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TIME Magazine, Dr. Oz, What to Eat, and Supplements

Here on SBM we have frequently had cause to criticize the media for poor science reporting and for spreading misinformation. Among many other individual offenders, we have criticized Dr. Oz for promoting alternative medicine on his TV show and gullibly promoting guests who pretend to talk to the dead and pretend to heal people with carnival sideshow tricks. We tend to be negative and critical because somebody has to do it, but it’s not pleasant.  For once, I have some good things to say.

The September 12 issue of TIME magazine was a Special Nutrition Issue. The cover featured pictures of food and the title “What to Eat Now: Uncovering the Myths about Food by Dr. Oz.” It devotes 7 pages to an article by him entitled “The Oz Diet: No more myths. No more fads. What you should eat — and why.” This is followed by a 5 page article by John Cloud “Nutrition in a Pill? I took 3000 supplements over five months. Here’s what happened.” Both articles have a rational, science-based perspective without any intrusions of woo-woo. (more…)

Posted in: Nutrition, Science and the Media

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Gullible George

I get the occasional email.  Very little hate mail, unfortunately, since hate mail is often more amusing.  I read what little email I receive, and usually do not respond, mostly as I do not have the time.  I am a slow writer and a slower typist, and there are just so many hours in the day, and the older you get, the shorter th0se hours become.

Recently, over at the center of the growing Mark Crislip multimedia empire, I had the following in the feedback section:

Just thought you’d like to know:

My kids watch the PBS show “Curious George” which usually does a good job with introductory Physics, Astronomy, scientific method, etc. Interspersed with the cartoons they have scenes with real children that do a real-life parallel investigation of what happened on Curious George.

Today’s episode involved the Man with the Yellow Hat catching a cold, and Curious George going to the pharmacy and picking up various drugs to assist in making the guy feel better, mainly to have him sleep and be comfortable.

The interspersed skit, however, had the children visit a naturopath, where they learned:
* Oregano cures infections
* Various pressure points that correspond to energy lines
* And that taping magnets to these points is really effective.

I sat here simply amazed.

Me, not so much.  Alternative medicine has always been a blind spot for PBS.  While PBS  would not show perpetual motion machines,  suggest that astrology is legitimate, or give credence to a flat earth, alternative medicine, as it is for many otherwise thoughtful people, is exempt from even cursory critical thinking. PBS has broadcast  Drs. Chopra and North, so its track record with science based medicine is not so good. My children are long past the Curious George part of their lives, but I read them the books when they were kids.  Not my favorite (I like the Madeleine books better; 6 weeks in hospital for an acute appendix never failed to amuse me) but they were a quick read when the kids wanted a story at bedtime and I was too tired for a longer exposition. (more…)

Posted in: Naturopathy, Science and the Media

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Dummy Medicine, Dummy Doctors, and a Dummy Degree, Part 2.0: Harvard Medical School and the Curious Case of Ted Kaptchuk, OMD

Review

The recent albuterol vs. placebo trial reported in the New England Journal of Medicine (NEJM) found that experimental subjects with asthma experienced substantial, measured improvements in lung function after inhaling albuterol, but not after inhaling placebo, undergoing sham acupuncture, or “no treatment.” It also found that the same subjects reported having felt substantially improved after either albuterol or each of the two sham treatments, but not after “no treatment.” Anthropologist Daniel Moerman, in an accompanying editorial, wrote, “the authors conclude that the patient reports were ‘unreliable,’ since they reported improvement when there was none”—precisely as any rational clinician or biomedical scientist would have concluded.

In Part 1 of this blog we saw that Moerman took issue with that conclusion. He argued, with just a bit of hedging, that the subjects’ perceptions of improvement were more important than objective measures of their lung function. I wondered how the NEJM editors had chosen someone whose bibliography predicted such an anti-medical opinion. I doubted that Editor-in-Chief Jeffrey Drazen, an expert in the pathophysiology of asthma, had ever heard of Moerman. I suggested, in a way that probably appeared facetious, that Ted Kaptchuk, the senior author of the asthma report, might have recommended him. (more…)

Posted in: Acupuncture, Chiropractic, Clinical Trials, Health Fraud, Herbs & Supplements, History, Medical Academia, Medical Ethics, Naturopathy, Pharmaceuticals, Science and Medicine, Science and the Media

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“Integrative medicine”: A brand, not a specialty

Author’s note: This post was inspired in part by a post by Wally Sampson entitled Why would medical schools associate with quackery? Or, How we did it.

PRELUDE

Once upon a time, there was quackery.

