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The Media and “CAM”

Recently I have been generally critical of how mainstream media deals with scientific topics. Science is often complex and requires hard work and diligence on the part of a journalist to get the story right. In recent years mainstream news outlets have been downsizing or eliminating their science journalists and tasking general reporters and editors to handle science stories.

Meanwhile, as science progresses it grows more complex and challenging to distill for a lay audience. At the same time there are growing pseudoscientific institutions and social forces making it even more difficult to sort out the reliable from the nonsense. This is especially true, in my opinion, when it comes to medical reporting of controversial treatments and claims.

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Posted in: Science and Medicine, Science and the Media

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Mercury Must Be Bad – If Not in Vaccines, In Teeth

Those of us who are baby boomers or older can remember playing with mercury when we were young. The thermometer broke, and you pushed the little globules around. Or you fooled around with the stuff in science class. My husband says he used to get mercury to flow over the surface of a dime and make it look really shiny. Who knew our old playmate would turn out to be such a bugaboo?

The real dangers of mercury have been recognized. Guidelines have been published to limit exposure. Instructions for safe cleanup of mercury spills are available online. This is good. Other developments are not so good. Scaremongers have demonized mercury and blamed it for everything from autism to Alzheimer’s.

Just when you thought the mercury/autism scare was finally subsiding, another mercury scare has resurfaced. The alarm has been raised (again!) about the mercury in amalgam fillings. (more…)

Posted in: Dentistry, Health Fraud, Politics and Regulation, Science and the Media

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Jenny McCarthy, Jim Carrey, and “Green Our Vaccines”: Anti-vaccine, not “pro-safe vaccine”

Jenny McCarthy & Jim Carrey at Green Our Vaccines

Last week, there was a rally in Washington, D.C. How many people actually attended the rally is uncertain. The organizers themselves claim that 8,500 people attended, while more objective estimates from people not associated with the march put the number at probably less than 1,000. Of course, such wide variations in estimates for the attendance at such events are not uncommon. For my purposes it is irrelevant whether 500 or 8,000 attended because even if the lowest estimate is closer to the true number this march represented the largest march on Washington ever for this particular cause, the previous largest having occurred three years ago.

Fortunately for public health interests, the organizers’ timing was very bad (for them, at least) in that they marched last Wednesday, the very day after Barack Obama clinched the Democratic nomination. The media were rife with coverage of the history-making nomination of the first African-American as a nominee of a major party, as well as speculation about when and whether Hillary Clinton would concede and endorse Obama. Drowning out most other news, Obama’s nomination led to almost nonexistent news coverage of the rally, aside from a handful of television appearances by one of its celebrity organizers. Its relative lack of success notwithstanding, however, all who support science- and evidence-based medicine should nonetheless remain concerned about this rally, because it was a dagger aimed at the heart of the most effective public health innovation ever conceived by the human mind, an intervention that has arguably saved more lives over the course of human history than every other medical intervention combined. That this dagger turned out to be a toothpick is fortunate indeed but by no means a reason to dismiss the movement that spawned it as irrelevant.

I’m referring, of course, to the antivaccinationist movement, and the rally was known as the “Green Our Vaccines” rally, led by the celebrity couple Jenny McCarthy and Jim Carrey and organized and funded by Talk About Curing Autism (TACA), Generation Rescue (upon whose board McCarthy now sits), and a panoply of other groups that promulgate the myth that either vaccines containing mercury in the form of their thimerosal preservative or vaccines themselves cause autism.
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Posted in: Neuroscience/Mental Health, Politics and Regulation, Public Health, Science and the Media, Vaccines

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The Weekly Waluation of the Weasel Words of Woo #7

What Talent!

I, like Joe, am utterly humbled by the translations of the entry in the W^5/2 #6! Namidim (twice), Stu (m’man!), Michelle B (using the Now-Venerated, Awesome Power of Simple Substitution that had Suddenly Swept Stu to SuperStar Status lo! These many W^5/2s ago!), and Michael X (it’s Larry’s turn to cry!) each nailed that passage lacka split hawg through the Penetrating Power of Poignant Parody©.

