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The wild Weil world of woo

Dr. Weil is often seen as the smiling “mainstream” of alternative medicine. He’s a real doctor (unlike, say, Gary Null), and much of what he advocates is standard and uncontroversial nutritional advice. But Weil illustrates the two biggest problems with so-called alternative medicne: once you’ve decided science is dispensible, the door is open to anything, no matter how insane; and no matter how altruistic you may start, sooner or later you start selling snake oil. Most doctors out there are working hard to help their patients prevent and overcome disease use the available evidence.  Others decide that science is too constraining and start practicing at the periphery of knowledge, throwing plausibility and ethics to the wind.

The fact that Weil claims to donate to charity all of his ill-gotten gains does not mitigate the harm he causes.

The flu pandemic has been challenging to all of us who practice medicine.  We try to keep up day to day with the latest numbers, evidence, and best practices, while trying not to worry about getting ill.  And since the vaccine isn’t widely available yet, we also worry about our family’s health.  So we go about our work every day, wearing masks when appropriate and washing hands frequently.  If the numbers reach a certain threshold, we will implement sophisticated pandemic plans.

All of that is rather hard, though, so perhaps we should just throw caution to the wind and start selling flu snake oil just like the smiling Dr. Weil.

The FDA and FTC have let Weil know in very clear terms that his fake flu remedies are being marketed illegally.  Weil has taken the site down, but here’s a relevant screen shot.
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Oh Canada.

Oh Canada. Look over here. Not there. Not at the press release. Look here. A real study. Published. With methodologies you can evaluate. Something you can sink your teeth into to help guide policy decisions.  You know, published epidemiology.  Science.

Its called  “Partial protection of seasonal trivalent inactivated vaccine against novel pandemic influenza A/H1N1 2009: case-control study in Mexico City.” and published on line in the BMJ on October 6th.

Are you aware of….Oh, Canada, pay attention, your eyes are wandering.
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9 Reasons to Completely Ignore Joseph Mercola

Some of our more astute readers may have noticed that we are paying influenza slightly more attention than other topics of late.  That’s because this situation is new, rapidly changing, and covers more areas of science and medicine than one can easily count.  It’s also a subject about which the general public and media are keenly interested.  This is an outstanding learning and teaching opportunity for us as a professional community.  Unfortunately, it is also fertile ground for confusion, fear, and misinformation, and a playground for those who would exploit such things.

Mercola.com is a horrible chimera of tabloid journalism, late-night infomercials, and amateur pre-scientific medicine, and is the primary web presence of Joseph Mercola.  Unfortunately, it is also one of the more popular alternative medicine sites on the web and as such is uncommonly efficient at spreading misinformation.  I am not a fan, and have addressed his dross in the past.

Joseph Mercola has recently posted an excerpt from an individual he evidently holds in high regard, Bill Sardi.  Bill published “18 reasons why you should not vaccinate your children against the flu this season.”  Mercola chose his nine favorites (one would assume the nine best reasons), and re-posted it on Mercola.com.  There are so many mistakes, so much misinformation in so little space, it’s almost a work of art.  You know, like that crappy art that you might expect to find on the wall at an hourly motel.  Without further delay, let’s examine Mercola and Sardi’s nine best reasons for you not to vaccinate your children against influenza this season: (more…)

Posted in: Public Health, Science and Medicine, Vaccines

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CFS: Viral vs somatization

On 10/08/09, the NIH and Science through press releases announced the following remarkable information:  Consortium of Researchers Discover Retroviral Link to Chronic Fatigue Syndrome (CFS.) From Science on line:

Scientists have discovered a potential retroviral link to chronic fatigue syndrome, known as CFS, a debilitating disease that affects millions of people in the United States. Researchers from the Whittemore Peterson Institute (WPI), located at the University of Nevada, Reno, the National Cancer Institute (NCI), part of the National Institutes of Health, and the Cleveland Clinic, report this finding online Oct. 8, 2009, issue of Science.

“We now have evidence that a retrovirus named XMRV is frequently present in the blood of patients with CFS. This discovery could be a major step in the discovery of vital treatment options for millions of patients,” said Judy Mikovits, Ph.D., director of research for WPI and leader of the team that discovered this association. Researchers cautioned however, that this finding shows there is an association between XMRV and CFS but does not prove that XMRV causes CFS.

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Posted in: History, Medical Academia, Neuroscience/Mental Health, Science and Medicine

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Science-based medicine and Eurocentrism

A reader sent me an interesting post from her own blog. It’s well-written, compelling, and betrays an exceptional intelligence. It’s also completely wrong.

