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Reality is unfair

This space has often hosted musings on the nature of scientific knowledge, on how medical science is based in methodological naturalism (MN), rather than supernaturalism.  MN requires that our acquisition of knowledge about the natural world be based on natural phenomena.  The reason for this should be quite obvious:  the natural world is the only one that exists, for all intents and purposes, and explanations must be based on natural processes.  Can you name any supernatural processes?  Can you measure them?  Of course not.

This bothers adherents of alternative medical practices.   Since science doesn’t support their ideas, they would like to carve out exceptions to natural laws.   Remember, we know quite a bit about the universe.  We don’t understand exactly what matter is yet, but we can measure it and experience it without ambiguity.  We know the universe has matter/energy; we understand pretty well the primary forces of electromagentism, gravity, small and weak nuclear; and there are probably a few other things whose effects we can measure even if they aren’t completely understood (dark energy, dark matter).

All of modern medicine works in ways consistent with our understanding of the universe.  Even when we don’t completely understand something, it does not behave contrary to these laws.  A beta blocker has never caused someone to levitate.  No one has been revivified by electricity, a la Dr. Frankenstein (“That’s Frahnkensteen!“).  Human bodies follow natural laws, and natural explanations are the ones that have explanatory power.

Since these natural laws explain what we see in the clinic and lab, what are the altmed gurus to do?

They have three main strategies, each of which is conveniently described by a logical fallacy. (more…)

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Christine Maggiore and Eliza Jane Scovill: Living and dying with HIV/AIDS denialism

Christine Maggiore

On Science-Based Medicine, we strive to apply the light of science and reason on all manner of unscientific belief systems about medicine. For the most part, but by no means exclusively, we have concentrated on so-called “complementary and alternative medicine” (CAM) because there is an active movement to infiltrate faith-based, rather than science-based, modalities into “conventional” medicine. Indeed, such efforts are well-financed, both by public and private organizations, and are alarmingly successful at insinuating postmodernist and pseudoscientific beliefs into academia to form an unholy new monster that has been termed by some as “quackademic medicine.”

However, one pseudoscientific belief system about medicine that we at SBM have perhaps not dealt with as much as we should is the belief that, contrary to the overwhelming scientific consensus built up over 25 years, the Human Immunodeficiency Virus (HIV) does not cause Acquired Immune Deficiency Syndrome (AIDS). True, working with Tara Smith, our fearless leader Steve Novella has published an excellent primer on the phenomenon, but not on this blog. This belief system, which is commonly called HIV/AIDS denial or HIV/AIDS denialism, is championed by virologist Peter Duesberg, along with a panoply of groups, such as Alive & Well AIDS Alternatives and Rethinking AIDS; blogs, such as Science Guardian, HIV/AIDS Skepticism, and AIDS Is Over; podcasts, such as How Positive Are You?; books, such as What If Everything You Thought You Knew About AIDS Was Wrong? by Christine Maggiore; and movies, such as The Other Side of AIDS (which resembles in many ways the anti-evolution movie Expelled! and the pro-quackery movie The Beautiful Truth). The influence of HIV/AIDS denialism is horrific, too, particularly in Africa, where advocates of such nonsense, such as Matthias Rath, have advocated quackery over antiretroviral therapy and had the ear of South African President Thabo Mbeki, who lost power in late 2007.
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Posted in: Health Fraud, Public Health, Science and Medicine, Science and the Media

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A Year of Science-Based Medicine

On January 1, 2008 I wrote the first blog entry on Science-Based Medicine introducing the new blog. Now, by coincidence, I have the privilege of writing the last entry of 2008. It seems like a good time to look back over the last year and reflect on our little project.

I am happy to write that by all measures SBM has been a satisfying success. Most blogs end after a few months. We not only kept up our schedule for the entire year, we expanding our writing about midway through the year. Given that there are millions of blogs, by necessity most blogs are relatively obscure. SBM rather quickly garnered a respectable readership and gained the attention of the some in the media as well as those with oppossing views.