Long ago, back in the mists of time before many of our current readers were even born and far back in the memory of even our wizened elders of medicine, “quackery” was the preferred term used to refer to ineffective and potentially harmful medical practices not supported by evidence. Physicians, having a grounding in science and prior plausibility, for the most part understood that modalities such as homeopathy, reflexology, and various “energy healing” (i.e., faith healing) methodologies were based either on prescientific vitalism, magical thinking, and/or science that was at best incorrect or at the very least grossly distorted. More importantly, physicians weren’t afraid to call quackery quackery, quacks quacks, and charlatans charlatans.

Not surprisingly, quacks and charlatans did not like this.
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Posted in: Homeopathy, Science and Medicine, Science and the Media

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Train Therapy

Summertime and the living is busy.  Finally we have sun in the Northwest.  While the rest of the country has been melting in heat, this year we have rarely cracked 85.  Global heating has avoided Oregon this year, and I will need some green tomato recipes.  Good weather, work is busy, and it is the last two weeks with my eldest before he is off to Syracuse, so there is little time for writing, so a brief entry this week.

I always wince at the way anything can be called ‘therapy.’ We have music therapy and garden therapy and pet therapy and art therapy.  I do not deny that it is beneficial for people to participate in those activities while in the hospital, although I am never happy to see disease vectors, er, animals in a hospital.   Dinner should be food therapy, reading should be book therapy, and using the internet should be computer therapy.  I guess it is like calling something ‘medical’ grade, and you can bill more for it.

Some ‘therapies’ are a wee bit more odd.  Indonesians are using railroad therapy.  People lie down on electric railroad tracks because “the electricity current from the track could cure various diseases.”  To date no one has been either electrocuted or squashed, but I suppose it is only a matter of time.

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Posted in: Energy Medicine, Faith Healing & Spirituality, Science and the Media

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Revisiting Daniel Moerman and “placebo effects”

About three weeks ago, ironically enough, right around the time of TAM 9, the New England Journal of Medicine (NEJM) inadvertently provided us in the form of a new study on asthma and placebo effects not only material for our discussion panel on placebo effects but material for multiple posts, including one by me, one by Kimball Atwood, and one by Peter Lipson, the latter two of whom tried to point out that the sorts of uses of these results could result in patients dying. Meanwhile, Mark Crislip, in his ever-inimitable fashion, discussed the study as well, using it to liken complementary and alternative medicine (CAM) as the “beer goggles of medicine,” a line I totally plan on stealing. The study itself, we all agreed, was actually pretty well done. What it showed is that in asthma a patient’s subjective assessment of how well he’s doing is a poor guide to how well his lungs are actually doing from an objective, functional standpoint. For the most part, the authors came to this conclusion as well, although their hedging and hawing over their results made almost palpable their disappointment that their chosen placebos utterly failed to produce anything resembling an objective response improving lung function as measured by changes (or lack thereof) in FEV1.

In actuality, where most of our criticism landed, and landed hard—deservedly, in my opinion—was on the accompanying editorial, written by Dr. Daniel Moerman, an emeritus professor of anthropology at the University of Michigan-Dearborn. There was a time when I thought that anthropologists might have a lot to tell us about how we practice medicine, and maybe they actually do. Unfortunately, my opinion in this matter has been considerably soured by much of what I’ve read when anthropologists try to dabble in medicine. Recently, I became aware that Moerman appeared on the Clinical Conversations podcast around the time his editorial was published, and, even though the podcast is less than 18 minutes long, Moerman’s appearance in the podcast provides a rich vein of material to mine regarding what, exactly, placebo effects are or are not, not to mention evidence that Dr. Moerman appears to like to make like Humpty-Dumpty in this passage:
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Posted in: Acupuncture, Basic Science, Clinical Trials, Neuroscience/Mental Health, Science and the Media

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Consumer Reports drops the ball on alternative medicine

Ever since I was a teenager, I’ve intermittently read Consumer Reports, relying on it for guidance in all manner of purchase decisions. CR has been known for rigorous testing of all manner of consumer products and the rating of various services, arriving at its rankings through a systematic testing method that, while not necessarily bulletproof, has been far more organized and consistent than most other ranking systems. True, I haven’t always agreed with CR’s rankings of products and services about which I know a lot, but at the very least CR has often made me think about how much of my assessments are based on objective measures and how much on subjective measures.

Until now.

I just saw something yesterday on the CR website that has made me wonder just how scientific CR’s testing methods are, as CR has apparently decided to promote alternative medicine modalities by “assessing” them in an utterly scientifically ignorant manner. Maybe I just haven’t been following CR regularly for a while, but if there’s an article that demonstrates exactly why consumer product testing organizations should not be testing medical treatments; they are ill-equipped to do so and lack the expertise and knowledge. The first red flag was the title, namely Hands-on, mind-body therapies beat supplements. The second red flag was the introduction to the article:

A new survey of subscribers to Consumer Reports found that prescription drugs generally performed better than alternative therapies for 12 common health problems. But hands-on treatments such as chiropractic care and deep-tissue massage, as well as mind-body therapies such as yoga and meditation, held their own, especially for certain conditions. Far fewer said that dietary supplements helped a lot.

