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Archive for Science and Medicine

The Need for Transparency

A recent editorial in PLOS Medicine discusses the need for transparency in the medical literature, specifically with regard to comparative effectiveness research (CER). The editorial makes many excellent points, but also puts into clear relief the double standard that is consciously being fabricated by proponents of non-science-based medicine.

I wrote previously about another editorial that took a very different approach. Speaking for The Kings Fund, Professor Dame Carol Black said.

“The challenge is to develop methods of research that allow us to assess the value of an approach that seeks to integrate the physical intervention, the personal context in which it is given, and non-specific effects that together comprise a particular therapy.”

The editorial essentially defended the use of CER and other forms of evidence to bolster the evidence base for so-called CAM (complementary and alternative medicine) in order to promote its use.

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Posted in: Science and Medicine

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Cold Flusion?

This is a quick entry to allow me to have a little spleen venting.  And I am cross posting this over at Medscape.

Background for you youngsters.  In 1989 two electrochemists Martin Fleischmann and Stanley Pons, announced they had successfully developed cold fusion: nuclear fusion at room temperature.  Pons was chairman of the chemistry department at the University of Utah at the time and lent a fair amount of respectability to the announcement.

A great deal of brouhaha followed, but in the end “is heard no more: it is a tale Told by an idiot, full of sound and fury, Signifying nothing.” Cold fusion was and is a bust, although millions were spent in pursuit of that pot of gold.

Fast forward to this week.  Here is the data upon which important public health decisions are being made, in its entirety:

“new Canadian study — which has not yet been peer reviewed or published —that found those who receive the seasonal flu vaccine become two times more likely to get H1N1.”

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Posted in: Science and Medicine

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AAFP Endorses CAM

I recently chastised the American Family Physician (the journal of the American Academy of Family Physicians) for assigning a high SORT (strength of evidence) rating to acupuncture treatments that did not merit that rating. While the AAFP claims to strongly support evidence-based medicine, I have observed a gradual infiltration of CAM into their journal, their website, and their CME offerings. They seem to be more concerned with the popularity of CAM and with not offending its believers than with maintaining scientific rigor. The problem is only getting worse.

Recently a “News Now” article was published on the AAFP website: “New Report Details Billions Americans Spend on Complementary, Alternative Medicine: Physicians Can Benefit from Adding CAM to Their Practices, Says FP” It is very disturbing. (more…)

Posted in: Science and Medicine

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HIV/AIDS denialists do it too!

Remember my post from Monday about fake scientific conferences organized by the anti-vaccine movement that are designed to paint a picture of legitimate science being done, so much so that they even fool some academics into speaking there? (I realize that the server issues we had from Monday through Wednesday that rendered the site completely FUBAR may have prevented some of you from reading it.)

Well, it turns out that HIV/AIDS denialists do it too!

Why am I not surprised?

Posted in: Medical Academia, Science and Medicine, Science and the Media

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Boost Your Immune System?

This post is a wee bit of a cheat in that it is a rewrite of a Quackcast, but I have three lectures and board certification in the near future, so sometimes you have to cook the wolf.

What does that mean: boost the immune system? Most people apparently think that the immune system is like a muscle, and by working it, giving it supplements and vitamins,  the immune system will become stronger. Bigger. More impressive, bulging like Mr. Universe’s  bicep. That’s the body part I am thinking about. What they are boosting is vague, on par with chi/qi or innate intelligence. They never really say what is being boosted.

The other popular phrase is “support”.  A product supports prostate health, or breast health or supports the immune system.  It sounds like the immune system is sagging against gravity due to age and needs a lift.

The immune system, if you are otherwise healthy, cannot be boosted, and doing those things you learned in Kindergarten health  (reasonable diet, exercise and sleep), will provide the immune system all the boosting or  support it needs.
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CAM and Fibromyalgia

ResearchBlogging.orgOne of the common themes regarding alternative medicine is the reversal of normal scientific thinking. In science, we must generally accept that we will fail to validate many of our hypotheses. Each of these failures moves us closer to the truth. In alternative medicine, hypotheses function more as fixed beliefs, and there is no study that can invalidate them. No matter how many times a hypothesis fails, the worst that happens is a call for more research.

Sometimes this is the sinister and cynical intent of an alternative practitioner—refuse to let go of a belief or risk having to learn real medicine. Often, though, there are flaws in our way of thinking about data that interfere with our ability to understand them.

