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Trick or Treatment

I’ve just finished reading Trick or Treatment: The Undeniable Facts about Alternative Medicine by Simon Singh and Edzard Ernst. I’d been looking forward to the publication of this book, and it exceeded my expectations.

Edzard Ernst, based at the University of Exeter in England, is the world’s first professor of complementary medicine, a post he has held for 15 years. An MD and a PhD, he also embraced alternative medicine and used to practice homeopathy. He has done extensive research and published widely. His stated objective is “to apply the principles of evidence-based medicine to the field of complementary medicine such that those treatments which demonstrably do generate more good than harm become part of conventional medicine and those which fail to meet this criterion become obsolete.” His most important accomplishment has been to “demonstrate that complementary medicine can be scientifically investigated which, in turn, brought about a change in attitude both in the way the medical establishment looks upon complementary medicine and in the way complementary medicine looks upon scientific investigation.”

Simon Singh is a science writer with a PhD in particle physics. As a team, he and Ernst are uniquely qualified to ferret out the truth about alternative medicine and explain it to the public. (more…)

Posted in: Book & movie reviews

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Threats to science-based medicine: When clinical trials for new drugs are designed by the marketing division

ResearchBlogging.orgTHREATS TO SCIENCE-BASED MEDICINE

The theme of this blog is science-based medicine. It’s even the name given the blog by our fearless leader, Steve Novella. By “science-based” medicine we generally mean medicine that is both grounded in scientific plausibility based on our best understanding of human physiology and disease as well as in strong evidence from well-designed clinical trials, both of which are extremely important We SBM bloggers tend to concentrate mainly on so-called “alternative,” “complementary and alternative,” or “integrative” medicine because it does indeed represent a major threat to the consensus among medical professionals that medicine should be science- and evidence-based. Moreover, the infiltration of pseudoscientific and antiscientific woo into medical schools, academic medical centers, and medicine at large, coupled with large amounts of money going to promote CAM, both from the government and wealthy private foundations, does represent an extremely worrisome trend that makes all of us, who range from mid-career to retired physicians, fear for the future generation of physicians and their ability to apply science and critical thinking to the evaluation of implausible health claims, such as reiki, homeopathy, applied kinesiology, and the large variety of woo that falls under the rubric of CAM. Worse, this trend began not long after a concerted push to make medicine more science- and evidence-based and less dogma- and authority-based.

Unfortunately, though, the antiscience of implausible health claims is not the only threat that science-based medicine faces. We bloggers here at Science-Based Medicine concentrate on it because its resurgence and infiltration into the very heart of academic medicine represent a sea change in the culture of scientific medicine, which once rightly and without reservation rejected much of what CAM represents as quackery. Also, I can’t speak for others, but pseudoscience interests me; it brings up questions of why people believe irrational and clearly false propositions. That being said, at the risk of ruffling a few feathers among my co-bloggers, I have observed that, if there is one thing that this blog has not to this point emphasized sufficiently, it’s that the commerce of medicine, the very manner in which we develop new therapies, can, if not carefully observed and regulated, represent a threat to science-based medicine even more potent than Andrew Weil, David Katz, and their all-out assault on the very foundations of scientific medicine and drive to return medicine to the days of anecdote-based rather than science-based medicine.

I’m talking about pharmaceutical companies. I’m also about to destroy any opportunity I might ever have to work for or receive any funding from Merck & Company. C’est la vie. A skeptical doc’s got to do what a skeptical doc’s got to do. Not that I won’t at least partially protect myself by adding the disclaimer that the following represents my opinion, and my opinion alone. It does not represent the opinion of my university, cancer institute, or partners.

Now that that’s taken care of, let’s start with a little primer on a pernicious phenomenon known as the “seeding trial.”
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Posted in: Clinical Trials, Medical Ethics, Pharmaceuticals, Politics and Regulation

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Thanks, Jenny McCarthy! Thanks for the measles!

27452983I would like to take this opportunity to echo my co-blogger Steve’s sentiment and thank Jenny McCarthy.

What? You say. Has Gorski completely lost his mind? (Or maybe you used another word besides “mind,” a perhaps not so savory word.) Not really. I just agree with Steve that accomplishment should be recognized, and there’s no doubt that in her year as the new celebrity spokesperson for the antivaccination movement, Jenny McCarthy has pulled off a major coup.

