Articles

Archive for Science and Medicine

Getting It On with Homeopathy

I have more thoughts on the homeopathy matter than fit in follow-up notes, so here goes.

First, David Gorski recalls the 1994 Pediatrics report on childhood diarrhea treated with tailored homeopathic remedies for each patient. There is more to the story than has been written. I am certain much of this will get back to the authors, but others may benefit from knowing how this group of homeopaths operate.

I recall the paper well, because it was the first journal report that I deconstructed and published (Pediatrics, Oct 1995) as a regular article. I think it was the first time the journal had published a formal rebuttal outside the Letters section. The head of pediatric pharmacy at Valley Medical Center, San Jose, brought the paper to me and asked what I thought if it. Bill London of National Council against Health Fraud and I spent six months discussing it and working over the details.

The paper had so many flaws, that one letter could not contain them. It had five or six end points, several arithmetical errors, graphs with missing data, only one end point reached consensus signficance (barely.)

Each case received a remedy tailored to the age, condition, duration of symptoms, appearance and odor of the stool, the recall of the parent or relative about stool frequency (which depended on how often the child’s diapers were changed, and a number of other qualities, typical of a homeopathic approach to diagnosis. The remedies given were not based on etiology, but based on personal observations, We saw that the remedy was chosen at a snapshot in time, depending on all those factors which varied from hour to hour. So the remedies depended on the time at which the child was brought in for examination and were unchanged throughout the duration of illness. That made no sense at all. Besides, the specific remedies had no data behind them for proof of efficacy, and were chosen on basis of charts and computer references.

One could hardly find anything about the paper that would lend credibility to its conclusion that suggested homeopathy “worked“ better than placebo. The results in our opinion demonstrated nothing more than the variations in the clinical trial system (noise.)
(more…)

Posted in: Clinical Trials, Homeopathy, Science and Medicine

Leave a Comment (1) →

Disintegrating Integrative Medicine: Lessons From Baking

Suppose I were to bake you a cake and my ingredient list included the following:

  • Eggs
  • Milk
  • Butter
  • Sand
  • Flour
  • Baking Powder
  • Vanilla
  • Melamine
  • Sugar
  • Chocolate icing

What is the problem with the ingredient list? It has integrated inedible and poisonous items into the very fine basic ingredients that make a good cake. This is the exact same problem that the medical profession faces with the “integrative medicine” movement. Insofar as it espouses and promotes well-vetted, healthy ingredients, it is a boon to patients. But when inordinate emphasis is placed on placebos (“sand”) or when dangerous practices (“melamine”) are inserted into the prescription for our patients’ “health and wellness,” that attractive-appearing cake becomes a recipe for disaster.

(more…)

Posted in: Science and Medicine

Leave a Comment (23) →

A natural product of his environment

I’m delighted to have the opportunity to join this outstanding group of medical professional bloggers in adding my natural products angle to the application of science-based medicine.  With the exception of Dr. Gorski, who holds MD and PhD degrees, I believe I am the first “only a PhD” to be invited to SBM.  However, I have spent much of my career training, and training with, physician-scientists; so enthusiastic am I about the special qualities of the physician-scientist that I married one (or, rather, she chose to marry me, truth be told.).  Conversely, I view the invitation to write here as a responsibility in representing what my fellow basic scientists bring to bear on discussions of the scientific arguments for and against modalities classified broadly as complementary and alternative medicine or integrative medicine.

Why write about herbal medicines and natural products?

I have long been interested in bringing objective scientific information to the public, perhaps as early as my college years in bars while visiting my working-class hometown of Wallington, NJ, or while shooting darts with Philadelphia cops across from my undergrad apartment.  Any chat I’d have with an old buddy or bartender about drugs, cancer, or drugs and cancer would invariably draw some interest from fellow patrons overhearing my discussions.  These were usually followed by, “Hey, aren’t you Frankie Kroll’s boy?,” or “I’ve heard the government is hiding the cure for cancer – do you have any inside dope on that?”
(more…)

Posted in: Herbs & Supplements, Medical Academia, Pharmaceuticals, Science and Medicine, Science and the Media

Leave a Comment (15) →

Is there no end to unscientific treatments for autism?

OK, it’s true that I’m only scheduled to post every other week or so, but I couldn’t resist sharing this one with you (which I’ve cross-posted over at denialism blog).  I promise to get back to my assigned schedule after this one.  Thanks for your indulgence.  –PalMD

If you’ve been a regular reader of SBM or denialism blog, you know that plausibility plays an important part in science-based medicine.  If plausibility is discounted, clinical studies of improbable medical claims can show apparently positive results.  But once pre-test probability is factored in, the truth is revealed—magic water can’t treat disease, no matter what a particular study may say.  So it was with great dismay that I read an email from a reader telling me about parents buying hyperbaric chambers for their autistic children.  Let’s review some science.