Prescription drugs helped the most for nine of the conditions we asked about: allergies, anxiety, colds and flu, depression, digestive problems, headache and migraine, insomnia, irritable bowel syndrome, and osteoarthritis.

But chiropractic care performed better than drugs for back pain, and deep-tissue massage beat drugs for neck pain. Massage was as also as good as drugs for fibromyalgia. Those hands-on therapies also scored near the top for osteoarthritis as well as for headaches and migraines.

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Posted in: Science and the Media

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On the Orwellian language and bad science of the anti-vaccine movement: “SmartVax” versus “MaxVax”?

If there’s one thing that’s true of the human race, it’s that when it comes to persuasion language is has power. Words have power. Just ask the advertising industry or politicians, who rely on their skills manipulating language to persuade for their very livelihood and authority. In the specific bailiwick of this blog, Science-Based Medicine, many of us have spent considerable verbiage describing how advocates of unscientific modalities rebranded as “complementary and alternative medicine” (CAM) and/or “integrative medicine” (IM) are incredibly skilled at the manipulation of language and renaming of terms in order to make them sound more persuasive, particularly to make it sound as though their modalities are scientifically supported or that it’s just another “alternative” to SBM. In fact, Kimball Atwood has made a special study of the language of CAM, even going so far to do an amusing feature that he used to call the Weekly Waluation of the Weasel Words of Woo. Indeed, the very name “integrative medicine” is a masterful term that makes it sound as though they’re just “integrating” the best of scientific medicine and “traditional” or “alternative” medicine when in fact what is happening all too often is the “integration” of quackery with medicine or, as I sometimes like to call it, “integrating” fake medicine with real medicine. Unfortunately, my definition of “integrative medicine” doesn’t appear to be winning, although I was gratified that I got several Tweets during our panel at TAM9 quoting my line about integrating quackery with medicine.

The anti-vaccine movement has been pretty good, albeit not as masterful as, say, Andrew Weil, when it comes to manipulating language to its own end. Who can forget three years ago, when the meme started spreading throughout the anti-vaccine movement that it’s “not anti-vaccine but rather ‘pro-safe vaccine’” and started demanding that the government and pharmaceutical companies “green our vaccines.” The reason is obvious; even anti-vaccine activists know that it’s a public relations loser to be explicitly anti-vaccine, which is Jenny McCarthy and the anti-vaccine groups that participated in her “Green Our Vaccines” rally did their best to downplay and hide their radical anti-vaccine base. They failed. (The signs about vaccines as “weapons of mass destruction” rather undercut the “pro-safe vaccine” message. I’ve dealt with this fallacy before in depth, explaining why it is appropriate to call them “anti-vaccine,” even as they strenuously deny that they are. More recently, the preferred narrative has been “too many, too soon,” which leads me to another term coined by the group SafeMinds and promoted on—where else?—Age of Autism.

Now, the SafeMinds/AoA approach is being dubbed “SmartVax.”
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Posted in: Public Health, Science and the Media, Vaccines

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Dummy Medicines, Dummy Doctors, and a Dummy Degree, Part 1: a Curious Editorial Choice for the New England Journal of Medicine

Background

This post concerns the recent article in the New England Journal of Medicine (NEJM) titled “Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma.” It was ably reviewed by Dr. Gorski on Monday, so I will merely summarize its findings: of the three interventions used—inhaled albuterol (a bronchodilator), a placebo inhaler designed to mimic albuterol, or ‘sham acupuncture’—only albuterol resulted in a clinically important improvement of bronchial airflow; for that outcome the two sham treatments were equivalent to “no intervention.” For all three interventions, however, self-reported improvements were substantial and were much greater than self-reported improvements after “no intervention.” In other words, dummy treatments made the subjects (report that they) feel better, whereas real medicine not only made them feel better but actually made them better.

Before proceeding, let me offer a couple of caveats. First, the word ”doctors” in the flippant title of this post refers mainly to two individuals: Daniel Moerman, PhD, the anthropologist who wrote the accompanying editorial, and Ted Kaptchuk, the Senior Author of the trial report. It does not refer to any of the other authors of the report. Second, I have no quarrel with the trial itself, which was quite good, or with the NEJM having published it, or even with most of the language in the article, save for the “spin” that Dr. Gorski has already discussed.

My quarrels are the same as those expressed by Drs. Gorski and Novella, and by all of us on the Placebo Panel at TAM. This post and the next will develop some of those points by considering the roles and opinions of Moerman and Kaptchuk, respectively.

