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Environmental Medicine – Not Your Average Specialty

I recently received an announcement for a conference on “Inflammation and Autoimmunity.” The topic sounded interesting, but as I read further I saw some red flags:

A gathering of healthcare leaders with a shared vision.

This event focuses on the the [sic] true causes and effects of inflammatory and autoimmune diseases, including new treatments available for this rapidly emerging crisis.

Both of these comments sound ideology-driven. I would not expect to find language like this for, say, a conference organized by the American Academy of Pediatrics or the American Academy of Allergy, Asthma and Immunology. This conference was organized by the American Academy of Environmental Medicine. I did some checking, and it seems the AAEM is not your average academy, and environmental medicine is not your average specialty.

The AAEM is not recognized by the American Board of Medical Specialties.
It is listed as a questionable organization on Quackwatch. And the American Board of Environmental Medicine is listed as a dubious certifying board. (more…)

Posted in: Science and Medicine

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The NCCAM Seeks Comments for its “Strategic Plan: 2010.” Part I

The National Center for Complementary and Alternative Medicine (NCCAM) has posted three essays about its latest “strategic planning process,” and has invited “stakeholders” to make comments. I have previously made my own opinions clear,* as have fellow bloggers Gorski, Novella, Lipson, and Sampson: the best strategic plan for the NCCAM would be to extinguish itself. Since politics makes that plan unlikely, there are strategies that could minimize the considerable harm now done by the Center, while possibly offering a modest benefit. In summary:

  • For both scientific and ethical reasons the NCCAM must dispense with trials of highly implausible claims. It should start by abandoning the ongoing Trial to Assess Chelation Therapy (TACT), its largest and most expensive trial yet, and one that has proven to place experimental subjects in considerable danger. It should publicly acknowledge such mistakes and explain why they must not be repeated—no matter how much political pressure there may be to do so.
  • The Center should use its website’s Health Information function to explain what’s known, rather than continue its customary practice of putting the best possible slant on most “CAM” claims, no matter how absurd or disproven.
  • The Center should address aspects of “CAM” advocacy that it has previously avoided, the most important being the close affiliation of such advocacy with the anti-vaccination (and autism quackery) movement. The NCCAM should consider itself an important source of rational information for a public that is currently, and dangerously, misled about immunizations. A related example of mischievous “CAM” advocacy, so far also ignored by the Center’s website, involves an imagined, sinister cartel of physicians, the AMA, pharmaceutical companies, and the FDA. The NCCAM should vigorously debunk such myths by providing facts and data.
  • The Center should pursue the question of why some people are stubbornly attracted to implausible, unproven, and/or inert treatments. Wally Sampson suggested this idea years ago. It is one of many legacies of the late Barry Beyerstein, among others, whose writings could serve as a template for legitimate NCCAM research topics.

The NCCAM’s Charter and its boosters in Congress make such strategies exceedingly unlikely, as explained here. Therefore, in this and two subsequent postings I’ll address a few of the assertions made in each of the Center’s three “big picture” essays. These will not be comprehensive critiques of those essays, which would require deconstructions of nearly every sentence.

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Posted in: Medical Academia, Medical Ethics, Politics and Regulation, Science and Medicine, Science and the Media

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What’s the right C-section rate? Higher than you think.

Editor’s Note: Dr. Mark Crislip has been kidnapped by anti-vaccinationists. Fortunately, we have sent our black Illuminati, pharma-funded, vaccine-wielding helicopters to rescue him, but unfortunately, as a result of his trauma, his usual Friday post is likely to be delayed either until this afternoon or Saturday. In any case, fortunately for us our latest addition to the SBM crew, Dr. Tuteur, was willing to fill in on short notice; so here she is. Dr. Crislip will post by tomorrow. To whet your appetite for his patented sarcasm, let me just say that he will be having a little fun with a certain article from The Atlantic about flu vaccines. There, now doesn’t that make you want to check back tomorrow to find out what his take is on the article? I thought it would.

Buried in the midst of it new report, Monitoring emergency obstetric care; a handbook, the World Health Organization acknowledges what obstetricians have been saying for some time. The WHO’s goal of a 10-15% C-section rate lacks any empirical basis.

