Science-Based Medicine

A correspondent asked me to look into the GAPS diet.  I did. I was sorry: it was a painful experience. What a mishmash of half-truths, pseudoscience, imagination, and untested claims!

GAPS stands for Gut and Psychology Syndrome. It is the invention of Dr. Natasha Campbell-McBride. According to her, a wide variety of health problems can be traced to a single cause: an imbalance of gut microbes.  She cites ancient wisdom: Hippocrates said all diseases begin in the gut. She says science confirmed that wisdom when it discovered that 90% of all cells and all genetic material in the human body belongs to the gut flora. She says the modern world poses many dangers for the gut flora, and once it is damaged, the health of the whole body enters a downward slide towards disease. She claims that autism and ADD, OCD, schizophrenia, epilepsy, depression, and numerous other ailments are all digestive disorders. Continue Reading »

Stem cells are magical.

At least, if you listen to what docs and “practitioners” who run stem cell clinics in various parts of the world, usually where regulation is lax and money from First World clientele is much sought after, that’s what you could easily come to believe. Unfortunately, it’s not just Third World countries in which “stem cell clinics” have proliferated. For instance, they are not nearly uncommon enough in Europe. The example that is most troubling right now is Italy, and the reason is that there is currently a law being considered that would greatly weaken the regulation of stem cell therapies, so much so that on Friday I saw something that’s fairly rare: a major scientific journal published a pointed editorial about this new law. Specifically EMBO Journal published a commentary by an international group of scientists warning about the path that the government of Italy is considering entitled Regulation of stem cell therapies under attack in Europe: for whom the bell tolls.

Stem cell quackery is a very popular form of quackery these days because, well, stem cells are so magical-seeming. You can now find stem cell treatments offered for autism (one of which, offered at a clinic in Costa Rica, I’ve discussed before and involves injecting “stem cells” into the cerebrospinal fluid of autistic children for a cool $15,000). Kent Heckenlively, the man who took his daughter to the aforementioned Costa Rica clinic for this treatment, is not alone in subjecting his autistic child to such unproven uses of stem cells. Just a couple of months ago, a broadcast journalist in the Philippines named Karen Davila took her autistic son to the Villa Medica Clinic in Germany, which offers variants of stem cell therapy. One is known as “fresh cell therapy” and involves harvesting cells from lamb fetuses and injecting them into the patient. The other is called fat stem cell repair therapy, which is claimed to involve harvesting fat from the patient’s abdomen or thigh and then isolating “stem cells” from them to be injected back into the patient’s body.
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Animal-assisted therapy is a huge topic: almost 1500 hits using those terms alone. There is no way I am going to cover all of them and do them justice. Instead I am going to cherry pick, er, I mean, select references of interest to illustrate issues surrounding animals in the hospital. Sometimes I get the impression that readers of the blog expect encyclopedic knowledge and understanding of a topic whenever we put pixel to screen. That is only true of the other contributors to the blog, not me.

I would like to mention that I do, in fact, like animals, even dogs. I loathe most dog owners, as confirmation bias suggests there is no such thing as a considerate dog owner. But I never have contact with the dogs that don’t bark, that don’t crap on my yard, that don’t run up to me to nip at my legs. I only see the dogs that their owners allow to behave in ways I would never allow a human to behave.

It is no surprise that my kids have grown up mostly animal free. My eldest did wear me down and I bought him a hamster. It promptly bit me, drawing blood. Great, I thought, LCM. Just what I need. Then in the dead of winter it escaped, fell down a heating duct (we were putting in new floor) and electrocuted itself on the heating coils so every time the heat turned on we smelled rotting, roasting hamster. It cost $500 to take the furnace apart and clean it. Good thing it wasn’t a beagle. That was enough pets in the house for me. Continue Reading »

If the “Health Freedom” movement has its way, everyone in the United States will be able to practice medicine. It may be quack medicine but that doesn’t seem to bother them. Short of that, chiropractors, naturopaths and acupuncturists are aiming to reinvent themselves primary care providers and even physicians. As David Gorski pointed out, this will reduce medical doctors to just another iteration of physician, the “allopathic” type, equal in stature to the chiropractic, naturopathic and acupuncture types. These “physicians” already call themselves “doctor” (e.g., “Doctor of Oriental Medicine”) and claim to graduate from four-year “doctoral” programs. This despite the fact that their schools operate outside the mainstream American university system and avoid some of the basics of typical graduate programs, such as entrance exams, as well as the extensive clinical training required for medical doctors.

Consumers are confused by all of this, and who wouldn’t be? In 2008 and 2010, surveys done for the American Medical Association by outside firms revealed that many patients did not know the qualifications of their healthcare provider. The comparisons were between allied health professions (e.g., audiologists and nurse practitioners) and medical doctors, but chiropractors were included. In 2008, 38 per cent of those surveyed (n=850) thought chiropractors were medical doctors, although that dropped to 31 per cent in 2010. Still, we are talking about roughly one-third of the survey participants.

The surveys also asked about the use of the term “physician” and confusion in advertising materials.
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A great deal of science is funded by the US government. The total research funding for 2009 was 54.8 billion dollars (much more if you include all R&D). A breakdown by agency of total R&D shows that the NIH (National Institutes for Health) funding is 28.5 billion while the NSF (National Science Foundation) is 4.1 billion.

There is general agreement that this expenditure is an investment on critical intellectual infrastructure for our nation and is vital to our competitiveness and standard of living. The government certainly has the right, and in fact the duty, to ensure that this money is well-invested. Government oversight is therefore understandable. Inevitably, however, politics is likely to intrude.

