In August of this year, a new policy statement from the American Academy of Pediatrics was published which tackled the widespread problem of insufficient sleep in our adolescent population. They even went so far as to label insufficient sleep as “one of the most common, important, and potentially remediable health risks in children.” The statement, which gave a number of recommendations on how to address the problem, made the news rounds primarily because of the call for schools to delay start times until at least 8:30 AM.
I wrote about pediatric sleep in March for a post on the potential link between some sleep disorders in children, specifically nightmares and night terrors, and the development of psychosis. Those claims are suspect but please read that post for a review of what sleep is, why we need it, and what can go wrong with it in children of all ages. For this post, my focus will be on adolescent sleep specifically, and on the role of delaying school start times in improving a variety of health parameters.
What are the common adolescent sleep challenges?
The typical modern teenager faces a variety of challenges to consistently obtaining a full nights sleep, which is considered by most sleep experts to be in the 8.5 to 9.5 hours per night range. This doesn’t mean that every teenager will fall apart if they only get 7 hours of sleep each night, but sub-optimal sleep can adversely affect school performance in many, and even lead to long-term health problems in some children who establish such a pattern during these pivotal years. Hold that thought for now, however.
One obvious reason for insufficient sleep in teenagers, at least it is likely obvious if you have one of your own or have ever spent more than two minutes near one, is technology. Most older children have electronic media in their rooms, if not attached to their bodies in the form of a smart phone. 24-7 access to the internet and social media is a commonly cited impediment to sleep onset. The increasing availability and popularity of energy drinks containing absurd amounts of caffeine among adolescents likely also plays a role as both a coping strategy for daytime fatigue resulting from insufficient sleep, and as a cause of it. In fact, I think I’ve just come up with the topic for my next post.
This is another post in the naturopathy versus science series, where a naturopath’s advice is assessed against the scientific literature.
It’s Naturopathic Medicine Week in the United States, so it’s time for another look at the alternative medicine practice that a friend of the blog likes to call the One Quackery to Rule them All. Naturopathy is an oddity among alternative medicine, because it’s a hodgepodge of other practices linked by an underlying belief in vitalism: the pre-scientific notion that living things have a “life force”. Vitalism disappeared from medicine when Wöhler synthesized urea in 1828, yet the belief in vitalism is a central tenet of naturopathic philosophy. Naturopaths liken themselves to be primary care providers akin to family physicians (general practitioners) but their practices are quite different: rather than make decisions based on scientific evidence, naturopaths pick and choose based on what they feel is congruent with their vitalistic philosophy, sometimes despite good scientific evidence that shows they are wrong. For example, homeopathy is an alternative medicine practice that is very popular with naturopaths. It is an elaborate placebo system where “remedies” contain no medicinal ingredients: they are literally sugar pills. There is no demonstrable medical effect from homeopathy, and so it isn’t part of science-based medicine. Yet homeopathy is a “core clinical science” for naturopaths, and the practice of homeopathy is part of their licensing exam.
One common feature of pseudoscience is that proponents of a specific belief tend to exaggerate its scope and implications over time. In the world of physics this can eventually lead to a so-called “theory of everything” – one unifying theory that explains wide-ranging phenomena and displaces many established theories.
In medicine this tendency to exaggerate leads in the direction of the panacea, the miracle cure for everything. Why does this happen?
There are numerous examples. Here is a video of Bruce McBurney trying to sell his Precious Metals Nano Water to investors in the Dragon’s Den. The product is nothing but distilled water with a tiny amount of silver. McBurney claims that this magic water will essentially cure everything, all bacterial and viral infections, and even cancer.
The panacea is also not the sole domain of the lone crank. Straight chiropractors essentially believe that adjusting the spine can cure everything from bed wetting to asthma, and yes, even cancer.
What factors predispose to the panacea claim?
Vaccination is arguably medicine’s greatest success. It has eradicated smallpox and has saved millions from death and suffering from a growing list of preventable diseases. It’s surprising that it has so many critics. Most of them are either not educated in medical science (like Jenny McCarthy) or are educated but prefer to reject science in favor of anecdotal experience (like Jay Gordon). Their arguments have been examined ad nauseum on this blog and elsewhere, and are easy to dismiss. But when I learned that an immunologist had written a book rejecting the whole idea of vaccination, I couldn’t dismiss it so easily. An expert in the field obviously knows more than I do about the relevant science; and if nothing else, she might have some valid criticisms of vaccines that I had overlooked. In 2012 Tetyana Obukhanych, PhD, published a short (53 page) book that is available in a Kindle edition: Vaccine Illusion: How Vaccination Compromises Our Natural Immunity and What We Can Do To Regain Our Health. I read the book hoping to learn something, and I did learn some things, but not anything that would make me question the current vaccine recommendations. I tried valiantly to understand her message; I think I succeeded. I’ll try to summarize what she is saying and explain why I think she got it wrong.