Earlier editions of this handbook set a minimum (5%) and a maximum (15%) acceptable level for caesarean section. Although WHO has recommended since 1985 that the rate not exceed 10–15%, there is no empirical evidence for an optimum percentage or range of percentages …

Of course, they’re not going to give up their recommendation simply because there is no science that supports it, insisting that “a growing body of research that shows a negative effect of high rates.”

Dr. Marsden Wagner, former head of the Perinatal Division of the WHO, appears to be responsible for the purported optimal C-section rate of 10-15%, the level at which both maternal and neonatal mortality rates are supposedly the lowest. Ironically, Dr. Wagner is a co-author of a recent study that actually demonstrates the opposite.
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Posted in: Obstetrics & gynecology, Science and Medicine

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The Skeptical O.B. joins the Science-Based Medicine crew

I’m very pleased to announce that Dr. Amy Tuteur, otherwise known as The Skeptical O.B., has joined Science-Based Medicine. Dr. Tuteur will fill in an area where we are lacking, namely an expert in women’s health and childbirth. For those of you who don’t know Dr. Tuteur, she is an obstetrician-gynecologist. She received her undergraduate degree from Harvard College and her medical degree from Boston University School of Medicine. Dr. Tuteur is a former clinical instructor at Harvard Medical School. Her book, How Your Baby Is Born, an illustrated guide to pregnancy, labor and delivery was published by Ziff-Davis Press in 1994. She runs the website AskDrAmy.com and has her own iPhone app, the Ask Dr. Amy Am I Pregnant Quiz. Dr. Tuteur blogs at The Skeptical OB.

We expect great things from Dr. Tuteur, and hope you will join us in welcoming her to the fold. She will begin tomorrow and will post new material every Thursday. Finally, with the addition of Dr. Tuteur, it should also be noted that, due to the demands of her day job, Dr. Val Jones will decrease her posting frequency from every Thursday to every other Thursday. She will thus not be posting this week, and her next post will be on Thursday, November 12.

Posted in: Science and Medicine

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Those who live in glass houses…

The last two weeks have brought good news to those who seek to hold chiropractic to the standard of evidence and science-based medicine.

In the first bit of good news, on October 14th Simon Singh was granted permission to appeal the High Court ruling on meaning of the term “bogus” within his original article.  I’m sure most readers of this blog are familiar with Simon Singh’s legal battle with the British Chiropractic Association (BCA) regarding an article in The Guardian entitled “Beware the Spinal Trap.”  We’ve covered it several times over the last year and will continue to do so as the case progresses. The nuances of the British legal system (or any legal system for that matter) are beyond my ken, and are far better explained by Jack of Kent here.  The take-home point is that gaining permission to appeal the ruling on meaning was virtually essential if Simon were to have any real chance of winning this lawsuit.

Even if the BCA should win its lawsuit for libel against Singh, it seems likely to be something of a pyrrhic victory.  After all, in the year since this story began, we’ve been belatedly provided with the BCA’s best evidence in support of chiropractic’s efficacy, and promptly treated to its subsequent evisceration. (more…)

Posted in: Chiropractic, Science and Medicine

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A Science Lesson from a Homeopath and Behavioral Optometrist

Charlene Werner is getting a lot of attention she probably did not anticipate or desire. She is the star of a YouTube video in which she explains the scientific basis of homeopathy. Before you watch it, make sure you are sitting down, relax, and brace yourself for an onslaught of profound scientific illiteracy combined with stunning arrogance. For those with more delicate constitutions I will give you the quick summary:

Einstein taught us that energy equals matter and light, but because matter can be condensed down to a very small space if you remove all the empty space between the elementary particles (I am paraphrasing to make her statements minimally coherent), we can mostly ignore matter. Therefore energy is light, and we are all made of energy – not matter (or at least so little matter, you can ignore it). Stephen Hawking then came up with string theory, which tells us that all matter (which we can ignore) is made of vibrating strings. Therefore we are made of vibrating energy. All diseases are therefore caused by unhealthy vibrational states, and all disease can be treated by returning the body to a previous healthy vibrational state. This can be done with homeopathy, which extracts the vibrational energy out of stuff and places it in a small pill that can be used at any time.