Representative Lamar Smith has been developing legislation that would in effect replace the peer-review process by which grants are currently given with a congressional process. Rather than having relevant scientists and experts decide on the merits of proposed research Smith would have politicians decide. It is difficult to imagine a more intrusive and disastrous process for public science funding.

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In his first book, On Being Certain: Believing You Are Right Even When You’re Wrong, neurologist Robert Burton showed that our certainty that we are right has nothing to do with how right we are. He explained how brain mechanisms can make us feel even more confident about false beliefs than about true ones. Now, in a new book, A Skeptic’s Guide to the Mind: What Neuroscience Can and Cannot Tell Us About Ourselves, he investigates the larger question of how a brain creates a mind. There is no alternative to the scientific method for studying the physical world, but Burton thinks there are essential limitations to science’s ability to investigate conundrums like consciousness and free will. Brain scientists fall into error because:

…our brains possess involuntary mechanisms that make unbiased thought impossible yet create the illusion that we are rational creatures capable of fully understanding the mind created by these same mechanisms.

He has a bone to pick with neuroscientists. They are discovering fascinating information, but their interpretations often go beyond what the data can really tell us. They often draw questionable conclusions from imaging studies that could have other explanations. Continue Reading »

Sometimes blogging topics arise from the strangest places. It’s true. For instance, although references to how tobacco causes cancer and the decades long denialist campaign by tobacco companies are not infrequently referenced in my blogging (particularly from supporters of highly dubious studies alleging a link between cell phone radiation and cancer and the ham-handed misuse of the analogy by antivaccinationists, who seem to think that vaccine companies engage in deceit on a scale similar to the deceptive practices of tobacco companies in “denying” that vaccines cause autism and all the other conditions, diseases, and horrors their fevered imaginations attribute to them), I’ve never really delved particularly deeply into one of the most useful repositories of documents on the topic that exists, namely the UCSF Legacy Tobacco Documents Library. Actually, the reason I started poking around there is not due to tobacco science, but because a fellow blogger mentioned to me that there were some articles and documents about Stanislaw Burzynski there dating back to the late 1970s. My curiosity was piqued.

As I explored, however, I learned that the documents there were not so much about Stanislaw Burzynski per se. In fact, they were more about the state of the underground “alternative cancer cures” industry in the late 1970s, which interested me greatly. The reason is that, when it comes to having delved so deeply into cancer quackery, I’m a relative newbie. Compared to, for example, Wally Sampson, Stephen Barrett, Peter Moran, or even Kimball Atwood, I’m inexperienced, having only noticed this phenomenon in a big way in the Usenet newsgroup misc.health.alternative back around 2001 or so, give or take a year. As a result, I don’t have the shared historical perspective that they do, mainly because I can only learn about that era from reading, studying, and talking to people who were active then. After all, in the late 1970s I was still in high school, and in the 1980s I was in college and medical school. There was no Internet (at least none that I had access to and that contained the wealth of easily accessible information to which we have become accustomed). In any case, in high school I had other interests, and throughout the 1980s I was too focused on getting an education and training to be a surgeon and researcher, a process that extended into the late 1990s. (Yes, it takes that long sometimes, particularly if you are masochistic enough to want to get a PhD, complete a general surgery residency, and do a fellowship in surgical oncology.)
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A concept that has been well-recognized in pediatric medicine, at least since it was first described in 1964, is that of vulnerable child syndrome (VCS). Classically VCS occurs when a currently healthy child is felt to be at increased risk for behavioral, developmental, or medical problems by a primary caregiver, usually a parent, and typically follows a serious illness. It can lead to some pretty serious behavioral complications in the parent, and subsequently the child, and severely impact entire families.

In the past, I have mistakenly thought of this entity more as “sick child syndrome” but that is problematic. It implies that it only occurs in the aftermath of true illness or injury. As I will explain in detail, there is much more to the development of VCS and it is the concern of VCS in children without true medical problems that led me to amend my understanding and make the connection with alternative medicine.

Is VCS Really a Problem?

Every parent (well, most parents – I’ve seen some things), worries about the well-being of their children. The desire to protect our personal genetic repositories is hardwired. And as with many behaviors, there is a point where parental worry becomes pathologic and interferes with normal functioning. In the case of VCS, the relationship between the parent and child can be severely impacted and the consequences can be disastrous.

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When you pick up a bottle of supplements, should you trust what the label says?  While there is the perception that supplements are effective and inherently safe, there are good reasons to be skeptical. Few supplements are backed by good evidence that show they work as claimed. The risks of supplements are often not well understood. And importantly, the entire process of manufacturing, distributing, and marketing supplements is subject to a completely different set of rules than for drugs.  These products may sit on pharmacy shelves, side-by-side with bottles of Tylenol, but they are held to significantly lower safety and efficacy standards. So while the number of products for sale has grown dramatically, so has the challenge to identify supplements that are truly safe and effective. Continue Reading »

Changing behavior is difficult. It is also an increasing priority for health care. We have entered a period of history when lifestyle choices have a dominant impact on health and longevity. People are no longer dying young of incurable infectious diseases in significant numbers. Rather they are surviving long enough to die from their bad habits.

Further, health behaviors are having a huge impact on the overall cost of health care. So the motivation is greater than ever to impact public health by influencing behavior. Yet, we are not very good at doing this.

It’s not that we’re not trying – it’s simply that having a large influence on people’s day-to-day behavior is remarkably difficult. There is ongoing research looking at how to effectively change behavior at the individual and public level, but it is complex, often conflicting, and new techniques at best yield only marginal gains.

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