The piece is called, “Bias, Racism, and Alternative Medicine”, an intriguing title. The first part tries to establish that “Western medicine” in one of many ways of understanding health and disease. She starts with some personal anecdotes—always interesting, rarely generalizable:

While receiving Western biomedical treatment for ADD, the side effects of my therapy convinced me that western medication alone would not provide a solution to my problems.

One of the author’s fundamental misunderstandings is that the failure of a particular treatment to make her feel better does not invalidate all of medical science, and more important, it does not validate “other ways of thinking”. Still, I can understand how this happens. Personal experience is powerful; unfortunately, it is also misleading. I like this writer. She seems very kind. She goes on to describe her enlightenment further, but this is where a pleasant anecdote goes terribly wrong: (more…)

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Medicine is hard and should be practiced with caution

It’s tempting to think that the practice of medicine should be simple and intuitive.  Unlike other sciences, we all have access to the basic materials—ourselves.  We feel that because we are intimately familiar with our bodies, we know a lot about how they work.  Unfortunately, it’s a little more complicated than that.  The biochemical processes walking around in this sack of meat are pretty complicated.  Learning these processes is important, but in medicine, it’s not enough.  If we have a hypothesis that some change in biochemistry will affect some disease, we must test this in groups of real people in well-designed clinical trials.  Or, we can use the Huffington Post method and  just make it all up.

The latest abomination is an article on diabetes, by Kathy Freston.  Bad information on diabetes is particularly dangerous.  The longer diabetes goes untreated, the higher the likelihood of complications.  When reading medical writing it’s important to evaluate the source.  The author of this article wrote a book called, The Quantum Wellness Cleanse which pretty much says it all. But is it really fair to judge someone on a crappy book title?

Well, yes, but more important is the crappy interview she conducts with Dr. Neal Barnard.  I have no way of knowing with absolute certainty whether Barnard is as dangerous a fool as he sounds, but I suspect so.  He and Freston promulgate a dangerously over-simplified view of diabetes.   (more…)

Posted in: Science and Medicine

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Flu Vaccine Efficacy

I guess I will be spending the rest the flu season writing about the nonsense that is promulgated about the flu vaccine and the disease. One of the more common laments about the flu vaccine is that it doesn’t work:  I got the flu vaccine and still got the flu. Well maybe. Maybe not.  It takes a few weeks to get protection, so the flu could have developed before the antibody response to the vaccine.  The vaccine does not protect to the numerous other viral infections that circulate each winter, so perhaps you had an adenovirus but thought it was the flu. Then there is the evidence.  Some readers of the blog are worried that the literature does not support the use of the vaccine.

“My research for  good studies on the efficasy (sic) of seasonal flu vaccines so far has left me wondering if I’ve somehow missed the good research. Tom Jefferson of the Cochrane Institute says that Most studies are of poor methodological quality and the impact of confounders is high. I agree.  Please would you refer me to some of the best studies on the efficasy (sic) of seasonal flu vaccines.  After a critical appraisal of the best studies you know of I’d like to submit the same for publication in the interest of science.”

Why some readers think I am a research librarian, I do not know. It is not an uncommon request. As an aside,   I have a full time job and a family to raise.  Don’t be asking me to do your grunt work. It’s called Pubmed. Use it.

But the topic for this post concerns the efficacy of the flu vaccine. I am limiting myself to the use of the vaccine in adults.
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Posted in: Science and Medicine, Vaccines

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Monkey business in autism research, part II

Over the last couple of months, I’ve noticed something about the anti-vaccine movement. Specifically, I’ve noticed that the mavens of pseudoscience that make up the movement seem to have turned their sights with a vengeance on the Hepatitis B vaccine. The reason for this new tactic, I believe, is fairly obvious. The fact that the Hep B vaccine is administered shortly after birth seems somehow to enrage the anti-vaccine movement more than just about any other vaccine. Moreover, given that, aside from maternal-child transmission when the mother is infected, hepatitis B is usually only contracted through either bloodborne contact (the sharing of needles, the administration of contaminated blood) or sexual activity, it’s very easy for anti-vaccinationists to make a superficially plausible-sounding argument that it’s not a necessary vaccine, even though there are reasonable rationales for giving it to infants. The image of sticking a needle into a newborn infant trumps that, though, at least for the anti-vaccine movement. Another possibility, suggested by Steve Novella just yesterday, is that, with the collapse under a overwhelmingly huge pile of evidence of the idea that the mercury-containing preservative thimerosal that used to be used in childhood vaccines until 2001, caused an “epidemic” of autism and the failure of the “too many too soon” slogan to convince anyone who is not already an anti-vaccinationist, the movement needed a new bogeyman to blame for autism. The hepatitis B vaccine, which was added to the pediatric vaccination schedule in the 1990s, around the right time to confuse correlation with causation when it comes to the increase in autism diagnoses (just like thimerosal) was a perfect next target, given that it’s administered shortly after birth.