Therefore:

I thought it wouldn’t happen for a while, if ever, and I tremble as I write this, but…I have no choice but to confer the legendary, coveted, Soaring Standard of Stu® upon each of the four prodigal W^5/2 scholars named above! My hat is also off to homeboy David Gorski, who followed that passage with a Perfectly Pertinent Post-post Posting©, demonstrating such uncanny, spontaneous timing and recall that he must be Duly Acknowledged as one of the Baddest Bosses of the Blogosphere®. (more…)

Posted in: Humor, Science and the Media

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Touched by a Touched Healing Toucher

Recent posts by Drs. Sampson and Hansen and some recent comments have got me to thinking for the umpteenth time about this issue: quackery is quackery, even if it seems harmless and even if some people seek it. This is the first of a series that will discuss it. I’m afraid I will ramble a bit; it may be that not every post will support that premise. Nevertheless, in the aggregate I’ll try to do exactly that.

The posts about Healing Touch sent me on a walk down memory lane, to one of my early forays into “CAM” skepticism. It was there that I discovered just how removed from reality some true believers, even those that project a superficial air of sobriety, can be. Here I’ll recount a brief exchange that I had with one such person, who was undoubtedly well-meaning. My attempts to influence her by the use of reason proved futile.

Shortly after the publication of the famous Emily Rosa article in 1998, I read a report about it in Newsday. It wasn’t all that bad, but my annoyance with mainstream publications giving the slightest credence to “alternative medicine” had been growing, and this moved me to act. I wrote a diatribe to Newsday that was not published (I can’t imagine why):

To the Editor:

“Therapeutic touch” is such obvious humbug that it never should have been taken seriously by anyone with the slightest aquaintance with how things work. Nevertheless, academic careers have been based on it, hundreds of useless papers have been written about it, courses in it have been given and even required of nursing students, grant money has been provided for it (but not used to test it!), and scores of ridiculous magazine and newspaper articles have praised it, apparently to a naive and credulous public. All of this constitutes a huge embarrassment to nurses, a fact that would appear to be lost on their largest professional organization (the ANA).

One of the statements in your article about the JAMA study was incorrect: the practitioners were not able to detect the energy field half of the time. They were able to guess the correct hand half the time, as would be predicted by chance alone. Thus there is no evidence that the “energy field” was detected at all. This is no surprise, because this kind of “energy field” exists only in the fantasies of true believers.

Dolores Krieger’s objection to the study, that the right practitioners were not tested, is disingenuous. She has been asked numerous times, by James Randi and others, to submit to testing of the same sort as described in Rosa’s study (Randi’s foundation has even offered a $1 million reward for anyone who can demonstrate the ability to detect the “energy field”!). Neither she nor any of her trainees or colleagues has come forward, nor has any of them published a single study supporting the efficacy of “therapeutic touch.”

Among the shamelessly fawning, uncritical articles on TT referred to above is one in Newsday by Tina Morales, 7/8/96. Really, now. There are very simple, basic skills useful for evaluating questionable claims. If the writer doesn’t have them the editor certainly should!

Before gentle readers admonish me for the scolding, schoolmarmish tone of that letter, let me assure them that I have long since learned to couch my objections to “woo” in more matter-of-fact, less provocative language. As frustrating as it may be, amiable, well-meaning, intelligent people who haven’t the slightest idea how to evaluate questionable claims vastly outnumber their more savvy counterparts, even in surprising fields: journalism and medicine, for example. Ten years ago I had no intention of becoming more than a temporary, annoying gadfly. I imagined that the “CAM” fad would soon blow over, and that I’d go back to spending my free time watching re-runs of Seinfeld and Law and Order. Alas, ’twas not to be. Patience.

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Posted in: Energy Medicine, Faith Healing & Spirituality, Health Fraud

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Connections

I have a friend who’s an artist and he’s some times taken a view which I don’t agree with very well. He’ll hold up a flower and say, “look how beautiful it is,” and I’ll agree, I think. And he says, “you see, I as an artist can see how beautiful this is, but you as a scientist, oh, take this all apart and it becomes a dull thing.” And I think he’s kind of nutty.First of all, the beauty that he sees is available to other people and to me, too, I believe, although I might not be quite as refined aesthetically as he is. But I can appreciate the beauty of a flower.

At the same time, I see much more about the flower that he sees. I could imagine the cells in there, the complicated actions inside which also have a beauty. I mean, it’s not just beauty at this dimension of one centimeter: there is also beauty at a smaller dimension, the inner structure…also the processes.

The fact that the colors in the flower are evolved in order to attract insects to pollinate it is interesting – it means that insects can see the color.