She’s helped reignite a movement that was until her entrance (and especially the entrance of her far more famous boyfriend Jim Carrey, who’s said some things just as breathtakingly dumb as Jenny has) more or less moribund, to the point where it’s now become so effective that measles is coming back far faster than I had thought possible. Between her tireless prosletyzing on Oprah Winfrey’s show that vaccines caused her son’s autism and that “biomedical” quackery can “cure it”; her organizing of a march on Washington, D.C. this summer to push an explicitly antivaccine agenda disguised under the deceptive and disingenuous (but brilliantly Orwellian) slogan “Green Our Vaccines“; her holding celebrity fundraisers (complete with Britney Spears, Hugh Hefner, and Charlie Sheen, yet!); and her fronting WWE events to raise money for Generation Rescue, she’s done it all in a little more than a year. And she’s not resting on her “laurels” (such as they are), either. This September, she will be publishing the followup to her previous book on “healing autism” (with quackery), Mother Warriors: A Nation of Parents Healing Autism Against All Odds. No doubt she will again appear with Oprah to fawning acclaim to make the unfounded assertion that vaccines injured her son to make him autistic and that her favored forms of quackery have successfully “healed him.”

In light of these “accomplishments,” it’s only right that we all give Jenny (and Jim) the “thanks” they deserves for their role in bringing the measles back to the U.S.
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Posted in: Neuroscience/Mental Health, Public Health, Science and the Media, Vaccines

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The New England Journal of Medicine Disappoints

On July 31 of this year, a collective groan could be heard emanating from critics of pseudomedicine. The causative factors (which is medical bombast for “the cause”) were two book reviews published in the usually staid New England Journal of Medicine (NEJM):

Integrative Oncology: Incorporating Complementary Medicine into Conventional Cancer Care

Edited by Lorenzo Cohen and Maurie Markman. 216 pp., illustrated. Totowa, NJ, Humana Press, 2008. $79.95. ISBN 978-1-58829-869-0.
Reviewed by Donald I. Abrams

Alternative Medicine? A History

By Roberta Bivins. 238 pp., illustrated. New York, Oxford University Press, 2008. $35. ISBN 978-0-19-921887-5.
Reviewed by Teresa L. Schraeder

The Wooification of Medical Journals

I’ll review the reviews, but first let’s consider why their presence in the NEJM is so disturbing. The NEJM is the most widely read and cited medical journal in the world. Among American journals, the top three are usually reckoned to be the NEJM, the Journal of the American Medical Association (JAMA) and, at least for internists, the Annals of Internal Medicine (Ann Int Med). The extent to which each journal has sacrificed its integrity for the promotion of the recent wave of pseudomedicine has varied among the three: the NEJM rarely and, for the most part, unwittingly; JAMA famously in 1998 and occasionally since; and the Ann Int Med repeatedly and embarrassingly, most notably with a series of puff pieces on “CAM” that spanned several years and violated the Annals’ own policies regarding funding disclosures by authors and editors.

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Posted in: Book & movie reviews, Cancer, Medical Academia

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Snipers – A Short Reflection

The blogosphere held no fascination for me before my involvement with sciencebasedmedicine.com. I had checked into a few blogs, and found some capturing attention, allowing exploration of ideas and personal views in greater scope than allowed for in scientific papers. But many seemed not to expand discussion after an original post.  When the blogger would describe some series of events or ideas, there would follow a series of pro and con short commentaries, whose authors seemed to enjoy sniping at irrelevant issues. The emotional level rose with each series of exchanges. One had to search for pages with comments that expanded knowledge, and were not just argumentative.Some commenters took off on small details in the original.. Then ensued a series of yes I did – no I didn‘t, you said – I said, you said – I meant, you‘re a blank – you’re a worse blank, and on, as readers know.

I wrote an article or two for an online ‘zine, and the format allowed for extended exchanges, like the blogs. Comments followed a similar pattern. They continued for 2 weeks. Same thing happened when I critiqued traditional Chinese medicine, implausible claims, ethics of “CAM” in editorials in an online journal. Questions there were screened by editors, but I filled more space  elaborating answers than I was allowed by the word limit to the original articles. I noted that even news items in online news sources were followed by series of comments, challenges, counterchallenges and on they went, often getting uncomfortably personal. Lost in some of this was the meat of the original article as small point after smaller point appeared.

All this is old stuff to most of you readers, but to me, it was new. And I wondered not only about the format and policies that allowed ongoing sniping, but had to look at my own reactions, often surging in the same direction of telling people off. I keep telling myself not to answer snipes, but the temptation sometimes wins. Too much chance to show cleverness and to enjoy that basic, innate joy of putting it to someone who wrote something that really ticked me off.
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Posted in: Basic Science, Science and Medicine

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Recognizing Dubious Health Devices

The public is often left to fend for themselves in the marketplace of medical devices and health aids. Current regulations in most countries are inadequate to prevent grossly misleading claims in advertising and to provide adequate evidence for safety and effectiveness for products on the market. So it is helpful for consumers to be aware of the red flags for dubious devices to watch out for.

I came across this ad for The Rebuilder, which purports to be a treatment for painful neuropathy.  About 2.4% of the population has some kind of peripheral nerve damage (neuropathy), which means there are about 7.2 million Americans with neuropathy. In most cases there is no cure (although there is effective treatment for some of the symptoms of neuropathy) so it is not surprising that neuropathy is a common target for questionable treatments and devices.

