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Counterfeit Drugs: A Growing Global Health Crisis

A resistant strain of bacteria –created by partially effective counterfeit antibiotics – doesn’t need a VISA and passport to get to the U.S.

-    Paul Orhii, National Agency for Food and Drug Administration and Control, Nigeria

I attended a conference in DC yesterday called, “The Global Impact of Fake Medicine.” Although I had initially wondered if homeopathy and the supplement industry would be the subjects of discussion, I quickly realized that there was another world of medical fraud that I hadn’t previously considered: counterfeit pharmaceuticals.

Just as designer goods have low-cost knock-offs, so too do pharmaceuticals and medical devices. Unfortunately, counterfeit medical products are a higher risk proposition – perhaps causing the death of hundreds of thousands of people worldwide each year.

It is difficult to quantify the international morbidity and mortality toll of counterfeit drugs – there have been no comprehensive global studies to determine the prevalence and collateral damage of the problem.  But I found these data points of interest (they were in the slide decks presented at the conference):
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Posted in: Pharmaceuticals, Politics and Regulation, Public Health

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Science is hard, and best left to professionals (the same may be said for journalism)

It might seem a bit undemocratic, but science, like medicine or dentistry, is a profession. One doesn’t become a scientist by fiat but by education and training. I am not a scientist. I apply science. My colleague Dr. Gorski is a scientist (as well as physician). He understands in a way that I never will the practical process of science—funding, experimental design, statistics. While I can read and understand scientific studies in my field, I cannot design and run them (but I probably could in a limited way with some additional training). Even reading and understanding journal articles is difficult, and actually takes training (which can be terribly boring, but I sometimes teach it anyway).

So when I read a newspaper article about science or medicine, I usually end up disappointed—sometimes with the science, and sometimes with the reporting. A recent newspaper article made me weep for both. Local newspapers serve an important role in covering news in smaller communities, and are often jumping off points for young, talented journalists. Or sometimes, not so much.

The article was in the Darien (CT) Times. The headline reads, in part, “surveys refute national Lyme disease findings.” Epidemiologic studies, such as surveys, are very tricky. They require a firm grounding in statistics, among other things. You must know what kind of question to ask, how many people to ask, how to choose these people, etc, etc, etc. So what institution conducted this groundbreaking survey on Lyme disease?
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Posted in: Science and Medicine, Science and the Media

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Connecticut Legislature Intrudes on Debate Over Chronic Lyme Disease

The tick borne spirochete infection known as Lyme disease was named after Lyme, CT – a part of the country where the disease remains endemic. It is therefore especially poignant that the Connecticut state senate unanimously passed Public Act No. 09-128: AN ACT CONCERNING THE USE OF LONG-TERM ANTIBIOTICS FOR THE TREATMENT OF LYME DISEASE.The bill had previously passed the state House, also unanimously.

This is a terrible bill that is both anti-science and anti-consumer protection. How it passed both houses without dissent reflects exactly why such micro-management decisions should not be made by politicians.  It is the result of lobbying by a narrow interest group and does not reflect either the state of the science on Lyme disease nor the proper role of regulation to ensure standards of care within medicine.

This is also not an isolated case. There is already a similar law in Rhode Island, and there have been similar bills proposed in Pennsylvania, Massachusetts, and New York, and a bill in Maryland that would compel insurance companies to pay for antibiotic treatment for chronic Lyme disease CLD.   This is part of a coordinated effort by individuals and organizations who hold an ideological opinion regarding the cause and treatment of CLD. They wish to use the political process to win a victory for their view that they have been unable to win in the arena of science (sound familiar).

The bill now awaits Governor Rell’s signature, which given the heavy political support for this bill seems almost certain.

This bill represents much which is wrong with the state of science and medicine in the US.