It adds a question – does this aesthetic sense also exist in the lower forms that are…why is it aesthetic, all kinds of interesting questions which a science knowledge only adds to the excitement and mystery and the awe of a flower.

It only adds. I don’t understand how it subtracts.

Taken from Richard Feynman:  What Do You Care What Other People Think?

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Posted in: Science and Medicine

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Stem Cell Therapy and the Need for Transparency

Dr. Geeta Shroff is an Indian physician who is running a New Delhi clinic offering embryonic stem cell therapies for a large number of various medical conditions. The only thing these medical conditions have in common is that they are incurable. Indian law allows for the use of unproven treatments for terminal or incurable diseases. I cannot know Dr. Shroff’s intentions, but she has rejected the ethics and standards of science-based medicine and in so doing has transformed herself into a dangerous charlatan.

Embryonic Stem Cell Therapy

Embryonic Stem Cells (ESC) are controversial because of the ethical and moral consideration regarding harvesting ESC and the rights of an embryo. But that is not what makes Dr. Shroff’s treatments controversial, and not what I am going to write about here. The question, rather, is the state of the science of ESC therapy.

ESC’s are scientifically interesting because they have the potential to turn into any type of cell in the body. The hope for ESC therapy is that they can be used to replace dead or abnormal tissue in the body, something which is not now possible for many conditions. (Organ and bone marrow transplants are among the current treatments to replace failing tissue.) For example, an injured spinal cord might be repaired by using ESC’s to replace the damaged motor neurons and reestablish a connection between the brain and muscles. Atrophied muscles themselves can be repaired by having ESC’s turn into working muscle cells.

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Posted in: Clinical Trials, Medical Ethics, Science and Medicine, Science and the Media

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Diagnostic Dilemmas

Sometimes diagnosis is straightforward. If a woman has missed several periods and has a big belly with a fetal heartbeat, it’s pretty easy to diagnose pregnancy. But most of the time diagnosis is much more difficult. Alzheimer’s can’t be diagnosed for sure until the patient dies and you do an autopsy. If only we had one of those Star Trek gadgets to point at our patients and give us a quick and accurate answer! Alas! We are far from perfect. All too often, we really have no idea what’s causing a patient’s symptoms. We do a complete workup and still don’t know. What then?

We all know people who have symptoms that a series of doctors have failed to diagnose, who continue to doctor-shop, hoping to find that one doctor somewhere who will find something the others have missed. Occasionally they do; but far more often these people spend a great deal of time and money chasing a will-o’-the-wisp. Sometimes as they are searching, the illness gradually runs its course and goes away. When this happens, whatever they tried last gets the undeserved credit for the “cure.” Sometimes the symptoms persist and these searches consume their life, encourage unhealthy self-absorption, and permanently ensconce them in the “sick” role.

One of the attractions of alternative medicine is that it offers far more certainty than scientific medicine. If your scientific doctor can’t see anything on x-rays, your chiropractor can. He’ll tell you he knows exactly what’s wrong: a subluxation that he can fix. Sherry Rogers will tell you all illness is due to toxins accumulating in your cells and you must “detoxify or die.” Hulda Clark will tell you it’s all parasites that she can eliminate with her magic zapper. Robert Young says the cause of all disease is acidosis. They all have confident, precise answers. Wrong ones.

The One Cause of All Disease?

It’s really easy to figure out what’s causing a patient’s symptoms if you believe there is one simple cause for all disease. While I was writing this I got sidetracked and searched the Internet for “the one cause of all disease.” I found a lot of them, including: (more…)

Posted in: Diagnostic tests & procedures, Science and Medicine

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Early detection of cancer, part 2: Breast cancer and MRI

Note: If you haven’t already, you should read PART 1 of this two-part series. It defines several terms that I will be using in this post, and I don’t plan on explaining them again, given that they were explained in detail in Part 1. Of course, if you’re a medical professional and already know what lead time bias, length bias, and stage migration are, then it goes without saying that you should still read Part 1 for its scintillating prose.

