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Archive for Science and Medicine

HIV Denial and “Just Asking Questions”

The “just asking questions” maneuver is familiar to many skeptics. The idea is to feign neutrality, to insulate oneself from accountability or being held to answer for any specific position, but meanwhile to sow doubt about a scientific claim by raising (dubious) questions.

Sometimes the “I’m just asking questions” gambit also tries to disguise itself as sincere journalism. That’s what journalists do, right, ask the tough questions, uncover the uncomfortable truth?

I find this approach particularly deceptive. It tries to hide the fact that the journalist is working off of a particular narrative. Asking questions is, in fact, just another narrative style, one that is meant to lead the reader/viewer to a particular conclusion about the subject. The narrative determines what questions are asked and how they are answered.

A perfect example of this deceptive approach is the HIV denialist movie, House of Numbers. Here is the synopsis from the movie’s website:

What is HIV? What is AIDS? What is being done to cure it? These questions sent Canadian filmmaker Brent Leung on a worldwide journey, from the highest echelons of the medical research establishment to the slums of South Africa, where death and disease are the order of the day. In this up-to-the-minute documentary, he observes that although AIDS has been front-page news for over 29 years, it is barely understood. Despite the great effort, time, and money spent, no cure is in sight.

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Does treating fever spread influenza?

Influenza

One of these things is not like the other

Treating a fever with medication like Advil or Tylenol is reflex action when we come down with colds and influenza. But could treating fevers actually worsen an illness and contribute to its spread in the population? That’s the impression you may have gained from the headlines and press last week, where antipyretics (fever-reducing medications) were described as some type of “anti-vaccine”:

Fever-reducing meds encourage spread of flu: McMaster report

Taking over-the-counter flu medication to cut your fever might help you feel better, but it might not be so good for the people you come into contact with.

When it comes to fever, your mother really did know what’s best

Who would have thought that the simple giving of a fever reducing agent, to either one of our family members or ourselves before we go off to school or work, may inadvertently lead to the death of someone that we see that day?

Use of fever-reducing drugs may lead to tens of thousands more influenza cases

The bottom line is that fever suppression increases the number of annual cases by approximately five per cent, corresponding to more than 1,000 additional deaths from influenza in a typical year across North America.

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Posted in: Epidemiology, Pharmaceuticals, Science and Medicine

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Fighting Against Evidence

For the past 17 years Edge magazine has put an interesting question to a group of people they consider to be smart public intellectuals. This year’s question is: What Scientific Idea is Ready for Retirement? Several of the answers display, in my opinion, a hostility toward science itself. Two in particular aim their sights at science in medicine, the first by Dean Ornish, who takes issue with large randomized controlled clinical trials, and the second by Gary Klein, who has a beef with evidence-based medicine.

These responses do not come out of nowhere. The “alternative medicine” meme that has taken hold in the last few decades (a triumph of slick marketing over reason) is all about creating a double standard. There is regular medicine which needs to justify itself with rigorous science, and then there is alternative medicine, where the rules of evidence bend to the needs of the guru or snake oil salesperson.

We have been hearing arguments from alternative medicine proponents for years now for why the strict rules of science need to be relaxed or expanded. Andrew Weil has advocated for the use of “uncontrolled clinical observations,” (also known as anecdotes). David Katz advocates for a “more fluid concept of evidence.” Dr. Oz went as far as advocating outright medical relativism, saying. “You find the arguments that support your data, and it’s my fact versus your fact.” (more…)

Posted in: Clinical Trials, Science and Medicine

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The New Cough and Cold Products for Children: Evidence is Optional and Science is Marketing

Zarbee's Helixia, Oscillococcinum

It’s the time of year where if you’re not sick, someone you know probably is. The influenza season in the Northern hemisphere started out slowly, but seems to be accelerating and hasn’t peaked yet. Add that to cold viruses circulating, and you get the peak purchasing period for cough and cold remedies. John Snyder gave a nice summary of the evidence base for the common treatments a few weeks ago. In short, despite all the advertising, there is little evidence to suggest that most of the “tried and true” products we’ve used for decades have any effect on our symptoms. One of the most sensible developments that’s occurred over the past few years has been the discontinuation or relabeling (depending on your country) of cough and cold products for children. The rationale to pull these products is compelling: Cough and cold remedies have a long history of use, and were sold without prescriptions before current regulatory standards were in place. They were effectively grandfathered onto the marketplace. When it comes to their use in children, the data are even more limited. There are few published trials and the results are complicated by different age groups, irregular dosing, lack of placebo control, and very small patient numbers. What’s even harder to believe was that doses were based mainly on expert opinion, not data, and generally didn’t consider that children don’t handle drugs the way adults do. So why withdraw them from pediatric use, but not adult use? Like most regulation, it comes down to risk and benefit. Both are troubling for pediatric use. (more…)

Posted in: Herbs & Supplements, Science and Medicine

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Quantum Snake Oil – A Primer

Let’s conduct a little thought experiment. First, for the sake of this thought experiment let’s assume that you have no morals, ethics, or conscience. You are comfortable lying to people, even if they are sick, and even if it will harm their health.

Your task is to get as many people as possible to believe that small bits of plastic can improve their health and treat their symptoms. This is not as difficult as it may at first appear, and the payout can be huge. Small plastic stickers can be mass produced for pennies. The primary investment will be creating and maintaining a website. Then, if you can get people to believe that the plastic stickers are magical, the money will come rolling in.

