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Antivaccine hero Andrew Wakefield: Scientific fraud?

Pity poor Andrew Wakefield.

Actually, on second thought, Wakefield deserves no pity at all. After all, he is the man who almost single-handedly launched the scare over the MMR vaccine in Britain when he published his infamous Lancet paper in 1998 in which he claimed to have linked the MMR vaccine to regressive autism and inflammation of the colon, a study that was followed up four years later with a paper that claimed to have found the strain of attenuated measles virus in the MMR in the colons of autistic children by polymerase chain reaction (PCR). It would be one thing if these studies were sound science. If that were the case, then Wakefield’s work would have been very important and would have correctly cast doubt on the safety of the MMR. Unfortunately, they were not, and, indeed, most of the authors of the 1998 Lancet paper later withdrew their names from it.

Over the next decade, aided and abetted by useful idiots in the media, by British newspapers and other media that sensationalized the story, and the antivaccine movement, which hailed Wakefield as a hero, Wakefield managed to drive MMR vaccination rates in the U.K. below the level of herd immunity, from 93% to 75% (and as low as 50% in some parts of London). As a result Wakefield has been frequently sarcastically “thanked” for his leadership role in bringing the measles back to the U.K. to the point where, fourteen years after measles had been declared under control in the U.K., it was in 2008 declared endemic again.

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Posted in: Science and the Media, Vaccines

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Where Does Sanjay Gupta Register On The Quackometer?

Four weeks ago I wrote a blog post about Sanjay Gupta’s nomination by the Obama administration as our potential new Surgeon General. Many of you voiced concerns about Sanjay’s nomination, specifically because of his poor handling of the Raelians’ Clonaid fiasco, his inability to counter Michael Moore’s health statistics as presented in Sicko and his relationship to the pharmaceutical industry.

As I wondered about what Sanjay Gupta might be like as Surgeon General – and specifically how he might assist in “restoring science to its rightful place” – I decided to educate myself about his thought processes by purchasing his recent book “Chasing Life.” The question I sought to answer was, “is Sanjay Gupta a crank?”

The short answer is: I’m not sure.  Although I wouldn’t go so far as to say that he is a crank, I think he’s more likely to be a shruggie. For those of you who haven’t read my post on shruggies, here’s the definition:

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.

The longer answer involves an exploration of Gupta’s disturbing insistence on flirting with cranks, if it gets him publicity. The back cover of Chasing Life caries an endorsement from Deepak Chopra – and the inside page a favorable review from Andrew Weil. Normally, I would assume that the author of any book endorsed by those two would contain an intolerable blend of science and pseudoscience and refuse to read it. But for the sake of the readers of Science Based Medicine, I stifled my gag reflex and purchased the book. I hope that my sacrifice will benefit you all.
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Posted in: Book & movie reviews, Public Health, Science and the Media

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The Many Faces Of Snake Oil

It is my unhappy duty to reveal yet another depressing example of dishonest gain in medicine. This time, however, patients were not the only victims. Many healthcare professionals, including physicians, were prey to what has been called “an intellectual property ponzi scheme.”

In a press release dated January 28, 2009, the HealthCentral Network announced the acquisition of a company called Wellsphere from its young CEO, Ron Gutman. Many of my fellow medical bloggers are familiar with Wellsphere as they’ve received countless email form letters from its CMIO, Dr. Geoffrey Rutledge. The form letters are flattering, and suggest that the company would like to feature the blogger’s writing on their platform.

But what happens next is disturbing – to become a member of Wellsphere, bloggers provide access to their blog’s RSS feed. Hidden in the fine print is the blogger’s consent for Wellsphere to publish the entire feed (in other words, all of the blogger’s written work) and that once it’s published on their site, they own the intellectual property rights to it.

Astonishingly Wellsphere convinced some 1700 bloggers to join their network, and have now sold their site (which is comprised almost entirely of blog post content) to HealthCentral Network for an undisclosed amount, likely in the millions.

How much did the health bloggers get for their writing? As far as I know, zero dollars.

In the reference section below you will see copies of emails sent by Dr. Rutledge and excerpts from the website’s Terms of Use document.

Is this the biggest scam ever pulled on health bloggers? You decide. The Wall Street Journal health blog reports:

As for the thousands of bloggers HealthCentral picks up with the merger, there is already grumbling in the blogosphere that Wellsphere built its business on health bloggers who don’t benefit from the deal. “But most are happy and we hope with all our resources and quality-content background we will really strengthen these engagements,” Schroeder told us.

Interesting statement from Schroeder – “most are happy.” He clearly hasn’t read the comments section of my blog. If there ever were a time for the medical/science/health blogosphere to rise up “Motrin moms-style,” it would be now. You may Tweet in protest by entering your comment with “#wellsphere” on Twitter. Or kick it old-school here in our comment section.

