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The Reality of Ancient Wisdom: Acupuncture and TCM Weren’t So Great

Thirty years in Moukden

Thirty years in Moukden

A mythology has grown up around traditional Chinese medicine (TCM). The ancient wisdom of the inscrutable Orient supposedly helped patients in ways that modern science-based medicine fails to understand or appreciate. A typical claim found on the Internet: “The ancient beliefs and practice of traditional Chinese medicine have been healing people for thousands of years.”

As Steven Novella has said, “TCM is a pre-scientific superstitious view of biology and illness, similar to the humoral theory of Galen, or the notions of any pre-scientific culture”. TCM really hasn’t been doing a creditable job of healing people for thousands of years. A book that was brought to my attention by one of our readers (thank you!) provides a unique insight into what Chinese medicine was really like circa 1900. I wish everyone who believes in ancient Chinese medical wisdom would read the chapter on Chinese medicine in this book. It provides a much-needed reality check. (more…)

Posted in: Acupuncture, History, Traditional Chinese Medicine

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One more time: No, wearing a bra does not cause breast cancer

A red bra

EDITOR NOTE: THERE IS AN ADDENDUM, ADDED SEPTEMBER 10.

Besides being a researcher and prolific blogger, I still maintain a practice in breast cancer surgery. It’s one of the more satisfying specialties in oncology because, in the vast majority of cases I treat, I can actually remove the cancer and “cure” the patient. (I use the quotes because we generally don’t like to use that term, given that some forms of breast cancer can recur ten or more years later, but in many cases the term still fits, albeit not as well as we would like.) Granted, I get a little (actually a lot of) help from my friends, so to speak, the multimodality treatment of breast cancer involving surgical oncology, radiation oncology, and medical oncology, but breast cancer that can be cured will be primarily cured with surgery, with chemotherapy, hormonal therapy, and radiation therapy working mostly to decrease the risk of recurrence, either local in the breast or distant elsewhere in the body. Through this multimodality approach, breast cancer mortality has actually been decreasing over the last couple of decades.

However, as a breast cancer surgeon, I not infrequently have to deal with many of the common myths that have sprung up around breast cancer. Some are promoted by quacks; others are just myths that sound plausible but aren’t true. (That’s why they persist as myths.) One such myth has been in the news lately, in particular last week; so I thought now was a good time to take a look as any. Besides, I spent most of the weekend out of town visiting my wife’s family, and I didn’t have a lot of time for this post. So this week sticking to something I know well makes sense and inspired me to make like Harriet Hall and Steve Novella and keep my post to a reasonable length for a change. There’s also so much less mucking about on PubMed and Google that way to make sure I’m not missing something, too.
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Posted in: Cancer, Epidemiology

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Ebola SCAMs

ebola-virus

Click to embiggen. Transmission electron micrograph of an Ebola viral particle, by Dr. Frederick Murphy (1976), from the Centers for Disease Control and Prevention’s Public Health Image Library (PHIL), with ID #1833.

Ebola, like all diseases, is an opportunity for some to offer up curious treatments. Here is a brief budget of Ebola-related SCAM (supplements, complementary and alternative medicine) and a few Dug the Dog digressions.

Homeopathy

Reality seems valueless by comparison with the dreams of fevered imaginations; reality is therefore abandoned. ~ Emile Durkheim. Homeopath?

In its classic form, as promulgated by Hahnemann, homeopathy is divorced from the modern understanding of medical and chemical reality. I can cut Hahnemann a little slack since he came up with his fictions at the end of the 18th century. But I would think that even a modest understanding of chemistry and physiology would suggest that homeopathy is 100% pure bunkum. But homeopaths are nothing if not inventive. Since Hahnemann’s time they have come up with a remarkable number of variations on their nonsense. The motto “you are only limited by your imagination” must have had homeopaths in mind and they have fevered imaginations. Who knows what they could invent if they only had a box. There are nosodes, the homeopaths answer to vaccines. Of course, it is an answer that would be wrong on any reality-based exam. Nosodes are the vaccines of the homeopathic world, only without efficacy. I have written about nosodes in the past.

