optimal sleep can adversely affect school performance in many, and even lead to long-term health problems in some children who establish such a pattern during these pivotal years. Hold that thought for now, however.
One obvious reason for insufficient sleep in teenagers, at least it is likely obvious if you have one of your own or have ever spent more than two minutes near one, is technology. Most older children have electronic media in their rooms, if not attached to their bodies in the form of a smart phone. 24-7 access to the internet and social media is a commonly-cited impediment to sleep onset. The increasing availability and popularity of energy drinks containing absurd amounts of caffeine among adolescents likely also plays a role as both a coping strategy for daytime fatigue resulting from insufficient sleep, and as a cause of it. In fact, I think I’ve just come up with the topic for my next post.
One common feature of pseudoscience is that proponents of a specific belief tend to exaggerate its scope and implications over time. In the world of physics this can eventually lead to a so-called “theory of everything” – one unifying theory that explains wide-ranging phenomena and displaces many established theories.
In medicine this tendency to exaggerate leads in the direction of the panacea, the miracle cure for everything. Why does this happen?
There are numerous examples. Here is a video of Bruce McBurney trying to sell his Precious Metals Nano Water to investors in the Dragon’s Den. The product is nothing but distilled water with a tiny amount of silver. McBurney claims that this magic water will essentially cure everything, all bacterial and viral infections, and even cancer.
The panacea is also not the sole domain of the lone crank. Straight chiropractors essentially believe that adjusting the spine can cure everything from bed wetting to asthma, and yes, even cancer.
What factors predispose to the panacea claim? (more…)
Dr. Oz, one half of the You Doctors. And a professor. A professor.
I receive a monthly newsletter from my medical board. Among other issues discussed are the results of disciplinary actions for physicians. Occasionally a physician who has boundary issues is required to have a chaperone present when doing exams.
I was thinking that the concept of a chaperone could be more widely applicable. Consider “You Docs: Amazing acupuncture,” the latest from Drs Oz and Roizen. Both are professors at their respective institutions. Professors. To judge from the ability to read and interpret the medical literature, both should not be allowed near a journal without a chaperone to remind them about cognitive biases, logical fallacies and what constitutes a good clinical study. Looking at their recent review of acupuncture suggests they lack an understanding of all three.
They start with the argument from antiquity, which is not only wrong as a logical fallacy, it is wrong historically when they say:
acupuncture has been a go-to therapy for 5,000 years.
Off by a factor of about 500. They are unaware that acupuncture as currently practiced is relatively new, having been a form of bloodletting until recently when the modern version with steel needlesbecame popular under Mao.
However, in the early 1930s a Chinese pediatrician by the name of Cheng Dan’an (承淡安, 1899-1957) proposed that needling therapy should be resurrected because its actions could potentially be explained by neurology. He therefore repositioned the points towards nerve pathways and away from blood vessels-where they were previously used for bloodletting.
They explain the mechanism of action as stimulating
points in the body that affect chi or qi, the life energy.
without noting that chi or qi is a fantasy. No life energy has ever been measured and virtually every point on the body is an acupoint in one of the multiplicity of styles that are acupunctures. Except, as mentioned in the past, the genitals.
Foolproof cure for hiccups?
nOne of the most common questions I get in the newborn nursery, especially from first time parents, involves hiccups. Babies hiccup in the womb and most, if not all of them, will have periodic bouts of hiccups in the neonatal period. But many new parents are surprised by their baby’s first spasmodic contractions of the diaphragm. When brought up, it is often to simply acknowledge that their baby had a run of a few hiccups, usually associated with a feed, with some parents expressing surprise and others nervousness. Regardless of their assumed motivation, I always provide reassurance that hiccups are a normal experience for babies, as they are across the entire spectrum of age.
The medical term for hiccups, which I admit I only learned while researching this topic, is “singultus.” We doctors like to use our own peculiar language as much as possible in order to maintain a sense of superiority when dealing with today’s internet savvy customers, I mean patients, and their families. The rumbling of your stomach, that’s actually borborygmus. You don’t have a unibrow above your nose, that’s a synophrys. It isn’t abdominal or pelvic discomfort associated with ovulation that keeps annoying you midway through your menstrual cycle, it’s mittelschmerz. But since this is a forum meant for general public consumption, I’ll use the rather pedestrian and philistine “hiccup” for the duration of the post. (more…)