Got it? This is now my favorite example of meaningless pseudobabble from a CAM proponent. Also, I am not picking on some unrepresentative crank – this is as good as homeopathy gets. Werner may be more clumsy and fumbling than more eloquent homeopathy proponents, but when you strip it down, magical vibrations is what you get. But Werner does a fabulous job of exposing the gaping holes is homeopathic nonsense.

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Posted in: Homeopathy, Ophthalmology, Science and Medicine

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A Not-So-Split Decision

For those who battle tirelessly against the never ending onslaught of anti-vaccine propaganda, misinformation, and fear, there was great news the other day from Merck. The pharmaceutical company, and maker of the MMR vaccine against measles, mumps, and rubella, has decided not to resume production of the individual, or “split”, components of the vaccine. A Merck representative made the announcement during a meeting of the CDC Advisory Committee on Immunization Practices (ACIP) on Tuesday. During previous ACIP meetings, science experts on that committee presented compelling arguments against  continued, large scale production of the monovalent components of the MMR vaccine, which were echoed by scientists in Merck’s vaccine division. In a moment, I’ll discuss the arguments against the split vaccine, and why this is so important a decision. First, some background on the issue of splitting the MMR.
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Posted in: Science and Medicine, Vaccines

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“Methodolatry”: My new favorite term for one of the shortcomings of evidence-based medicine

I’d like to thank revere right now publicly. He’s taught me a new word:

Methodolatry: The profane worship of the randomized clinical trial as the only valid method of investigation.

Many of you have e-mailed me and other SBM bloggers about a recent article in The Atlantic by Shannon Brownlee and Jeanne Lenzer, two reporters whose particular bias is that we as a nation are “over treated.” That may be true, although not to the extent that Brownlee, at least, seems to think, and her article on swine flu was truly biased and painful to read. Moreover, “methodalatry” perfectly describes one of the complaints we at SBM have about the “evidence-based medicine” paradigm. So I’m really glad that revere took it on and demolished it.

The hero of The Atlantic article, Tom Jefferson clearly has an agenda about flu vaccines. Indeed, he has such an agenda that he was invited to the National Vaccine Information Center’s vaccine conference in early October. The NVIC is the oldest and biggest antivaccine organization there is. Either he didn’t know that, in which case he’s clueless, or he didn’t care. In any case, it was clear that he was invited there because of his stance on flu vaccination, and he was even going to be awarded the NVIC “Courage in Science” Award. To his credit, Jefferson backed out when he found out that he would be sharing the stage with Andrew Wakefield, who was to be given the NVIC “Humanitarian Award.” He was appropriately horrified. Still, he should never have accepted in the first place, given that the NVIC clearly wanted to coopt him and use his gadfly status to make its anti-vaccine stance seem reasonable and science-based.

That’s just one reason why I don’t take Tom Jefferson particularly seriously anymore. I tend to agree with revere that Jefferson is drifting perilously close to crank territory with respect to flu vaccines. Indeed, “methodolatry” is an awesome term to describe his approach. Actually, it’s a great term to describe some of the Cochrane scientists responsible for analyzing the efficacy of mammography screening, as well; their conclusions and methods rather remind me of Jefferson’s.

Finally, you might also want to reread (or read for the first time if you haven’t read it already) Mark Crislip’s article on flu vaccine efficacy, which, although not directly written in response to Brownlee’s article, does address many of the shortcomings in its analysis of H1N1 vaccine efficacy.

Posted in: Science and Medicine, Science and the Media, Vaccines

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Hi Ho Silver

I was making rounds at the hospital and, for some strange reason, I was being asked about influenza. No, this is not going to be an entry on influenza. But I was asked if there was anything besides the vaccines that can prevent influenza.  Masks and good hand washing will help, I said.

Anything else?

A nurse suggested colloidal silver.
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Posted in: Science and Medicine

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The New Plague

I’m taking this opportunity to introduce a new blog to the SBM audience, and to draw yet more attention to the growing and dangerous trend of parental vaccine refusal. So, please take a momentary break from your perusal of this most esteemed font of knowledge, and point your browser to Gotham Skeptic.

Posted in: Public Health, Science and Medicine, Vaccines

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