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More Nonsense from Dr. Jay Gordon

Dr. Jay Gordon is a pediatrician to a particular subculture of pseudoscientific celebrities, such as Jenny McCarthy. He lends his MD cred to this community. He also appears, in my opinion, to be a shameless self-promoter – one of those pop professionals (Dr. Oz, Dr. Phil) who has sold his soul for some easy celebrity.

Regardless of his motivations, he has been spouting arrogant nonsense about vaccines for years, essentially arguing that his clinical gut feeling and anecdotal experience trump the actual science. This is exactly the wrong approach to science-based medicine.

In a recent open letter on his website, he adds to the anti-vax chorus advising not to get the H1N1 (swine flu) vaccine. It’s almost as if this crowd wants to maximize the morbidity and suffering from this somewhat preventable disease. I know this is not literally true, but their ideologically motivated and confused actions will have the same effect.

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Posted in: Public Health, Vaccines

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CFS: Viral vs somatization

On 10/08/09, the NIH and Science through press releases announced the following remarkable information:  Consortium of Researchers Discover Retroviral Link to Chronic Fatigue Syndrome (CFS.) From Science on line:

Scientists have discovered a potential retroviral link to chronic fatigue syndrome, known as CFS, a debilitating disease that affects millions of people in the United States. Researchers from the Whittemore Peterson Institute (WPI), located at the University of Nevada, Reno, the National Cancer Institute (NCI), part of the National Institutes of Health, and the Cleveland Clinic, report this finding online Oct. 8, 2009, issue of Science.

“We now have evidence that a retrovirus named XMRV is frequently present in the blood of patients with CFS. This discovery could be a major step in the discovery of vital treatment options for millions of patients,” said Judy Mikovits, Ph.D., director of research for WPI and leader of the team that discovered this association. Researchers cautioned however, that this finding shows there is an association between XMRV and CFS but does not prove that XMRV causes CFS.

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Posted in: History, Medical Academia, Neuroscience/Mental Health, Science and Medicine

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H1N1 Update

I know we have been focusing on the vaccine issue extensively, but this is crunch time and the anti-vaccine forces are relentless. We are now facing a regular seasonal flu spiked with the H1N1 pandemic. Our best weapon against morbidity and mortality caused by the flu is information, and yet the public is being barraged with misinformation designed to encourage poor choices and thereby result in maximal morbidity and mortality.

I confess I was never impressed with FDR’s famous quip, “All we have to fear is fear itself,” – I think there is plenty else to fear. But his sentiment is very appropriate to the current situation – fear mongering around the seasonal flu and H1N1 vaccines is what we have most to fear.

And of course, as is almost always the case, accurate information is complex and requires a nuanced understanding. This creates uncertainty, which is easy to exploit to manufacture unreasonable fear.

The anti-vaccine fear mongers are playing every card in the deck. They are arguing (falsely) that H1N1 is not severe enough to warrant getting the vaccine, that the vaccine does not work anyway, and that there are unacceptable or unknown risks to the vaccine. In the most extreme cases, bizarre conspiracy theories are brought to bear, but I will not discuss these here as anyone compelled by such fantasies is likely beyond the reach of any information I could provide.

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Posted in: Public Health, Vaccines

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Science-based medicine and Eurocentrism

A reader sent me an interesting post from her own blog. It’s well-written, compelling, and betrays an exceptional intelligence. It’s also completely wrong.

The piece is called, “Bias, Racism, and Alternative Medicine”, an intriguing title. The first part tries to establish that “Western medicine” in one of many ways of understanding health and disease. She starts with some personal anecdotes—always interesting, rarely generalizable:

While receiving Western biomedical treatment for ADD, the side effects of my therapy convinced me that western medication alone would not provide a solution to my problems.

One of the author’s fundamental misunderstandings is that the failure of a particular treatment to make her feel better does not invalidate all of medical science, and more important, it does not validate “other ways of thinking”. Still, I can understand how this happens. Personal experience is powerful; unfortunately, it is also misleading. I like this writer. She seems very kind. She goes on to describe her enlightenment further, but this is where a pleasant anecdote goes terribly wrong: (more…)

Posted in: Science and Medicine

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Resveratrol: Of Mice and Men

We would all like to live longer. The most promising longevity research indicates that severe calorie restriction might extend life span, but such a diet is difficult to follow. Resveratrol, a phytochemical found in red wine, has been evaluated as a possible way out of the dilemma. When given to obese mice on a high calorie diet, it produced a number of changes associated with improved health, such as increased insulin sensitivity, and it increased survival. Perhaps by taking resveratrol you could eat as much as you want and get fat without suffering the usual consequences. Perhaps you could get the longevity benefits of severe calorie restriction without restricting calories.