In Breathing 101, we talked about how the oxygen delivered to your lungs depends on both the percentage of oxygen in the air, and the air pressure.  We looked at how diminishing atmospheric pressure, for example at altitude, makes it harder to breathe.

Of course it is also possible to expose people to increased atmospheric pressure, which has therapeutic uses in the form of hyperbaric oxygen therapy (HBOT).

Oxygen delivery to tissue depends on several factors.  We already talked about the air itself.  Once air gets enters the lungs, most of the oxygen transported to your tissues is carried by the hemoglobin molecules in your red blood cells (under normal conditions).  A small amount is directly dissolved in the blood.  The amount dissolved in the blood is dependent on (no surprise) the percentage of oxygen and the atmospheric pressure.  By increasing the atmospheric pressure from 1 atm (760 torr) to 3 atm, the amount of oxygen dissolved in the blood is enough to meet your body’s needs independent of heme-associated oxygen.

This is a good thing.
(more…)

Posted in: Neuroscience/Mental Health, Science and Medicine

Leave a Comment (28) →

Fake diseases, false compassion

Hi,  everybody!  I’m PalMD (although my byline says differently), and you may remember me from such other blogs as WhiteCoat Underground and denialism. The folks around here were kind enough to give me a regular gig dispensing my brand of medical information transfer, and I’m going to start out with a basic question: what is a disease?

Human beings have some pretty powerful pattern-recognition software—so powerful that it can over-perceive patterns, sometimes causing us to confuse randomness for order.  This impacts all aspects of human thought, including medicine.

In the realm of medicine, we define disease as alterations in physiology, anatomy, biochemistry, etc. that causes significant discomfort, disability, or increased risk for same.  OK, really, I sort of cobbled that together, but you get the idea — a disease is a definable alteration in normal function.  A corollary to this is that to define a disease, we must know something about what is normal (a discussion for another time).  A related term is syndrome, which we usually define as  “a set of signs or a series of events occurring together that often point to a single disease or condition as the cause.”  What this effectively means is that we use the word “syndrome” to indicate a set of abnormal findings without a clear cause, and “disease” to indicate the abnormal findings with a putative cause.

(All this verbosity is leading somewhere—I promise.)

“Syndrome” is sometimes a useful place-holder term for a nascent disease.  Sometimes, however, a set of signs and symptoms is simply coincidence that we erroneously recognize as a pattern.

In popular culture there’s a lot of talk about “overmedicalization”, that is, calling things abnormal that are simply slight variations in the wide range of human health.   You’ll find people who argue that treating ADHD with medications is tantamount to abuse (and lost in the hysteria is the real possibility that we are over-medicating some kids). You’ll also find groups that argue that deafness or autism are simply “other”, but not “abnormal” as such.  This, of course, is wrong.  While a deaf or autistic person is just as valuable as a “normal”, and may have just as much to contribute to society, they are very far from normal human health.

And now you have the proper background to approach the problem of fake diseases.

(more…)

Posted in: Science and Medicine

Leave a Comment (62) →

Cholesterol Skeptics Strike Again

I’m really tired of arguing about cholesterol, but I feel obliged to stand up once more to defend science-based medicine from unfair calumny.

Lewis Jones’s article “Cholesterol-shmesterol” in Skeptical Briefs (December 2007) included errors and misconceptions about cholesterol. It was a re-hash of the same kind of misinformation that is being spread by The International Network of Cholesterol Skeptics (THINCS) and that I addressed in an earlier post. THINCS would like us to believe that cholesterol has nothing to do with heart disease; that low cholesterol is harmful and high cholesterol is beneficial; and they demonize statins, even falsely claiming that they cause cancer.

I answered Jones with my own article “Cholesterol Clarifications” in the June 2008 issue of Skeptical Briefs. I said I agreed that cholesterol does not “cause” heart disease, that low-fat and low-cholesterol diets have been promoted way beyond the evidence and that statins are being over-prescribed. The public has a lot of misconceptions, but thoughtful science-based doctors agree that the evidence shows: (more…)

Posted in: Nutrition, Pharmaceuticals, Science and Medicine

Leave a Comment (17) →

Nobel for HIV Discoverers

The Nobel Prize in Medicine was awarded this week to two French virologists, Françoise Barré-Sinoussi and Luc A. Montagnier, for discovering the AIDS causing virus, the Human Immunodeficiency Virus (HIV). They will share half the prize of 1.4 million dollars, the other half going to three Dr. Harald zur Hausen for discovering the human papilloma virus and its relation to cervical cancer.