[A nosode] is a homeopathic remedy prepared from a pathological specimen. The specimen is taken from a diseased animal or person and may consist of saliva, pus, urine, blood, or diseased tissue.

and they are usually diluted to between 30 and 300 C. (more…)

Posted in: Energy Medicine, Homeopathy, Science and Medicine

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Chiropractic “pediatrics” firmly in the anti-vaccination camp

chiropractice-baby

Chiropractor “adjusting” an infant.

Who would you invite to speak at your conference if you wanted to show the world you are firmly in the anti-vaccination camp? Barbara Loe Fisher, head of the National Vaccine (Mis) Information Center (NVIC)? How about Andrew Wakefield, the thoroughly disgraced British physician who, having been stripped of his medical license, continues his despicable anti-vaccination campaign? How about both?

The International Chiropractic Pediatric Association sprang for both. Fisher and Wakefield will be keynote speakers at the ICPA’s upcoming conference, “Celebrating the Shift to Conscious Choice.” The conference offers the mutually exclusive opportunities of participating “in the discussion of the latest evidence-based holistic research” while at the same time exploring “the vitalistic perspectives of conception, pregnancy and birth through family wellness.” I hate to be the bearer of bad news, but you can embrace evidence-based research or you can embrace vitalism, but not both at the same time. There will also be an opportunity for the requisite bashing of “conventional” medicine.

It’s hard to decide who’s slumming whom here. On the one hand, the ICPA is a small group (3,000 members). They are straight, subluxation-based chiropractors and they don’t need convincing that vaccination is “bad.” Fisher and Wakefield will be preaching to the choir. Wakefield, with his medical education and training, is most certainly aware that their subluxation-based “theory” is nonsense and they are incompetent to diagnose and treat pediatric patients. And this is a far cry from Fisher’s former gigs as an advisor to the government.

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Posted in: Chiropractic, Obstetrics & gynecology, Science and the Media, Vaccines

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CAM and Headaches

Acupuncture needling

A recent editorial entitled “CAM in the Real World: You May Practice Evidence-Based Medicine, But Your Patients Don’t” published in Headache: The Journal of Head and Face Pain by Robert Cowan, a headache specialist, addresses the use of complementary and alternative medicine (CAM) in the treatment of headaches. Unfortunately he propagates many common misconceptions about CAM in the article.

I do agree with one point – physicians need to be more aware of CAM treatments and their patients’ use of them. We should be directly asking our patients about such use, in a non-judgmental way, and we should be familiar enough with common CAM treatments so that we can provide knowledgeable guidance to our patients.

Cowan begins by, in my opinion, grossly exaggerating the current popularity of CAM. He writes:

As much as 82% of headache sufferers use complementary and alternative approaches.

The reference he cites, however, states:

Adults with migraines/severe headaches used CAM more frequently than those without (49.5% vs 33.9%, P < .0001); differences persisted after adjustment (adjusted odds ratio = 1.29, 95% confidence interval [1.15, 1.45]). Mind–body therapies (eg, deep breathing exercises, meditation, yoga) were used most commonly.

Only 4.5% of adults with migraines/severe headaches reported using CAM to specifically treat their migraines/severe headaches.

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Posted in: Neuroscience/Mental Health, Science and Medicine

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The Unpersuadables

The Unpersuadables

The Unpersuadables

We would like to believe people are rational. We would like to believe that if they have formed a false belief based on inaccurate information and poor reasoning, they will change that belief when they are provided with accurate information and better reasoning. We are frequently disappointed.

An example of what should happen

I recently talked with a college professor who believed chiropractic treatment could lower blood pressure. His belief was based on a media report of a chiropractic study. He thought it was plausible that neck manipulation could somehow relieve obstructions to blood flow to the base of the brain, thereby somehow correcting the cause of high blood pressure. I told him that rationale was anatomically and physiologically implausible. I pointed out that the researchers used NUCCA, a form of manipulation that is rejected by most chiropractors. He did not know what NUCCA was. I provided him with information, including links to the study itself and to chiropractor Sam Homola’s excellent critique of the study. My friend changed his mind and thanked me for educating him.