What claims should we make for the stickers? Let’s stay away from anything that has an objective outcome, so we won’t claim that they can be used as an antibiotic to treat pneumonia, or as a way to treat heart attacks. I also understand that in the US and other countries, they take a close look at claims made to treat specific diseases, but you can make vague “structure function” claims with abandon, so let’s go with those. We can always imply that they are effective for diseases, even serious ones like cancer. (more…)

Posted in: Science and Medicine

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Placebo effects are not the “power of positive thinking”

Here we go again. I once said that, in the wake of study after study that fails to find activity of various “complementary and alternative medicine” (CAM) beyond that of placebo, CAM advocates are now in the midst of a “rebranding” campaign in which CAM is said to work through the “power of placebo.” Personally, I’ve argued that in reality this new focus on placebo effects as the “mechanism” through which CAM “works” is in reality more a manifestation of the common fantasy that wishing makes it so.

None of this, of course, can stop everybody’s favorite apologist for “complementary and alternative medicine” (CAM) and, in particular, using placebo effects therapeutically, from continuing to do what he does with a study that’s been widely reported in the news and even featured on Science Friday last week. Basically, it’s a study in Science Translational Medicine, in which our old friend Ted Kaptchuk teamed up with an investigator interested in migraines, Rami Burstein, to do a study that finds that believing a medicine will work can have a strong effect on its actual activity on migraine. As is the case with most studies in which Kaptchuk is involved, it’s mildly interesting from a scientific standpoint. Unlike most studies in which he is involved, Kaptchuk seems a bit more able to tone down the hyperbole, which is a good thing. Unfortunately, this study, as much as it’s being touted by the press as providing new information on placebo effects, really doesn’t tell us much that is new. (more…)

Posted in: Science and Medicine

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Acupuncture Whac-a-Mole ™

Those who cannot remember the past are condemned to repeat it.
- George Santayana

Most people don’t have that willingness to break bad habits. They have a lot of excuses and they continue to produce bad clinical studies.
- Carlos Santana (Well, not the last 4 words.)

One is a guitar player, one is a philosopher. I get them confused.

I think George was in charge of SCAM research at the NIH. It was Dr. Gorski who first used the term Whac-a-Mole to describe what we do. The same badly-done studies are done over and over and misrepresented over and over, with only very minor variations on a theme. This is especially true of acupuncture, the most extensively studied pseudo-medicine in search of something, anything, for which it might be effective. They are still searching.

I loved going mano-a-mano with my kids when they were younger on the Whac-a-Mole machine in the Seaside arcade followed by root beer and elephant ears. It was the last time I beat either of them at any athletic endeavor. So I enjoy Whac-a-Mole, with mechanical rodents or bad research. (more…)

Posted in: Acupuncture, Clinical Trials, Critical Thinking, Science and Medicine

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Announcing the Society for Science-Based Medicine

We are proud to announce a new organization: The Society for Science-Based Medicine.
A Society for a community of like-minded individuals, both in and out of health care, who support the goals of Science-Based Medicine.

People should not suffer, die, go bankrupt, and lose time and hope because of complementary and alternative pseudo-medicine.
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Posted in: Announcements, Science and Medicine

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Corporal Punishment in the Home: Parenting Tool or Parenting Fail…

One of the most commonly practiced strategies used by parents to alter long term behavior of their children is corporal punishment, commonly referred to as spanking. But use of the term spanking is problematic in that how caregivers interpret it varies widely, and there is frequent overlap with what pediatricians consider to be abuse. Despite a great deal of evidence showing that spanking is ineffective, is a risk factor for greater forms of physical abuse and can negatively impact the behavioral and cognitive development of children in a variety of ways, it remains a controversial issue in the United States. The American Academy of Pediatrics and numerous other professional organizations have come down firmly against the use of physical punishment by parents, but unlike 34 other developed nations there are no federal laws banning spanking.

Laws regarding corporal punishment vary from state to state. 19 states currently allow the striking of a child in any school setting. Of the 31 states and the District of Columbia that ban the practice in public schools, only New Jersey and Iowa also include private schools. Many schools give the misbehaving child a choice between suspension and being beaten with a paddle. It is also common for schools to require a parent to opt out of their child receiving corporal punishment rather than having to sign a consent form before such physical correction is applied. Corporal punishment in schools is more prevalent in the South and in lower socioeconomic school districts, leading to poor black children being by far the most likely to face it.

Currently no state has a law that explicitly bans corporal punishment in the home. In fact, most state laws have specific language in their statutes on abuse, assault, battery, or domestic violence that make exceptions for spanking by a caregiver. In 2012, new child abuse legislation in Delaware made the news because it might possibly be interpreted as making spanking illegal. The law was put into place to serve as a means of improving the ability to protect children from physical abuse, but the language was vague. The lawmakers claim that it is not meant to interfere with parents who choose to use “reasonable force”, whatever that means, and do not cause injury. (more…)

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Doctors Are Not “Only Out to Make Money”

There’s an old joke about the doctor whose son graduates from medical school and joins his practice. After a while the son tells his father, “You know old Mrs. Jones? You’ve been treating her rash for years and she never got better. I prescribed a new steroid cream and her rash is gone!” The father responds, “You idiot! That rash put you through medical school.”

That’s a joke. It doesn’t reflect reality, but it reinforces a common misconception that doctors care more about their own income than about their patient’s outcome. That accusation is demonstrably untrue.

I’m sick and tired of all the doctor-bashing. They accuse us of being shills for Big Pharma. They say “Doctors are only out to make money.” Or “Doctors are greedy bastards only interested in the bottom line.” Or as one of our commenters recently put it: “First do no harm. Second ? Third, profit [sic]” Some have even made the ridiculous accusation that doctors have found the cure for cancer but have suppressed the information so as to keep people sick and increase their business. If profit were really their primary motivation, doctors would have to be astoundingly clueless, because they keep doing things that are guaranteed to reduce their profits. (more…)

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