I am very proud of the quality of the articles we have published here. Of course I have to thank all of my co-bloggers – David Gorski, Kim Atwood, Harriet Hall, Wally Sampson, and Mark Crislip who were with me from the beginning and Val Jones, David Kroll, Peter Lipson, and David Ramey who joined us part way through the year. Every week they each contributed a magazine-quality article, and then hung around to discuss their articles and others in the comments section. They all do this without any compensation, out of a pure desire to have a positive effect on the world.

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Egnorance is Bliss

A few years ago, at a skeptics conference in Los Angeles, Stephen Barrett of Quackwatch had just finished giving a talk and was fielding questions from the audience. Someone asked, “why don’t you ever talk about how dangerous regular medicine is?” Dr. Barrett, with a look of bewilderment in his face and a tone of exasperation in his voice, replied: “This is what I do.” That was his way of responding to a question that had nothing to do with his talk, as should have been obvious to both the questioner and the rest of the audience. The question might as well have been “why don’t you ever talk about global warming”?

If people are going to enter the fray of debate, at least they ought to play by the rules. One who doesn’t is the Intelligent Design apologist Michael Egnor, a nice counter-example to the popular myth that neurosurgeons are necessarily intelligent. I’m aware that Steve Novella posted the day before yesterday in response to Egnor’s recent lament about our close friend Orac and about Dr. Novella himself. I couldn’t help but stick in my two cents, however, because deconstructing Egnor’s essay is like shooting fish in a barrel, and it seemed appropriate for Boxing Day. I have avoided reading Dr. Novella’s piece so as not to color my own thinking, so please forgive any redundancies (speaking of that, I’m not the first to make the obvious pun of Egnor’s name). My post will be short and sweet and sour.

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Defending Science-Based Medicine

Science-based medicine is more than a website. It is a philosophy of medicine that is actively vying with other philosophies for dominance in the world of medicine. We believe that medicine should be based upon the best science available, according to a single universal standard of rigorous methodology and valid logic and reason. Others desire a double-standard, so that they can be free to practice or market whatever they wish without having to meet strict scientific standards. Still others have a non-scientific ideological world-view and want public policy to accord to, or at least admit, their personal beliefs.

I therefore expect that we will be attacked by proponents of unscientific medicine in all its forms.  Yesterday, however, we were attacked on the Evolution News & Views website of the Discovery Institute by creationist neurosurgeon, Michael Egnor. This may seem incongruous at first, but honestly I suspected that just such an attack was inevitable.

Many science bloggers, David Gorski and me prominent among them, have taken on both the DI and Dr. Egnor specifically over many anti-scientific arguments he has put forward over the last couple of years. We have sparred mostly about evolution in medicine, neuroscience and consciousness, and the materialist underpinnings of modern science. Dr Egnor’s day job, however, is that of a (from what I can tell) respected neurosurgeon, so I always wondered what he thought of his sparring partners’ writings about science-based medicine.

His entry yesterday ends any speculation – he wrote an incoherent, logical fallacy-ridden screed that would make any snake-oil peddler proud. This reinforces a point I have made in other contexts – all anti-scientific philosophies have science as a common enemy, and will tend to band together in an “unholy alliance” against those advocating for scientific rigor or defending science from ideological attack. That is why a website that is ostensibly about the “misreporting of the evolution issue” would post a blog attacking science-based medicine as an “arrogant medical priesthood.”

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Santa Visits the Hospital

Since Val has broken the ice, I thought I would offer some more Christmas humor. The following is a Narrative Summary (a report of a hospitalization) that was circulated at the Plattsburgh Air Force hospital where I worked in 1986. I published it in my memoirs, Women Aren’t Supposed to Fly. Unfortunately I don’t know who wrote it, so I can’t give credit where credit is due.