An example of what all too often happens

I was invited to give the “con” side of a pro/con presentation on dowsing to a local discussion group. I lent my opponent my copy of Vogt and Hyman’s classic book Water Witching USA so he would know ahead of time what I was going to say. He read it. The book explains how the ideomotor effect creates the illusion that the dowsing rod moves of its own accord and explains that dowsers have never been able to pass controlled scientific tests. I said as much in my “con” presentation. His “pro” presentation consisted of two arguments: he had personally seen dowsing work, and lots of people believed in it. He didn’t even try to rebut my facts and arguments; he simply refused to engage with them in any way. It was as if he had not read the book and had not heard anything I said. Afterwards, one of the audience was heard to say she would have liked to hear more about how dowsing worked and less about how it didn’t work!

Will Storr investigates

Sadly, some people are unpersuadable. They might as well be saying “My mind’s made up; don’t confuse me with the facts.” We have seen plenty of glaring examples in the comments section of this blog. Will Storr wrote a book The Unpersuadables: Adventures with the Enemies of Science about his struggle to understand the phenomenon. He did a great job of investigative reporting, interviewing people with strange beliefs, spending time with them and also with their critics, and reading pertinent research. (more…)

Posted in: Book & movie reviews, Critical Thinking

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The “CDC whistleblower saga”: Updates, backlash, and (I hope) a wrap-up

Vaccinefear

Given that this is a holiday weekend here in the US and that I’m having a bit of a staycation right now, I had thought of simply not posting today or of rerunning a “classic” (if you want to call it that) blast from the past. But the topic I wrote about last week has only festered and grown bigger since Monday; so at the very least I felt obligated to do a post updating you, our readers, on the twists and turns that have occurred in the saga of the so-called “CDC whistleblower.” For those of you familiar with the story (not to mention following my not-so-secret other blog), much of this will be familiar, but, given that this is SBM, I felt that this material should be on record here for your edification and (hopefully) education. I’ll take (more or less) a chronological approach since last Monday and then finish up by trying to put this whole mess into perspective. This is going to be longer than even my usual posts, but I want to be authoritative. So, if you’re very familiar with what’s happened, you might want to skim everything before the “backlash” and “conclusion” sections to fill in what you might have missed. If you’re less than completely steeped in what happened, read every scintillating word!

But first, for those who might be entering this saga right now, let me recap a moment. I’m referring to a conspiracy theory, which has been flogged to death by the antivaccine movement for nearly two weeks now, that there is a CDC whistleblower who has made “devastating” reports that the CDC hid data that showed a 3.4-fold increased risk of autism in African American males, based on an incompetent “reanalysis” of a 10 year old CDC study that found no evidence that children with autism were more likely to have received their first MMR vaccine earlier than neurotypical controls. As I (and others) have discussed, Hooker used howlingly bad statistical methodology (for instance, analyzing case control data as a cohort study and using risibly bad statistical analyses) to torture the data until they confess that vaccines cause autism. As I said at the time, when it comes to data, call Hooker the Spanish Inquisition. Such was the weakness of what he found that, even after forcing the data to sit in the comfy chair for extended periods of time, the most damning “confession” he could get from them was a correlation between age at MMR vaccination and autism diagnoses in one small subgroup: African American males.