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Posted in: Politics and Regulation, Science and Medicine

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What is disease? Diabetes, diagnosis, and real science

ResearchBlogging.orgOne of the concepts we often discuss around here is “what is disease?” As we’ve seen in the discussion of Lyme disease and so-called Morgellons syndrome, this is not always an easy question to answer. Knowing what states are disease states does not always yield a black-or-white answer. The first step is usually to define what a disease is. The next problem is to decide who in fact has that disease. The first question is hard enough, especially in disease states that we don’t understand too well. The second question can be equally tricky. To explore the scientific and philosophical issues of diagnosing an illness we will use as a model diabetes mellitus (DM). This won’t be quite as boring as you think, so don’t click away yet. (Most of the information here refers more specifically to type II diabetes, but most of it is valid for type I as well.) (more…)

Posted in: Science and Medicine

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Vaccines and Autism: A Deadly Manufactroversy

I was recently asked to write about vaccines and autism for Skeptic magazine. I approached the project with trepidation. So much has been written, from Paul Offit’s book Autism’s False Prophets to a veritable flood of blogorrhea on the Internet. I didn’t have anything new to add, and I couldn’t hope to cover all aspects of the subject.

After some thought, I realized I could contribute something useful. I could organize the highlights into a concise and accessible story. While it awaits publication in the magazine, Michael Shermer elected to pre-publish it in the e-Skeptic newsletter. You can read it here.

Posted in: Vaccines

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Animal acupuncture

Periodically, one sees newspaper articles extolling the virtues of acupuncture for animals. To those familiar with the practice of acupuncture, the tag lines are nauseatingly familiar, e.g., acupuncture has been around for thousands of years, it works to stimulate the animal’s natural energies, etc., etc. Ditto the testimonials; Fluffy wasn’t helped by anything else; now, after a few months of treatment (and plenty of time), Fluffy is running around happily. Some may even take such testimony further, asserting, for example, with some rather tortured logic, that since acupuncture “works” in animals, and animals aren’t thought to be susceptible to placebo effects, then acupuncture must therefore work in people.

In fact, other than testimonials, there’s really no good evidence that acupuncture does work in animals. In fact, acupuncture isn’t much practiced in veterinary medicine – a distinct (but very vocal) minority of veterinarians may practice it. In fact, the most recent review on the management of canine arthritis concluded, “There was weak or no evidence in support of the use of” various modalities, including electrostimulated acupuncture and gold wire acupuncture,”1 and a recent study of electroacupuncture for postoperative pain after back surgery in dogs concluded that there was “equivocal evidence” for an effect, even though there was no difference in analgesics used between treatment and control groups.2
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Posted in: Acupuncture, Veterinary medicine

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Applying evolutionary principles to cancer treatment

ResearchBlogging.orgEDITOR’S NOTE: Unfortunately, this weekend, I was forced to get my slides together for the upcoming SBM Conference, plus editing a manuscript for resubmission, plus working on a manuscript that I should have submitted six months ago, plus reading over some grants, plus…well, you get the idea. What this means is that, alas, I didn’t have any time to prepare one of the new, long posts that you’ve come to love (or hate). Fortunately, there are a lot of other things I’ve written out there that can be rapidly adapted to SBM. For instance, what I am about to present now. Since I wrote this, I’ve thought of a couple of things that I should have said the first time (and was kicking myself for not having done so); so publishing an updated version here allows me to rectify those omissions.

A couple of weeks ago, there was a lot of hype about a study that hadn’t been released yet. Indeed, there was a story in Wired entitled To Survive Cancer, Live With It and an editorial by the study’s lead author in Nature entitled A change in strategy in the war on cancer. Not bad for a study that hadn’t been released yet. Intrepid medical and science blogger that I am, I waited until the actual study was published a week ago the June 1 episode of Cancer Research. It’s a clever study, but the hype over it was a bit overblown. For example:

For all the weapons deployed in the war on cancer, from chemicals to radiation to nanotechnology, the underlying strategy has remained the same: Detect and destroy, with no compromise given to the killer. But Robert Gatenby wants to strike a peace.

A mathematical oncologist at the Moffitt Cancer Center, Gatenby is part of a new generation of researchers who conceive of cancer as a dynamic, evolutionary system. According to his models, trying to wipe cancer out altogether actually makes it stronger by helping drug-resistant cells flourish. Rather than fighting cancer by trying to eradicate its every last cell, he suggests doctors might fare better by intentionally keeping tumors in a long-term stalemate.

Maybe I’m being a bit picky, but what annoys me about the news reports on this study is that the concept of turning cancer into a manageable chronic disease like diabetes or hypertension is not by any means a new idea. Remember, one of my major research interests is the inhibition of tumor angiogenesis. Consequently, I know that the late, great Judah Folkman first proposed the concept of using antiangiogenic therapy to turn cancer into a chronic disease at least as early as the mid-1990′s. The only difference is the strategy that he proposed. The idea had also been floating around for quite a while before that, although I honestly do not know who first came up with it.