The prize comes 25 years after Barré-Sinoussi and Montagnier, working at the Pasteur Institute in Paris, published their paper identifying what was later called HIV. The last quarter of a century has proven their discovery to be a triumph of science-based medicine. The Nobel committee is correct, in my opinion, in waiting such long periods of time before granting such recognition. It reflects that fact that, even in a fast-paced arena of science such as medicine, it takes time for the meticulous process of science to work itself out. It takes decades to garner the perspective necessary to tell the difference between a crucial breakthrough and a false lead.

(more…)

Posted in: Science and Medicine

Leave a Comment (3) →

A “Shruggie” Awakening – One Doctor’s Journey Toward Scientific Enlightenment

ED. NOTE: Circumstances have dictated an unexpected change of plans; so you’re in for a treat. Dr. Val Jones is starting two days earlier than previously announced. Beginning next week, her posts will appear regularly on Thursday mornings. Harriet Hall’s post scheduled for today will appear on Thursday this week. Be ready; it’ll be the return of the cholesterol “skeptics.” Now, Dr. Val…

Greetings, everyone. I am a proud new member of the Science Based Medicine blogging team, and have committed to one post each Thursday morning. As part of my “grand entrance” onto the skeptical blogging stage, I was hoping to introduce a new noun into our lexicon. I’ve asked permission from Steve Novella and David Gorski, and they’ve given me a wink and a nod, so here goes:

Shruggie (noun): a person who doesn’t care about the science versus pseudoscience debate. When presented with descriptions of exaggerated or fraudulent health claims or practices, their response is to shrug. Shruggies are fairly inert, they will not argue the merits (or lack thereof) of complementary and alternative medicine (CAM) or pseudoscience in general. They simply aren’t all that interested in the discussion, and are somewhat puzzled by those who are.

I’m sure you’ve encountered shruggies in your daily life. They are quite common – in fact, they may actually be in the majority among healthcare professionals. And I have a confession to make — I used to be one myself.

If you’ll indulge me, I’d like to tell you the story of how I was awakened from my unhealthy indifference toward pseudoscience. (more…)

Posted in: Science and Medicine, Science and the Media

Leave a Comment (50) →

Pitfalls in Regulating Physicians. Part 2: The Games Scoundrels Play

A Few Things that No Doctor Should Do

When a physician is accused of DUI, “substance abuse,” being too loose with narcotic prescriptions, throwing scalpels in the OR, or diddling patients, the response of a state medical board† tends to be swift and definitive. Shoot first, ask questions later. After all, the first responsibility of the board is to the public’s safety, not to preserving the physician’s livelihood. One might therefore expect that a physician accused of using dangerous, substandard treatments would face a similar predicament. As you’ve undoubtedly guessed, such is not the case.

Here on Science-Based Medicine I’ve discussed at least 4 risky and implausible treatments: Laetrile, the “Gonzalez Regimen,” Na2EDTA “chelation therapy,” and intravenous hydrogen peroxide. Any medical board worth its salt ought to recognize each of those as dangerous and sub-standard, and therefore ought quickly to impose serious disciplinary measures upon any licensed physician found using them. Sometimes that is the case, but all too often it isn’t.

(more…)

Posted in: Health Fraud, Medical Ethics, Politics and Regulation, Science and Medicine

Leave a Comment (7) →

Cognitive Dissonance at the New York Times

Humans have the very odd ability to hold contradictory, even mutually exclusive, ideas in their brains at the same time. There are two basic processes at work to make this possible. The first is compartmentalization – the ideas are simply kept separate. They are trains on different tracks that never cross. We can switch from to the other, but they never crash into each other.

When contradictory ideas do come into conflict this causes what psychologists call “cognitive dissonance.” We then typically will relieve cognitive dissonance, which is an unpleasant state, through the second process – rationalization. We happily make up reasons why the two conflicting ideas actually don’t conflict at all. People are generally good at rationalization. It is a supreme intellectual irony that greater intelligence often leads to a greater ability to rationalize with both complexity and subtlety, and therefore a greater capacity to maintain contradictory beliefs.

In fact the demarcation between science and pseudoscience is often determined by the difference between sound scientific reasoning and sophisticated rationalization.

While cognitive dissonance refers to a process that takes place within a single mind, it is a good metaphor for the contradictory impulses of groups of people, like cultures or institutions. I could not help but to invoke this metaphor when reading two editorials published in the same day in the New York Times.

(more…)

Posted in: Clinical Trials, Science and Medicine

Leave a Comment (10) →
Page 73 of 84 «...5060707172737475...»