The ad is full of misleading or unsupported claims and blatant misinformation and provides an excellent example of the many features of quackery marketing to look out for.

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Posted in: Medical devices, Science and Medicine

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Peruvian Hamsters and Autism: Cui Bono?

Some people are very invested in the idea that thimerosal in vaccines causes autism. They have looked and looked, but have been unable to find enough credible evidence to convince the scientific community. Thimerosal was removed from US vaccines several years ago, and you might have thought that would end the debate. It didn’t. The spotlight has shifted to other countries that still use thimerosal-preserved vaccines, such as Peru.

Anti-vaccine activist David Kirby said,

If thimerosal is one day proven to be a contributing factor to autism, and if U.S. made vaccines containing the preservative are now being supplied the world over, the scope of this potential tragedy becomes unthinkable.

The anti-vaccine website Age of Autism accuses US policy of

[making]…Kirby’s nightmare suggestion a reality. U.S. vaccine manufacturers have continued to ship thimerosal containing vaccine formulations all over the world, in effect offering a defiant double standard of mercury risk for infants from rich countries as compared to poor countries. (more…)

Posted in: Neuroscience/Mental Health, Vaccines

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High dose vitamin C and cancer: Has Linus Pauling been vindicated?

ResearchBlogging.orgTHE ZOMBIE RISES AGAIN

Vitamin C as a treatment for cancer is back in the news again.

I’m not surprised. This is one therapy favored by advocates of “alternative” medicine that keeps popping up periodically (seemingly every couple of years or so). This latest bit of news has turned up almost right on time after the last time there was a push for rehabilitating vitamin C as a cancer cure a couple of years ago. Back in the spring of 2006, there were two studies published (more on them later) which were touted by the “complementary and alternative medicine” (CAM) crowd as evidence that Linus Pauling was supposedly vindicated. A little less than two weeks ago, an animal study was published suggesting that high-dose intravenous vitamin C had antitumor activity in mouse models. A couple of weeks prior, there had also been published a phase I clinical trial that showed that megadoses of IV ascorbate were safe and well-tolerated in cancer patients if they were appropriately screened for renal disease. Given the latest studies of this particular modality against cancer, it seemed like an opportune time for me to examine this new evidence and ask the question: Has Linus Pauling been vindicated?

I’ll cut to the chase. The short answer is: Not really, with the qualification that it depends on what you mean by “vindicated.” The long answer follows.
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Posted in: Basic Science, Cancer, Clinical Trials, Nutrition, Science and the Media

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Amanda Peet is My Hero(1)

“The graveyards are full of (unvaccinated) men.” Charles de Gaulle, modified by the author.

We live longer than anytime in history. Our long lives are due in large part to good nutrition, sanitation, and vaccines.

There have been numerous posts here and elsewhere about the vaccine deniers, primarily focused around the modern myth that vaccines cause autism.

That is not the topic of this post. Instead, I am going to take a brief tour of the childhood vaccines and review the morbidity and mortality caused by vaccine preventable diseases and the efficacy of the vaccines in preventing these diseases. With the brouhaha surrounding vaccines it is beneficial to step back and contemplate the death and misery that the vaccine preventable disease have caused and continue to cause.

In the interests of full disclosure, I am an Infectious Disease doctor. I make a living from treating diagnosing and treating infections. I don’t make dime one if people do not get infected, so I am against any and all vaccines as they cut into my bottom line (2).

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Posted in: Public Health, Science and the Media, Vaccines

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Pro-CAM Wikipedia – Skeptics Need Not Apply

The internet is arguably the ultimate expression of democracy and the free market. For the cost of internet access anyone can pull up a virtual soap box and preach to the world. There are no real gatekeepers, and the public can vote with their search entries, clicks, and links. Every point of view can be catered to and every special interest satisfied. Type in any obscure term or concept into Google and see how many hits you get (“banana farming” yielded 1,470,000 hits).

There is potentially a downside to this as well, however. Because there are websites fashioned for every opinion and perspective no one has to venture far out of their intellectual comfort zone. Virtual communities of like-minded individuals can gather and reinforce their prejudices, and to varying degrees keep out contrary opinions. This is harmless when dealing with aesthetic tastes, but can be stifling to intellectual discourse.

On the other hand defining the mission, scope, and character of a blog, website, or forum is necessary to some degree. Every site does not have to be a free-for-all. If biologists want a forum to politely discuss biological topics in a collegial fashion they have the right to create a virtual space in which to do that, and whoever owns and operates the site has the right to mandate whatever rules they wish. Allowing political activists to overrun the site and hijack the conversation would be counterproductive. Like most things a healthy balance probably works best.

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Posted in: Science and Medicine

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