If you have any additional information, feel free to post it in the comments section below.

References:

Here is the introductory form email sent out by Dr. Rutledge:
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Posted in: Health Fraud, Science and the Media

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Psychiatry-Bashing

Psychiatry is arguably the least science-based of the medical specialties. Because of that, it comes in for a lot of criticism. Much of the criticism is justified, but some critics make the mistake of dismissing even the possibility that psychiatry could be scientific. They throw the baby out with the bathwater. I agree that psychiatry has a lot of very dirty bathwater, but there is also a very healthy baby in there that should be kept, cherished, nourished, and helped to grow – scientifically.

Common criticisms in the media

  • We are over-medicating our children, producing a generation of drugged zombies.
  • We are using medication indiscriminately for people who don’t fit the diagnosis (i.e. antidepressants for people who only have normal mood fluctuations and life problems).
  • Antidepressants lead to violence and suicide.
  • Psychotropic medications all have terrible side effects.
  • Antidepressants are no better than placebo.
  • Psychotherapies are no better than talking to a friend.
  • Electroconvulsive therapy (ECT) is a barbaric, damaging assault with no redeeming value.
  • And we all remember how Tom Cruise attacked Brooke Shields on the issue of postpartum depression.

Thomas Szasz: Mental Illness is a Myth

Thomas Szasz goes even further: he rejects the whole concept of mental illness and considers it a plot to interfere with people’s human rights. He says:

  • Psychiatric diagnoses are not valid because they are based on symptoms rather than on objective tests. (Steve Novella has pointed out that there are other well-established diagnoses like migraine that cannot be verified by any objective tests.)
  • Mental illness is a myth: unusual behavior does not constitute a disease.
  • Psychiatric diagnoses are an arbitrary construct of society to facilitate control of individuals whose behavior does not conform.
  • Involuntary commitment is never justified even for the protection of the patient: patients always have the right to refuse treatment even if that means they will die. (more…)

Posted in: Neuroscience/Mental Health, Science and Medicine, Science and the Media

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Probiotics

The Wall Street Journal has an assessment of Probiotics in the Jan 13, 2009 issue entitled Bug Crazy: Assessing the Benefits of Probiotics (1). For some reason when I wander around the hospital on rounds people show me articles such as this and ask, so whatcha think about this?

Probiotics are interesting. They are live bacteria given to treat and prevent diseases. It is one of those overlap areas for scientific medicine and so called alternative medicine. There are good clinical trials to suggest areas where these agents are of benefit, but other aspects of their use are blown out of proportion for the real or imagined benefit probiotics may provide. Much of alternative medicine where it overlaps with real medicine is the art of making therapeutic mountains out of clinical molehills.

The Wall Street Journal article is the kind of reporting that drives. me. nuts. It drive me nuts because the reporting acts as if the underlying assumptions of the therapies are true.

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Posted in: Basic Science, Science and Medicine, Science and the Media

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How Is Alternative Medicine Like Earmark Spending?

I recently watched a special news report about John McCain leading the charge towards making legislative earmarks illegal. The Economist defines earmarks this way:

Earmarks, for the uninitiated, are spending projects that are directly requested by individual members of Congress and are not subject to competitive bidding.

Most Americans are rightly upset about the practice of slipping pet projects into larger, well-vetted, and consensus-built legislative initiatives. They know instinctively that it’s morally wrong to sneak in personal favors and appropriate tax payer dollars to special interest groups without allowing others to weigh in. I certainly hope that McCain and his peers will succeed in discontinuing this corrupt practice.

Coincidentally, just after I watched this news report about earmarks, I went online to catch up on my blog reading. The first post I encountered made reference to an opinion piece written by Deepak Chopra, Andrew Weil, Dean Ornish, and Rustum Roy in the Wall Street Journal. Chopra et al. were asking Americans to redouble their efforts to adopt healthy lifestyles (including wholesome diets and regular physical activity) as a means to promote good health and avoid disease. At the end of the article they slipped in a plea for President-elect Obama to consider integrating alternative medicine practices (which included everything from healthy diet to meditation and acupuncture) into a government-sponsored approach to health.
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Posted in: Nutrition, Politics and Regulation, Science and Medicine, Science and the Media

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Chopra and Weil and Roy, oh my! Or: The Wall Street Journal, coopted.