A True Story

Late one night during the 1960s a friend and I, already in a cannabis-induced fog, wandered into a house that had been rented by one of his friends. There were about 8-10 ‘freaks’ there (the term was laudatory at the time); I didn’t know any of them. The air was thick with smoke of at least two varieties. After an uncertain interval I became aware of a guy who was having trouble breathing. He was sitting bolt upright in a chair, his hands on his knees, his mouth open, making wheezing sounds. He took short noisy breaths in, followed by what seemed to be very long breaths out, as though he was breathing through a straw. You could hear the wheezing in both directions. Others had also noticed that he was in distress; they tried to be helpful (“hey, man, ya want some water or somethin’?”), but he just shook his head. He couldn’t talk. My friend, who had asthma himself, announced that this guy was having an asthma attack and asked if he or anyone else had any asthma medicine. No one did.

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Posted in: Acupuncture, Cancer, Clinical Trials, Energy Medicine, Faith Healing & Spirituality, Health Fraud, Homeopathy, Medical Academia, Medical Ethics, Naturopathy, Pharmaceuticals, Public Health, Science and Medicine, Science and the Media

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Anti-vaccine propaganda in The Baltimore Sun

The hypothesis that vaccines cause autism has been about as thoroughly falsified through research as any health hypothesis can be. Even if, by bending over backward into a back-breaking contortionist pose to be “open-minded”, some people will concede that there’s still a bit of room for reasonable doubt about whether there is no link between vaccines and autism in “susceptible” populations, there is no room for reasonable doubt left over whether vaccines caused the so-called “autism-epidemic” of the last two decades. They did not. Similarly, the mercury-containing preservative thimerosal, which used to be in several childhood vaccines until the end of 2001, when thimerosal was removed from all but some flu vaccines, has been about as cleared of being a cause of autism as it is possible for a substance to be. Basically, if thimerosal-containing vaccines were a cause of autism, we would have expected to see a decrease in autism prevalence beginning three to five years after the removal of thimerosal. Epidemiological studies have failed to find such a decline and have also failed to find evidence of correlation. I realize that anti-vaccine activists argue that there are still trace amounts of thimerosal in some vaccines, but, even so, thimerosal exposure in children fell almost overnight to levels lower than the 1980s, which was before the beginning of the “autism epidemic.” At the very least, one would expect autism rates to fall back to 1980s levels if thimerosal in vaccines were a driving force behind this “epidemic.” They haven’t. Quite the contrary, they’ve continued to climb.

So why does the manufactroversy that vaccines cause autism persist? There is no longer a scientific controversy; by and large, the question has been asked and answered. Vaccines do not cause autism, as far as we can detect. True, it’s impossible to completely prove a negative hypothesis, but if there is any way that vaccines do cause autism, it’s at a level below the ability of large epidemiological studies with tens or even hundreds of thousands of children to detect. Yet the fear persists.

One reason is that it’s very hard to eradicate a false belief, once entrenched. I’ve discussed many times how difficult it is to change people’s minds, as motivated reasoning leads them to seek confirming evidence and discount all else. Disconfirming evidence can even lead people to harden their beliefs even more. In particular, the hardcore anti-vaccine activists who persist in spreading the vaccine-autism myth have an interest and motivation in this mythology at least as potent as the interest pharmaceutical companies have in defending vaccines—more so, arguably, given the emotional attachment people have for their children. After all, all pharmaceutical companies are interested in, according to this mythology, is profit. If a parent, correctly or incorrectly, somehow comes to believe that something or someone has hurt his or her child, it is among the most potent motivations known to do something about it.

Another reason is that the concept has become entrenched in our culture—or at least parts of our culture—to the point where it appears regularly in the media, thus reinforcing the idea among those who don’t pay attention to the issue or those who do but haven’t decided if they believe that vaccines cause autism that maybe there is something to fear. Maybe there is still a controversy. A perfect example appeared in The Baltimore Sun over the weekend entitled We don’t know enough about childhood vaccines and subtitled Researcher asks: Are 36 doses of vaccine by age 2 too much, too little, or just right? I contend that the editors of The Baltimore Sun, by publishing this anti-vaccine propaganda, which would have been at home on the websites of the anti-vaccine blog Age of Autism or on the website of anti-vaccine groups SafeMinds, Generation Rescue, the International Medical Council on Vaccination or the National Vaccine Information Center (NVIC). Examining this article, written by Margaret Dunkle, described as a “senior research scientist at the Department of Health Policy at George Washington University and director of the Early Identification and Intervention Collaborative for Los Angeles County” and as having “a family member who is vaccine-injured,” is what I would consider a “teachable moment” in analyzing the tactics of the anti-vaccine movement.
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Posted in: Public Health, Science and the Media, Vaccines

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