This week, the New York Times had a piece on alternative therapies for fibromyalgia. First a little background.
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We’re Back

As you can see, Science-Based Medicine is now back online and fully functional. We have moved to a new host and a faster dedicated server. It seems that our problem was just that we outgrew our previous host.

Sorry for the inconvenience and thank you for your patience. We will now resume our usual schedule of postings.

Posted in: Science and Medicine

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SBM Problems

As many of you have probably noticed, the science-based medicine site has been having connection problems for the last week, and was in fact down for most of Friday. We are actively working on the problem and hopefully will have it fixed soon. The site is functioning now, but remains very slow.

Thanks for your patience, and sorry for any inconvenience.

Posted in: Science and Medicine

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“Gonzalez Regimen” for Cancer of the Pancreas: Even Worse than We Thought (Part II: Loose Ends)

Last week I discussed the dismal results of the “Gonzalez Trial” for cancer of the pancreas,* as reported in an article recently posted on the website of the Journal of Clinical Oncology. I promised that this week I’d discuss “troubling information, both stated and unstated [in the report],” and also some ethical issues. More has come to light in the past few days, including Nicholas Gonzalez’s own voluminous, angry response to the JCO article. I’ll comment upon that below, but first a brief review.

The trial was begun in 1999 under the auspices of Columbia University, after Rep. Dan Burton had pressured NCI Director Richard Klausner to fund it. It was originally conceived as a randomized, controlled trial comparing the “Gonzalez Regimen” to standard chemotherapy for cancer of the pancreas. In the first year, however, only 2 subjects had been accrued, purportedly because those seeking Gonzalez’s treatment were not willing to risk random assignment to the chemotherapy arm. In 2000, the protocol was changed to a “prospective, cohort study” to allow potential subjects to choose which treatment they would follow. Gonzalez himself was to provide the ‘enzyme’ treatments.

After that there was little public information about the trial for several years, other than a few determination letters from the Office of Human Research Protections and a frightening account of the experience of one subject treated by Gonzalez. By 2006 or so, those of us who pay attention to creeping pseudomedicine in the academy were wondering what had become of it. About a year ago we found out: the trial had been quietly “terminated” in 2005 after it met “pre-determined stopping criteria.” As explained here, that meant that the Gonzalez group had not fared well.

Four years after the trial’s ‘termination,’ the report was finally published: The Gonzalez cohort had not only fared much worse than the cohort that received chemotherapy, but it had fared worse than a comparable group of historical controls. Here, again, is the survival graph from the JCO paper:

Snapshot 2009-09-11 16-16-15

The Gonzalez group had also fared much worse in ‘quality of life’ scores, which included a measure of pain.

Now let’s read between the lines. Forgive me for taking shortcuts; I’m a little pressed for time. (more…)

Posted in: Clinical Trials, Health Fraud, Herbs & Supplements, Medical Academia, Medical Ethics, Science and Medicine, Science and the Media

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Kevin Trudeau’s Legal Trouble

Kevin Trudeau has made millions of dollars selling dubious medical products. He started his snake-oil salesman career selling coral calcium through infomercials. Trudeau claimed that this magical form of calcium could cure cancer and whatever ails you. The Federal Trade Commission (FTC) investigated Trudeau, who was making millions off his claims, and found that he was being, let us say, less than honest. As a result the FTC banned Trudeau from selling health products through infomercials.

But Trudeau is tenacious and creative – an innovator. Prior to getting into infomercials he was small time – he was convicted for writing bad checks and credit card fraud and spent some time in prison. I always find it interesting that convicted con-artists seem to hit upon such well-guarded secrets. Dennis Lee claims to have found the secret of limitless energy, if only he were not attacked by Big Oil and a corrupt government. Kevin Trudeau claims to have found the cures for just about everything, but The Man is trying to shut him down.

Undeterred by the FTC ban, Trudeau decided that even though he could not sell health products he could sell information – that was protected under free speech – so he started selling books through infomercial, including Natural Cures They Don’t Want You To Know About. Trudeau claimed he went from writing bad checks to discovering not only hundreds of natural cures but uncovering a government and Big Medicine conspiracy to keep this vital information from the public.

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Posted in: Politics and Regulation, Public Health, Science and Medicine

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