In addition to fat mice, resveratrol also extends the life of Saccharomyces cerevisiae, Caenorhabditis elegans and Drosophila melanogaster (yeast, nematodes, and fruit flies). But a study in non-obese mice found no increase in survival (although it did find several signs of improved health). Besides the anti-aging claims, there is also some evidence from in vitro and animal studies that it might have cardiovascular effects and anti-cancer effects. (more…)

Posted in: Herbs & Supplements

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Medicine is hard and should be practiced with caution

It’s tempting to think that the practice of medicine should be simple and intuitive.  Unlike other sciences, we all have access to the basic materials—ourselves.  We feel that because we are intimately familiar with our bodies, we know a lot about how they work.  Unfortunately, it’s a little more complicated than that.  The biochemical processes walking around in this sack of meat are pretty complicated.  Learning these processes is important, but in medicine, it’s not enough.  If we have a hypothesis that some change in biochemistry will affect some disease, we must test this in groups of real people in well-designed clinical trials.  Or, we can use the Huffington Post method and  just make it all up.

The latest abomination is an article on diabetes, by Kathy Freston.  Bad information on diabetes is particularly dangerous.  The longer diabetes goes untreated, the higher the likelihood of complications.  When reading medical writing it’s important to evaluate the source.  The author of this article wrote a book called, The Quantum Wellness Cleanse which pretty much says it all. But is it really fair to judge someone on a crappy book title?

Well, yes, but more important is the crappy interview she conducts with Dr. Neal Barnard.  I have no way of knowing with absolute certainty whether Barnard is as dangerous a fool as he sounds, but I suspect so.  He and Freston promulgate a dangerously over-simplified view of diabetes.   (more…)

Posted in: Science and Medicine

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The Science Fiction of Nutritional Genomics

EDITOR’S NOTE: Dr. Gorski is currently in Chicago attending the American College of Surgeons Clinical Congress. As a result, he has not prepared a post for this week (although he doesn’t feel too guilty about missing this week, given that he did write two rather hefty posts last week, one on the cancer quackery known as the German New Medicine and the other on a rather dubious monkey study being promoted by the anti-vaccine movement). Fortunately, we have Ben Kavoussi to fill in with a post on some of the more exaggerated claims of advocates of nutritional interventions for various diseases and conditions. Enjoy!

A centipede was happy quite,
Until a frog in fun
Said, “Pray, which leg comes after which?”
This raised her mind to such a pitch,
She lay distracted in the ditch
Considering how to run.

Anonymous

Just like complementary and alternative medicine (CAM), nutritionism — meaning the unexamined assumption that food is only a conveyor of the substances it contains 1,2 — has evolved independently of science and medicine since the 1970s, and has caused so much wondering and confusion about food and diet that many Americans have become unable to eat properly. Today, there isn’t a popular magazine that doesn’t have a “health and nutrition” section that — often with the backing of very little science — promises many health benefits of a nutrient or warns against the harms of another; and then provides a list of foods that contain it. The same publication might time and again write the exact opposite, further adding to the already-prevalent nutritional confusion. Nutritionism is thus an ideology sourced by popular beliefs, academic reveries, and the food and dietary supplements industry, where food is simply seen as a mean to achieve a specific health goal. In its latest form, however, coupled with genomics and biomedical informatics, and called “nutrigenomics” or “nutritional genomics,” nutritionism takes academic reveries to such an extent that it could be accurately described as “science fiction.” The Center of Excellence for Nutritional Genomics at UC Davis writes indeed (in bold) on its website that:

“The promise of nutritional genomics is personalized medicine and health based upon an understanding of our nutritional needs, nutritional and health status, and our genotype. Nutrigenomics will also have impacts on society — from medicine to agricultural and dietary practices to social and public policies — and its applications are likely to exceed that of even the human genome project. Chronic diseases (and some types of cancer) may be preventable, or at least delayed, by balanced, sensible diets. Knowledge gained from comparing diet/gene interactions in different populations may provide information needed to address the larger problem of global malnutrition and disease.”

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Posted in: Herbs & Supplements, Nutrition

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Flu Vaccine Efficacy

I guess I will be spending the rest the flu season writing about the nonsense that is promulgated about the flu vaccine and the disease. One of the more common laments about the flu vaccine is that it doesn’t work:  I got the flu vaccine and still got the flu. Well maybe. Maybe not.  It takes a few weeks to get protection, so the flu could have developed before the antibody response to the vaccine.  The vaccine does not protect to the numerous other viral infections that circulate each winter, so perhaps you had an adenovirus but thought it was the flu. Then there is the evidence.  Some readers of the blog are worried that the literature does not support the use of the vaccine.

“My research for  good studies on the efficasy (sic) of seasonal flu vaccines so far has left me wondering if I’ve somehow missed the good research. Tom Jefferson of the Cochrane Institute says that Most studies are of poor methodological quality and the impact of confounders is high. I agree.  Please would you refer me to some of the best studies on the efficasy (sic) of seasonal flu vaccines.  After a critical appraisal of the best studies you know of I’d like to submit the same for publication in the interest of science.”

Why some readers think I am a research librarian, I do not know. It is not an uncommon request. As an aside,   I have a full time job and a family to raise.  Don’t be asking me to do your grunt work. It’s called Pubmed. Use it.