Kringle, K. AD/Arctic AF 0-7 000-00-0000
D & T: ELF
USAF Hospital Plattsburgh, Plattsburgh AFB, NY 12903
Register number: classified.
Date of admission: 24 December 1986
Date of discharge: AMA 0100 25 December 1986

CHIEF COMPLAINT: Frostbitten tallywhacker.
HISTORY OF THE PRESENT ILLNESS: The patient is a three hundred and eight year old supernatural being employed as a stealth sleigh driver, powered by reindeer, who comes in on Christmas Eve stating that he was coming over the northern part of the Yukon Territory and, unfortunately, the fly of his pants came open, and his member was exposed to some rather cold air flowing by at rather high velocity. Unfortunately, he did not notice right at first and attempted to slide down a chimney at which point, he then scraped his member on the edge of the bricks. He now comes in appearing quite uncomfortable, and complaining of pain in his genital area. He also noted some mild abdominal discomfort, and admits to drinking large amounts of ethylene glycol earlier this evening, prior to his trip. The patient is rather vague about his trip but indicates that he really needs to be on his way, and really just wants something for his pain.
PAST AND FAMILY HISTORY: The patient gives a remarkable lack of much past history despite his age. He notes that about this time every year he does get rather anxious and occasionally requires some sedatives to calm him down. He also has occasional bouts with hemorrhoids, and was recently seen at this hospital for the same complaint while on a supply run. Family history is rather unremarkable, in fact, he doesn’t recall that he has any family other than his wife, twenty-two elves, and eight reindeer – one who seems to be constantly bothered by a red and runny nose. He is employed as a sleigh driver for the Arctic Air Force, but fails to reveal much other detail, saying he is on a “Super-Duper Top Clearance Mission.” He does claim to have recently recharged his batteries. Apparently, by that he means he had a nuclear-powered penile implant because he said even at 308 years old he still does enjoy his sexual activity, and that he just wasn’t quite as potent as he used to be.
PHYSICAL EXAMINATION: The patient has a blood pressure of 168/90. Pulse is 72, and regular. Respiratory rate is 18. He is afebrile. The patient is a rather old, jolly fellow. He is dressed in fur from his head to his foot and his clothes are all tarnished with ashes and soot. His eyes have a twinkle, his dimples how merry. His cheeks are like roses, his nose like a cherry. The stump of a pipe he clenches in his teeth, and the smoke encircles his head like a wreath. He is rather short, and has a little round belly that shakes when he laughs like a bowl full of jelly. The rest of the examination is remarkable for a rather large member. It appears to have some external abrasions, and some very mild frostbite at the tip. An eerie glow seems to emanate from his left femoral region, this is apparently his nuclear-powered implant.
LABORATORY DATA: Is remarkable for an ethylene glycol level of 38.
DIAGNOSIS: 1. Frostbitten penis secondary to exposure with some external abrasions.
  2. Ethylene glycol intoxication.
  3. Obesity, and mild gastritis secondary to number 2 and to excessive intake of snacks tonight.
COURSE IN THE HOSPITAL: The patient was admitted to the Internal Medicine Service. Surgical consultation with Dr. Costanzo was obtained, who debrided some frostbitten area. Right after this, the patient became quite agitated and signed out against medical advice (AMA) stating that he had a trip which he must complete tonight.
DISPOSITION: The patient was advised to keep his member covered for the remainder of the trip, and that we will look forward to seeing him again next year.

Signature of Physician: William Osler, M.D.

Merry Christmas to All!

Posted in: Humor, Science and Medicine

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Put your fears in perspective

I’m having a helluva Sunday.  My father-in-law’s in the hospital,  it’s 2 degrees out with a wind chill of 40 below, my clothes all smell like latkes, my daughter is having a melt-down, and I screwed up the .xml file for my podcast. The last part reminds me of something—science is hard, and when we step out of our areas of expertise, it’s easy to make some pretty silly mistakes.

If you don’t understand the basics of a subject, it’s easy to form conclusions that seem logical, but these same conclusions seem silly to those who have a deeper understanding of a subject.

With may damned podcast, I’m writing xml files based on templates—little thinking is involved.  I’m looking at other people’s code and inserting my own details, hoping it works.  If I actually understood the syntax of xml files, I could write a correct one based on a solid understanding of the specifics of the subject.

Medicine is one of those areas in which we all feel we should be experts.  After all, we all have a body, and we figure that our bodies follow a logic that we can plainly see—if you prick us, do we not bleed? If you tickle us, do we not laugh? If you poison us, do we not die? It all seems so logical.

Colons are full of poop. Poop is yucky. Therefore, cleaning out a colon is good.