But let’s see what Dr. Gatenby proposes. What makes it interesting is that his study actually looks at how scientists have applied evolutionary principles to cancer until recently, argues that we’ve been doing it wrong. He then proposes a way to use the evolutionary dynamics of applied ecology. He may well be on to something. First, here’s the problem:
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Posted in: Basic Science, Cancer, Science and Medicine

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“The Oprah-fication of Medicine” in The Toronto Star

I’d just like to take a moment to engage in a little bit of shameless self-promotion and point out that an SBM post has actually seen print. Specifically, my post about the malign influence Oprah Winfrey’s promotion of dubious medical practices on her show (The Oprah-fication of Medicine) has been adapted (with heavy cutting and editing) into an op-ed piece in The Toronto Star, entitled Is Oprah Winfrey Giving Us Bad Medicine?

No one was more shocked than I was when the editor of Sunday Insight section of The Toronto Star contacted me earlier this week to ask if he could adapt my post to a newspaper editorial. Actually, he and his editors did the vast majority of the work in whittling my usual logorrheic prose down to a manageable size and paraphrasing the sections of the NEWSWEEK article on Oprah that I had quoted liberally from. (After all, I didn’t want to be accused of plagiarism.) It was a rather educational experience, actually. Unfortunately, reading the finished version again, I don’t think it quite makes the link between Oprah and the infiltration of pseudoscientific CAM practices into modern medicine as clear as the original post, perhaps because the context of all the other blog posts on the topic by SBM bloggers is missing, which is why I hope that some Star readers will find their way here and be able to read the full length version.

In any case, compare:

The Oprah-fication of medicine (the original, full-length blog post)

Versus:

Is Oprah Winfrey Giving Us Bad Medicine? (the heavily edited op-ed piece)

And see what you think.

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

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Herd Immunity

Some infections can be eradicated from the face of the planet. Smallpox is the one example of disease eradication to date. Smallpox still exists in US and Russian labs, but there has been no wild cases since 1977.  It is, like the Dorothy, history.

Why were we able to eradicate smallpox?  Three reasons:

1) There is only one form of smallpox. Unlike influenza that changes from year to year.  So only one vaccine needed.
2) By what appears to be a once in a universe miracle, every county cooperated with  the WHO (much like we all cooperate with the IRS) so the entire planet received the vaccine. Once enough people were vaccinated, the disease was unable to perpetuate itself and spread and so died out.
3) Unlike bacteria, there are no asymptomatic smallpox carrier states.  Eradicable viruses usually cause symptomatic disease and do not result in asymptomatic, infectious carrier states that serve as a reservoir for infecting others.  HIV and Herpes cause chronic asymptomatic infections and will probably never be eradicated.

There are other diseases that are theoretically eradicable, like measles and polio. They have one antigenic type, have no carrier state and, if the entire world could be vaccinated, the disease would cease to exist in the wild.  I am sure there would be biologic weapons labs that would always carry a vial or 2 of every infection. Just to be safe.
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Posted in: Public Health, Science and Medicine, Vaccines

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Will The Real, Silent Majority Please Stand Up – To Oprah and Jenny McCarthy?

Much to my surprise and delight, my recent blog post about Jenny McCarthy’s  “educational” video was picked up by several other blogs and websites, resulting in a small flood of emails applauding my efforts to expose dangerous pseudoscience. I had braced myself for what I assumed would be an onslaught of hate mail (what else would irrational folks do about a sensible warning message?) and found that instead I received a small number of high-fives from advocates and health organizations committed to cutting through the rhetoric and providing accurate information about vaccines. Perhaps the hate is still in the mail?

I began wondering who is in the majority on the issue of vaccines – those who want to study concerns carefully and accept what the science shows, or those who are fixated on blaming vaccines for diseases they don’t cause, despite all evidence to the contrary.

Since the latter are louder than the former, one does tend to feel as if the world has gone a bit nutty. And when celebrities like Oprah Winfrey promote the unfounded anti-vaccine rhetoric of Jenny McCarthy, sensible parents across the country begin to shudder. But when will this shuddering lead to action?
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Posted in: Science and the Media, Vaccines

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