ResearchBlogging.orgWhen last I left this topic three weeks ago, I had discussed why detecting cancer at ever-earlier stages and ever-smaller sizes is not necessarily an unalloyed good. At that time, I discussed in detail a landmark commentary in the New England Journal of Medicine entitled, Advances in Diagnostic Imaging and Overestimations of Disease Prevalence and the Benefits of Therapy. The article, although nearly 15 years old, rings just as true today in its cautioning doctors about whether ever-increasing diagnostic sensitivity that imaging technology and new blood tests were (and are) providing was actually helping patients as much as we thought it was. Before we dive into this problem as applied to breast cancer, let’s review what Drs. Black and Welch had to say about screening tests for breast cancer 15 years ago, as way of background and linking my last post and this one:

Before the widespread use of mammography, most breast cancers were discovered on physical examination, as palpable lumps. In one of the few studies to assess directly the accuracy of physical examination in screening for breast cancer, only 27 percent of tumors more than 1.0 cm in diameter and 10 percent of those less than 1.0 cm in diameter were detected by physical examination. However, the mean size of breast cancers detected by state-of-the-art screening mammography is about 1.0 cm, and many of the cancers detected as microcalcifications are only a few millimeters in size.

Again, prevalence depends on the degree of scrutiny. According to the Connecticut Tumor Registry, clinically apparent breast cancer afflicts about 1 percent of all women between the ages of 40 and 50 years. In a recent medicolegal autopsy study, however, small foci of breast cancer were found in 39 percent of women in this age group. Most cancers were in the form of ductal carcinoma in situ. Furthermore, over 45 percent of the women with cancer had two or more lesions, and over 40 percent had bilateral lesions. Although it has been argued that such small in situ lesions are not detected by and are therefore irrelevant to screening mammography, about half the lesions in that study were detected, usually as microcalcifications, on postmortem plain-film radiography of the resected breasts. Because of continual technical improvements and increasingly broad criteria for the interpretation of mammograms, the detection threshold for breast cancer has fallen considerably since the time of the Breast Cancer Screening Project of the Health Insurance Plan of Greater New York (1963 to 1975). This can explain the increased prevalence of cancer on mammographic screening, from 2.717 to 7.614 per 1000 examinations (with the incidence increasing from 1.517 to 3.214 per 1000 examinations). The lower detection threshold can also explain the increase in the percentage of carcinomas in situ (stage 0) among all mammographically detected cancers — from 12.7 percent to over 30 percent. The principal indication for biopsy has changed from suspicious mass to suspicious microcalcifications. This can explain why the reported incidence of breast cancer has increased and why most of the increase is in smaller lesions, particularly ductal carcinoma in situ.

About a year ago, three major articles hit the medical press that made me start thinking about this more than I had in the past. It’s my job, after all, because breast cancer surgery is a large part of my practice, and I do breast cancer lab-based research. What also tweaked me not to put off doing part 2 of this series is that, just two days ago, there was an abstract presented at the American Society of Clinical Oncology Meeting (where I still am today) that also serves to highlight just how difficult this question of integrating a test as sensitive as MRI into a screening regimen for and preoperative evaluation of breast cancer is and how MRI should fit into in this regimen can be.
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Posted in: Clinical Trials, Public Health, Science and Medicine, Science and the Media, Surgical Procedures

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The TACT is at least as Bad as We Predicted

I had wanted to follow Dr. Sampson’s discussion of “Healing Touch” with one of my own, because I had an interesting experience with one of its proponents years ago, and I’ll do that soon. I had also wanted to begin a series of posts about acupuncture, which I’ll also do eventually. Just yesterday, however, Liz Woeckner, co-author of our recently published critique of the NIH Trial to Assess Chelation Therapy (TACT), made a startling discovery: the TACT “Portal” website, intended for investigators and others associated with the trial and previously password protected, is now available to anyone: http://www.chelationwatch.org/s/tact/index.html It is a goldmine of information and I’ve barely begun to look at it, but so far it verifies much of what we’ve written and more. For example, the latest version of the Consent Form is dated 2006 and includes this statement under “risks”:

EDTA, or ethylenediamine tetraacetate is in the chelation solution. It is approved for use by the FDA as a treatment for lead poisoning but not for coronary artery disease.

Yet three Investigator Brochures, dating back to 2003, contain this language:

Edetate disodium USP should not be confused with its calcium salt (calcium edetate), which is used to treat lead toxicity.

We had called attention, in our article, to TACT literature repeatedly conflating Na2EDTA and the safer CaNaEDTA. Now we have reason to believe that this has been done cynically, with eyes wide open.

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Posted in: Clinical Trials, Medical Ethics, Politics and Regulation, Science and Medicine

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