Indeed, just the other day, the anti-vaccine crank groups the National Vaccine Information Center (NVIC), Talk About Curing Autism (TACA), and the anti-vaccine crank blog Age of Autism posted a call for the elimination of hepatitis B vaccination for newborns:

Washington, DC – National Vaccine Information Center and Talk About Curing Autism are calling on President Obama to order the immediate suspension of the Centers for Disease Control and Prevention recommendation of the birth dose of the Hepatitis B vaccine after two recent studies linking the Hepatitis B vaccine to functional brain damage in U.S. male newborns and infant primates.  In a related development today, the United States Department of Health and Human Services, including the Health Resources and Services Administration and Centers for Disease Control and Prevention,  announced that 1 in every 91 children are now diagnosed with an autism spectrum disorder as reported in the November 2009 issue of Pediatrics. Previous data released by the CDC indicated a prevalence of 1 in every 150 children affected by the disorder.

Note how AoA not-so-subtly interposed the latest information about autism prevalence with its call to eliminate the birth dose of the hepatitis B vaccine. Very clever. By doing so, it linked the two in readers’ minds, as if one had something to do with the other. There’s no good scientific evidence that the hepatitis B vaccine has anything to do with the “autism epidemic.” Meanwhile, David Kirby is up to his usual nonsense, and the resident anti-vaccine propagandist at CBS News, Sharyl Attkisson, who has been known to feed Age of Autism information on at least one occasion in the past, served up this credulous, noncritical interview with Andrew Wakefield:

The quantity of misinformation in that single six minute video is far beyond the scope of this article. Were I to start dissecting it, I would not have time to do what the purpose of this article was intended to do: To deal with the study Wakefield is hawking. That’s why I leave the dissection of this pièce de résistance of disingenuousness and misinformation as an exercise for SBM readers–after reading the rest of this post, of course. Trust me, it will help you.

At the heart of this latest propaganda onslaught by the anti-vaccine movement are two studies, one a restrospective study in humans and the other a study in monkeys, both of which the anti-vaccine movement is promoting as slam dunk evidence that the hepatitis B vaccine is causing all sorts of horrific problems. Taking both of them on in one post is too much, even for my logorrheic tendencies. So I’ll deal first with Wakefield’s monkey study and then, either later this week or sometime next week, hopefully discuss the human study.
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Posted in: Public Health, Science and Medicine, Science and the Media, Vaccines

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Autism Prevalence

Two recent studies concerning the prevalence of autism in the US have been getting a lot of attention, because they indicate that autism prevalence may be higher than previously estimated. This, of course, fuels the debate over whether or not there are environmental triggers of autism.

One study was conducted by the CDC but has yet to be published. The results were announced ahead of publication by the US Health and Human Services Secretary Kathleen Sebelius to the autism community. She reports that the new prevalence of autism spectrum disorder (ASD) is now estimated at 1% or 100 in 10,000 children. This is an increase over the last few years. In 2002 the prevalence was estimated to be 66 per 10,000.

The second study was published in the journal Pediatrics and is a phone survey of 78,037 parents. They asked if they had any children who had ever been diagnosed with an ASD. Here are the results:

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Petit canard, grand canard

The flu pandemic of 1918 was horrific. Millions of people died (by some estimates 4% of the world’s population), and the medical establishment worked feverishly to find a cause and a treatment. There were many dead-ends in the search for the cause of the flu. One of the most enduring errors was the attribution of the pandemic to a bacterium called Haemophilus influenzae (H flu). It turned out that the flu was actually caused by a virus rather than a bacterium, but H. flu is still an important discovery. The fight against influenza was in many ways successful (although too late for the 1918 pandemic)—it led to the discovery of influenza and many other viruses, and the development of effective influenza vaccines. It is analogous to the discovery of HIV and the advances in science and medicine pioneered by HIV researchers. Influenza birthed the field of virology.

But what if we had stopped at one of our dead ends? What if we had held to the belief that H flu caused influenza, or that HTLV-1 caused AIDS? In science, dead-ends usually reveal themselves—eventually. As new discoveries fail to appear, scientists re-examine their underlying assumptions. H flu was found in many flu victims, but not all. Other researchers found that fluids that were run through filters that stopped bacteria were still infectious (in human volunteers!), leading them to conclude that there must be an infectious particle smaller than a bacterium. A quarter of a century after the Great Influenza pandemic, effective vaccines against influenza were in production.

While the world was torn by the first “modern” war, and influenza destroyed military and civilian populations, doctors were trying everything that might help.  In the U.S., sera and vaccines against various agents such as pneumococcus were produced and used with some efficacy, but many other immunologic treatments were dead-ends.  One of these dead-ends was named Oscillococcinum.

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