Science-Based Medicine

This August was a tough month for SBM bloggers reading The New England Journal of Medicine (NEJM). Just one week after a review of acupuncture for back pain—in which the authors recommended referring patients to traditionally trained acupuncturists despite data showing that traditional needling does not outperform a blinded sham control (click here here here for the trifecta takedown)— NEJM featured an original article about a study of Tai Chi for fibromyalgia. As critiqued by Dr. Gorski, the control intervention for the Tai Chi study was arguably inappropriate: the test and control groups experienced different intensities of exercise, for different durations of time, led by different instructors with different levels of enthusiasm. The special pleading and the weak design were not of themselves surprising, only their presence in such an august journal.

A group of editorial authors in that same NEJM issue preemptively address the SBM critics by describing Tai Chi as a “complex, multi-component therapy” and thereby implying that an appropriate sham cannot easily be designed. I agree that studying Tai Chi must be trickier than matching drugs to sugar pills. But “complex, multi-component” interventions can indeed be studied in a way that leads to convincing conclusions, as illustrated in the August 25, 2010 issue of The Journal of the American Medical Association (JAMA). A team of Boston psychologists studied a complex, multi-component intervention for attention deficit-hyperactivity disorder (ADHD) and reported their findings in “Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms: A Randomized Controlled Trial.” The abstract: Continue Reading »

Given that it’s a holiday and I debated whether or not I even wanted to post anything today, I think I’ll keep things light and uncharacteristically brief today. After all, not every post can be like last week’s epic on Avastin or the week before’s epic on peer review. That’s a lot of work, and it is a holiday, after all. Besides, sometimes a perverse mood overtakes me, and I feel the need to go slumming.

Bring on Mike Adams.

Mike Adams, as regular readers may know, runs the website NaturalNews.com from deep in the jungles of Ecuador. His website is a one-stop shop, a repository if you will, of virtually every quackery known to humankind, all slathered with a heaping, helping of unrelenting hostility to science-based medicine and science in general. True, Mike Adams is not as big as, say, Joe Mercola, whose website, as far as I can tell, appears to draw more traffic than NaturalNews.com, but what Adams lacks in fame he makes up for in sheer crazy. If you don’t believe me, check out his latest hip-hop video Vaccine Zombie:

Personally, if I had anything to do with the Michael Jackson estate, I’d be suing for copyright infringement. Still, grudgingly, I have to admit that the animation is pretty good, although when Mike Adams raps, “‘Cause livin’ without a brain ain’t half bad,” I don’t think he realizes that he is apparently living proof of that. In fact, so full of crazy is Mike Adams, that there has even been disagreement among SBM bloggers over whether we should lower ourselves to deal with some of his loonier stuff. Guess which side I took?

The reason I argue that, even at the risk of wrestling the proverbial pig in mud, we should not shy away from taking on some of Mike Adams’ lunacy from time to time is because he illustrates certain aspects of the mindset that allows unscientific so-called “alternative” medicine to remain popular. Sometimes, articles on Adams’ website bring up the question of whether Adams really believes the utter nonsense he lays down or whether he is simply a scammer, much like Kevin Trudeau is a scammer, and doesn’t believe a word of it but has such contempt for his followers that he thinks nothing of lying to them to sell them whatever nostrums he’s hawking on his website. You’ll see what I mean in a minute. I hope.

On Friday, Adams decided to attack “America’s doctor” and a promoter of woo whom we have from time to time taken on here at SBM, Dr. Mehmet Oz because, of all things, Dr. Oz apparently underwent colonoscopy and was found to have a precancerous polyp. That this might have happened to him is not at all surprising given that Dr. Oz recently turned 50 and current guidelines recommend commencing screening by colonoscopy at age 50. Indeed, I’m only a couple of years from needing to submit to the same screening myself. In any case, Adams decided to write one of his patented screeds, entitled, Dr. Oz colon polyps raises question of “spontaneous disease” without cause. In it, he inadvertently reveals a lot about alt-med thinking, making it worth a brief discussion.

Adams starts out:
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I’m only a monthly contributor here but between being a SBM reader and having my own blogs, I often grow weary of the blind criticism that researchers and drug companies couldn’t care less about traditional folk medicines as drug products. My laboratory spends every single day working on natural product extracts in the search for compounds that may have selective effectiveness against cancer. So, this is a bit of a sore spot for me.

Two papers this week from Cancer Prevention Research on the potential anticancer effects of a diabetes drug (Nathan Seppa story here) remind me to tell the story of a Middle Ages European herbal medicine used to treat polyuria that gave rise to one of the most widely prescribed drugs in the world, metformin (Glucophage in the US). Metformin, known chemically as a biguanide, dimethylguanide to be precise, traces its roots to the plant Galega officinalis. Known as goat’s rue, French lilac, or professor weed, this plant was shown to be a rich source of guanidine and a less toxic compound later called galegin or galegine (isoamyline guanidine).

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A topic of growing interest (and concern) at SBM is laboratory and diagnostic test pseudoscience. Bogus tests are everywhere, and Kimball Atwood recently discussed several of them. But over the past several years, diagnostic tests have emerged that appear to be science-based and offer gene-level insights into your health. And these tests don’t even require a physician’s visit – just a swab of saliva and a credit card get you reams of information on your genetics, traits, and risks of dozens of diseases. It looks like the ultimate in consumer health information, with the potential to offer truly personalized treatment strategies. Companies like 23andme, deCODEme, and Navigenics all promise “genetic insights” to improve your health. How could this information be anything but helpful?

Personalized medicine describes medical practices that use information about a person’s genes, proteins, and environment to prevent, diagnose and treat disease. Science-based practice has routinely incorporated environmental advice (e.g., diet and exercise) into medical management. And there are a number of genetic tests in routine use that are well established, clinical validated, and are highly predictive of future outcomes, such as tests for Huntington’s disease and hereditary breast cancer.
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There is an AIDS epidemic in Africa, and efforts to fight it are hampered by the endemic social problems of that continent. Chief among them are the lack of sufficient modern health resources, the spread of destructive rumors and myths about HIV/AIDS, and even the persistence of HIV denial in Africa (although this last factor is better than in the past).

The World Health Organization (WHO) and the International HIV/AIDS Alliance are teaming up with the Traditional Health Practitioners Association of Zambia (THPAZ) to address the first problem – the lack of health services. Most Zambians use traditional healers for primary health care. The WHO has therefore decided to utilize traditional healers in the fight against AIDS. There are interesting pros and cons to this policy, but it must first be recognized that there is no ideal solution to the problem. The resources to provide optimal modern health care to treat and prevent HIV/AIDS (which would need to include a massive education program) in Zambia and the rest of Africa simply do not exist. One might argue that the world should provide those resources, but let’s put that issue aside and focus on what to do in the meantime.

The arguments given in favor of this WHO strategy are:

Traditional healers far outnumber biomedical workers in the rural areas.

They are consulted, not only because they are closer and more affordable than their Western-trained counterparts, but also because they are embedded, extensively and firmly, within Ugandan culture.

Traditional healers are highly respected and widely consulted by communities.

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