Based on this utterly incompetent data torture and Hooker’s apparent budding relationship with a “CDC whistleblower,” Wakefield first made a video in which this “whistleblower’s” voice was electronically altered (not to mention edited into such selective snippets that it was impossible to glean any context from his seemingly-damning statements. This video, released through Andrew Wakefield’s and Tommy Polley’s Autism Media Channel, despicably likened this CDC “cover-up” to the Tuskegee syphilis study, and finished with a flourish of Godwin-y nonsense that included Adolf Hitler (of course!), Pol Pot, and Josef Stalin, implying that the CDC’s “crimes” with respect to this alleged cover-up were just as bad. It was a breathtaking demonstration of pure stupid hyperbole. Then, a few days later, Wakefield replaced the video with the alterations in the “whistleblower’s” voice with his real voice and revealed his real name: William W. Thompson, PhD, a psychologist and senior scientist at the CDC, as well as a co-author of the study being “reanalyzed,” DeStefano et al. Now, on to the update! (more…)

Posted in: Science and the Media, Vaccines

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A Touch to Fear: Chiropractic and the Newborn Baby

A significant part of my job as a pediatric hospitalist involves caring for newborns. It is arguably the best thing that I get to do as a physician, even if I do at times prefer the increased intellectual stimulation of the ill hospitalized child. While seeing newborns, I am almost always surrounded by happy and appreciative parents, grandparents and whoever else is invited to meet and greet the new arrival because the babies are almost always healthy. In fact, and not that I really care (sniff, sniff), the parents of newborns are with rare exception the only caregivers that ever thank me at discharge.

Unfortunately, sometimes I am called upon to assist babies that are having difficulty transitioning into the outside world for a variety of reasons. These reasons can range from the fairly minor and transient to the catastrophic. And despite our advances in the understanding of neonatal pathophysiology and in medical technology, there remain newborn infants that cannot be saved or who have severe lifelong deficits caused by their illness or injury. This will likely always be the case, especially if unqualified professionals continue to involve themselves in either the delivery or the care of babies.

Over the course of 11 years of practice, and after having seen thousands of both perfectly healthy and severely ill newborns, I have acquired a skill set which allows for the recognition of a baby in trouble and the ability to respond appropriately. All pediatricians and family doctors strive to develop this, particularly if they see patients in the newborn nursery, although I imagine none, including myself, would claim to have perfected this “art”. Newborn medicine can be very challenging for many reasons, not the least of which is the significant overlap of the presenting signs and symptoms of many serious conditions, with even normal baby behavior sometimes mimicking potentially life-threatening pathology. (more…)

Posted in: Science and Medicine

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Naturopathy vs. Science: Facts edition

Lalalala

This is another post in the naturopathy versus science series, where a naturopath’s advice is assessed against the scientific literature.

When you think medicine, your first thought may be “physician”. But the practice of medicine today is a collaboration, as few health professionals, even physicians, can deliver health care completely independently. As a pharmacist I’ve worked closely with physicians, nurses, and other health professionals my entire career. Collaboration starts early, and the setting is usually the teaching or academic hospital, which is always crawling with students, interns, and residents from all professions. Teamwork and trust are essential. In order for different professions to work effectively together, there has to be a common foundation. For medicine, that foundation is science. From basic science principles through a common understanding of fields like biochemistry and physiology, health professionals all work from the same basic understanding about how the body works and what the principles of medicine actually are. If I give a recommendation to a physician or a nurse, I’m basing that assessment on an evidence base that we both rely on. It’s not “pharmacist evidence” versus “physician evidence”, it’s “medical evidence”. This is reality-based healthcare. (more…)

Posted in: Science and Medicine

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Bad Science Journals

A peer reviewer

It’s an excellent business model. The only real infrastructure you need is a website, and you can have a custom site made for $5-10 thousand. Then you just have the monthly bandwidth charges. The rest is just e-marketing, which can be done for free, or the cost of some e-mails lists. After that, the money just comes rolling in.

The best part is that other people do all the actual work. All you have to do is charge them for publishing on your open-access online journal.

What you are selling is essentially scientific/academic fraud.

Unfortunately, this is a good business model, even though it is a terrible scientific model, and so it has proliferated. We may be living in the heyday of dubious open-access scientific journals.

The open-access format itself is not a bad one, and there are some very successful and respected open-access journals, such as the PLOS journals. The idea is that, instead of charging a subscription in order to gain access to published articles (in print or online), the articles are open-access, but authors pay a fee to have their work published.

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Posted in: Science and Medicine

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