But the topic for this post concerns the efficacy of the flu vaccine. I am limiting myself to the use of the vaccine in adults.
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Posted in: Science and Medicine, Vaccines

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David & Goliath: A Dramatic Role Reversal Spurred On By The Media

The Internet is teeming with false health claims and a long line of celebrities willing to throw their media weight behind every new flavor of snake oil. The irony is that alternative medicine proponents see themselves as a persecuted minority – the victims of some nebulous health industry conspiracy. But in reality, they have ingratiated themselves with the media to such an extent that they may in fact have the upper hand.

Pseudoscience has become Goliath, and physicians have never faced a more pernicious foe. With patients’ lives hanging in the balance, some of us are waging the war for hearts and minds with gumption, zeal, and a little help from a brave minority of media who have finally woken up and realized that alternative medicine is not as soft and cuddly as they once thought.

Take for example those who wrongly believe that vaccines cause autism. Many of them subject their children to unproven and harmful therapies, diets, and regimens – some of which are tantamount to child abuse. Consider the cases described most recently by David Gorski here. One child underwent repeated IV chelation therapy for years followed by the invasive injection of “stem cells” into her cerebrospinal fluid. (more…)

Posted in: Science and the Media

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Monkey business in autism research, part II

Over the last couple of months, I’ve noticed something about the anti-vaccine movement. Specifically, I’ve noticed that the mavens of pseudoscience that make up the movement seem to have turned their sights with a vengeance on the Hepatitis B vaccine. The reason for this new tactic, I believe, is fairly obvious. The fact that the Hep B vaccine is administered shortly after birth seems somehow to enrage the anti-vaccine movement more than just about any other vaccine. Moreover, given that, aside from maternal-child transmission when the mother is infected, hepatitis B is usually only contracted through either bloodborne contact (the sharing of needles, the administration of contaminated blood) or sexual activity, it’s very easy for anti-vaccinationists to make a superficially plausible-sounding argument that it’s not a necessary vaccine, even though there are reasonable rationales for giving it to infants. The image of sticking a needle into a newborn infant trumps that, though, at least for the anti-vaccine movement. Another possibility, suggested by Steve Novella just yesterday, is that, with the collapse under a overwhelmingly huge pile of evidence of the idea that the mercury-containing preservative thimerosal that used to be used in childhood vaccines until 2001, caused an “epidemic” of autism and the failure of the “too many too soon” slogan to convince anyone who is not already an anti-vaccinationist, the movement needed a new bogeyman to blame for autism. The hepatitis B vaccine, which was added to the pediatric vaccination schedule in the 1990s, around the right time to confuse correlation with causation when it comes to the increase in autism diagnoses (just like thimerosal) was a perfect next target, given that it’s administered shortly after birth.

Indeed, just the other day, the anti-vaccine crank groups the National Vaccine Information Center (NVIC), Talk About Curing Autism (TACA), and the anti-vaccine crank blog Age of Autism posted a call for the elimination of hepatitis B vaccination for newborns:

Washington, DC – National Vaccine Information Center and Talk About Curing Autism are calling on President Obama to order the immediate suspension of the Centers for Disease Control and Prevention recommendation of the birth dose of the Hepatitis B vaccine after two recent studies linking the Hepatitis B vaccine to functional brain damage in U.S. male newborns and infant primates.  In a related development today, the United States Department of Health and Human Services, including the Health Resources and Services Administration and Centers for Disease Control and Prevention,  announced that 1 in every 91 children are now diagnosed with an autism spectrum disorder as reported in the November 2009 issue of Pediatrics. Previous data released by the CDC indicated a prevalence of 1 in every 150 children affected by the disorder.

Note how AoA not-so-subtly interposed the latest information about autism prevalence with its call to eliminate the birth dose of the hepatitis B vaccine. Very clever. By doing so, it linked the two in readers’ minds, as if one had something to do with the other. There’s no good scientific evidence that the hepatitis B vaccine has anything to do with the “autism epidemic.” Meanwhile, David Kirby is up to his usual nonsense, and the resident anti-vaccine propagandist at CBS News, Sharyl Attkisson, who has been known to feed Age of Autism information on at least one occasion in the past, served up this credulous, noncritical interview with Andrew Wakefield:

The quantity of misinformation in that single six minute video is far beyond the scope of this article. Were I to start dissecting it, I would not have time to do what the purpose of this article was intended to do: To deal with the study Wakefield is hawking. That’s why I leave the dissection of this pièce de résistance of disingenuousness and misinformation as an exercise for SBM readers–after reading the rest of this post, of course. Trust me, it will help you.

At the heart of this latest propaganda onslaught by the anti-vaccine movement are two studies, one a restrospective study in humans and the other a study in monkeys, both of which the anti-vaccine movement is promoting as slam dunk evidence that the hepatitis B vaccine is causing all sorts of horrific problems. Taking both of them on in one post is too much, even for my logorrheic tendencies. So I’ll deal first with Wakefield’s monkey study and then, either later this week or sometime next week, hopefully discuss the human study.
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Posted in: Public Health, Science and Medicine, Science and the Media, Vaccines

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