The quest of advocates of unscientific medicine, the so-called “complementary and alternative medicine” (CAM) movement is to convince policy makers, patients, and physicians that it does not deserve the rubric of “alternative,” that it is in fact mainstream. Indeed, that is the very reason why “alternative” medicine morphed into CAM in order to soften the “alternative” label. Increasingly, however, advocates of such highly implausible medical practices appear no longer to like CAM as term for their dubious practicies, because it still uses the word “alternative.” That is, of course, because they recognize that labeling something as “alternative” in relationship to scientific medicine automatically implies inferiority, and CAM advocates are nothing if not full of hubris. Such a term conflicts with their desire to “go mainstream,” and they most definitely do want to go mainstream, but they want to do it on their own terms, without all that pesky mucking about with science, evidence, and rigorous clinical trials. Consequently, they increasingly use a new term, a shiny term, a term free of that pesky “alternative” label. Now they want to “integrate” their unscientific placebo-based practice with real, scientific medicine. Thus was born the term “integrative” medicine (IM, an abbreviation that is the same as that for internal medicine, an identity that I don’t consider coincidence).

One of the biggest complaints we at SBM (or at least I at SBM) have about the attitude of practitioners of scientific medicine towards CAM/IM is that most of them do not see it as a major problem. Dr. Jones characterized this attitude as the “shruggie” attitude, and it’s a perfect term. Equally perfect is her analogy as to why “integrating” pseudoscience with medical science is not a good idea. I myself have lamented the infiltration of pseudoscience and outright quackery into medical academia and the role that the National Center for Complementary and Alternative Medicine (NCCAM) has played in promoting that infiltration. In addition, wealthy patrons of CAM/IM such as Donna Karan and the Bravewell Collaborative have been generous spreading their money around. In this increasingly cash-strapped health care environment, hospitals know on which side their bread is buttered and see the “integration” of woo into their service portfolio as a means of beefing up the bottom line with cash on the barrelhead transactions that require no mucking about with nasty insurance forms. In fact, services such as reiki, homeopathy, acupuncture, and others often require no forms other than credit card receipts for the patient to sign.
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Posted in: Medical Academia, Politics and Regulation, Science and Medicine, Science and the Media

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Who Should Ascend To The Office Of Surgeon General?

President-elect Obama’s nomination of CNN medical correspondent, Sanjay Gupta, for the Office of Surgeon General of the United States has ignited a firestorm of debate across the Internet. Some argue that he is not qualified for the position, others say that his charisma would be a boon to public health communications, though the lay majority appear to have mixed feelings.

It is highly irregular for a Surgeon General nominee to be announced before the Secretary of Health and Human Services is confirmed. This faux pas in itself may speak to an irresistible opportunity for self-promotion, or that the Senate confirmation hearing is not the independent review event that we assume it is.

At age 39, Gupta has long aspired to become the Surgeon General, as sources close to him report that he has been saying (since age 33) that “it’s the next logical step in his career development.”

But before we draw conclusions about who’s right for the job, we need to understand what the job entails.

I asked Dr. Richard Carmona, 17th Surgeon General of the United States, to explain the roles and responsibilities of the office. A summary of our conversation follows:
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Posted in: Politics and Regulation, Public Health, Science and the Media

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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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AARP and Alternative Medicine

I know I said the next entry would be about the efficacy of the influenza vaccine. The road to blogging in paved with good intentions. I will eventually write that entry, but the ADD has kicked in and my attention has wandered elsewhere.

I am 51 and one of the benefits of this advanced age is you get to join AARP, the American Association of Retired People. Yes, I know I am not retired, and given the current economic situation I am already practicing for my retirement.

“Do you what paper or plastic?”

“For here or to go?”

“Do you want fries with that?

Piece of cake. Who needs a 401K?

The day I received the AARP application, on my 50th birthday, despite some misgivings (8), I joined.

The purpose of AARP, besides discounts at Denny’s and the right to yell at kids when they are on your lawn, is, according to their mission statement, “AARP is dedicated to enhancing quality of life for all as we age. We lead positive social change and deliver value to members through information, advocacy and service. (1)” AARP is a lobby/special interest group for the elderly. In medicine the elderly are considered a vulnerable/at risk group. The elderly may have have fixed incomes, chronic medical problems, declining cognitive function and social situations that make them particularly susceptible to scams of all kinds. So it was nice to have an organization looking after our interests.

AARP has at least 40 million members. Accompanying the membership is their magazine, somewhat eponymously entitled AARP Magazine. The AARP Magazine has the largest circualtion of any magazine in the US with 24 million copies, each read issue by more than one person (7). It has 3 times the circulation of Readers digest. Only Parade magazine has a wider circulation. These are the publications where people receive casual information about about health care. I would assume that a magazine from my advocacy organization would contain information that I can trust. After all, AARP is looking out for my interests as a senior, and any article they would publish, especially relating to health and finances, I should be confident was reliable.

The January/February had an article “Drug Free Remedies for Chronic Pain” by Loolwa Khazzoom (2).
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