Except that it’s not true. The human body is rather complex, and the study of the aggregate of all human bodies living together (e.g. public health) is more complex still.

Since the world of cult medicine hasn’t bothered to learn real science,  they often rest on what sounds “right”.  Like poop being yucky, this is often based on a sliver of fact that is horribly misused due to ignorance.

One of the more popular canards propagated by cult medicine leaders and their followers is that modern medical care kills.  Rather than exploring what the data are and what they mean in order to find a problem and correct it, they manufacture a problem out of whole cloth and come up with non sequitor solutions.

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Quackery tolerance – a learned response

Academic politeness turns to the vicious  This is more on the theme of academic and postmodern roots of sectarianism-quackery’s advance on medicine. I illustrate through the personal experience of a noted combatant – Mary Lefkowitz - in the front lines of the war with intellectual and academic buffoonery passing as scholarship. The joke is not in the buffoonery, though. The joke is turning on us.

Some of you are familiar with Prof.Lefkowitz’s academic dispute from publicity last spring. Prof. Lefkowitz is on the list of academic opponents to relativism and postmodernism. Lefkowitz’s travail began in 1993 when another Wellesley faculty member who led a department or course of Africana Studies claimed in lectures that ancient Greek and Roman intellectual advances were lifted from libraries and other sources of ancient Egypt, and that furthermore, those Egyptians were black Africans.

You recognize this as Afrocentrism, one of relativism and postmodernism’s multi-pronged attack on intellectualism and Western civilization. I attended a session on the problem in 1992 (or so) at the AAAS in San Francisco, and did not appreciate or understand what was going on, or why the raised rhetoric and voices. I do now, especially having read excerpts from Lefkowitz’s book, History Lesson, published earlier this year.
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Posted in: Basic Science, Medical Academia, Science and Medicine

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The Syndrome Syndrome

Have you ever heard of heavy leg syndrome? I hadn’t, until I read this BBC article about it – the British are apparently amused at this peculiarly French medical malady. Heavy leg syndrome is a common diagnosis in France, which alone consumes one third of the world’s drugs for this diagnosis.

Diseases certainly vary from population to population based upon genetics, environment, and lifestyle. But can it also vary just based upon the culture of diagnosis? It seems so.

Ever since it was recognized that there exists diseases – that different people can suffer from the same entity, rather than everyone having their own unique illness, the medical profession has described certain clinical presentations as syndromes. This is legitimate, but it must be recognized that this use of the term syndrome is purely descriptive. (As an aside, the term “syndrome” has a different and very specific use in describing certain genetic diseases.)

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How SHOULD We Discuss Quackery with Innocents and the Not-so-Innocent?

Recents posts by Drs. Albietz and Gorski have highlighted questions that are recurrent on SBM. We are convinced that medicine should be based on real knowledge, to the extent that it exists, and that physicians should be honest; these are matters of science and ethics. How do we reconcile that with heartfelt, if misguided beliefs of patients, their families, and others? When Dr. Albietz wrote that it might have been better for the chiropractor to visit in the same way that “priests, imams, prayer sessions, rabbis, etc visit children within the PICU,” it was reminiscent of Dr. Peter Moran’s hypothetical “witch doctor.” When he lamented academic medicine’s current dalliances with quackery, it brought to mind the NCCAM, David Katz, Andrew Weil, Bravewell , and their enablers.

Dr. Albietz argued that when talking to credulous patients or their families, taking a hard line against quackery is likely to be counter-productive. Most of us would agree with that. Dr. Gorski described a different scenario: after calling a quack “a quack” when talking to a friend of a friend who is a scientist, he concluded that he had been too “blunt.” Several commenters disagreed, but all would probably agree with Dr. Gorski that “you have to know when to pick one way over another; i.e., diplomacy over all out war or vice versa.”

Another Case of Foot-In-Mouth Disease

I recently had an experience strikingly similar to Dr. Gorski’s, during which I castigated myself for my rancor even as I was incapable of moderating it. Fellow blogger Dr. Val Jones was a witness!

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Posted in: Medical Academia, Medical Ethics, Science and Medicine

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