Four weeks ago, I wrote a post in which I explained why wearing a bra does not cause breast cancer. After I had finished the post, it occurred to me that I should have saved that post for now, given that October is Breast Cancer Awareness Month. The reason is that, like clockwork, pretty much every year around this time articles touting various myths about breast cancer will go viral, circulating on social media like Facebook, Twitter, Pinterest, and Tumblr like so many giant spider-microbes on the moon on Saturday. Sometimes, they’re new articles. Sometimes they’re old articles that, like the killer at the end of a slasher film, seem to have died but always come back for another attack, if not immediately, then when the next movie comes out.
So I thought that this October I should take at least a couple of them on, although I can’t guarantee that I’ll stick to the topic of breast cancer myths for the whole month. After all, our “atavistic oncology” crank (you remember him, don’t you?) is agitating in the comments and e-mailing his latest “challenge” to my dean, other universities, and me. It was almost enough for me to put this post on hold for a week and respond to our insistent little friend’s latest “evidence,” but for now I’ll just tell Dr. Frank Arguello, “Be very careful what you ask for. You might just get it.” Maybe next week. Or maybe on my not-so-super-secret other blog. Or maybe never. Because Dr. Arguello has officially begun to bore me.
In the meantime, I’m going to stick with the original plan, at least for now.
So, first up this week is a myth that I can’t believe that I haven’t covered in depth sometime during the nearly seven years of this blog’s existence, other than in passing a couple of times, even though it’s a topic that deserves its own post. I’m referring to the claim that antiperspirants cause breast cancer. I bet you’ve seen articles like this oldie but not so goodie from über-quack Joe Mercola entitled Are Aluminum-Containing Antiperspirants Contributing To Breast Cancer In Women? or this older and even moldier article from seven years ago entitled Why women should avoid using anti-perspirants that could cause breast cancer or this one from last year entitled Attention Deodorant Users: New Studies Link Aluminum To Breast Cancer. Surprisingly, I haven’t found that many from this year yet. (Maybe the Ebola scare is distracting the usual suspects and diverting their efforts.) The same ones, however, keep reappearing every year, and they’re all based on the same sorts of claims and the same studies. So let’s dig in, shall we?
I receive a monthly newsletter from my medical board. Among other issues discussed are the results of disciplinary actions for physicians. Occasionally a physician who has boundary issues is required to have a chaperone present when doing exams.
I was thinking that the concept of a chaperone could be more widely applicable. Consider “You Docs: Amazing acupuncture,” the latest from Drs Oz and Roizen. Both are Professors at their respective institutions. Professors. To judge from the ability to read and interpret the medical literature, both should not be allowed near a journal without a chaperone to remind them about cognitive biases, logical fallacies and what constitutes a good clinical study. Looking at their recent review of acupuncture suggests they lack an understanding of all three.
They start with the argument from antiquity, which is not only wrong as a logical fallacy, it is wrong historically when they say:
acupuncture has been a go-to therapy for 5,000 years.
Off by a factor of about 500. They are unaware that acupuncture as currently practiced is relatively new, having been a form of bloodletting until recently when the modern version with steel needlesbecame popular under Mao.
However, in the early 1930s a Chinese pediatrician by the name of Cheng Dan’an (承淡安, 1899-1957) proposed that needling therapy should be resurrected because its actions could potentially be explained by neurology. He therefore repositioned the points towards nerve pathways and away from blood vessels-where they were previously used for bloodletting.
They explain the mechanism of action as stimulating
points in the body that affect chi or qi, the life energy.
without noting that chi or qi is a fantasy. No life energy has ever been measured and virtually every point on the body is an acupoint in one of the multiplicity of styles that are acupunctures. Except, as mentioned in the past, the genitals.
Yahoo News appears to have confused NaturalNews with actual news. It’s not. NaturalNews is the in-house propaganda organ for Mike Adams, whom I’ll introduce in a minute (although he needs no introduction for most readers here). A couple of recent examples:
A recycled story, over a year old, from NaturalNews, appearing on Yahoo News last week. It starts out as a fairly straightforward report of the Japanese’s governments suspending its recommendation if favor of the HPV vaccine pending further research, although government health officials were still standing by the vaccine’s safety. Actually, Medscape reported that the actual rate was 12.8 serious adverse side effects reported per 1 million doses, a fact not revealed in the NaturalNews story. These effects were correlated with the vaccine; there is no evidence of causation.
After this rather tame start, NaturalNews cranks it up to 11 and beyond, as David Gorski would say. Governments which still recommend HPV vaccinations “remain under the thumb of Merck’s vaccinations spell” even though Merck is “an organization of murderers and thieves.” A scary list of adverse events are described as “side effects of Guardasil” even though causation has not been shown.
Two days ago there was an “ongoing debate”? There is no ongoing debate about “whether or not vaccines cause autism” because there never was any credible evidence that vaccines cause autism and there still isn’t.
In April 2013 President Obama announced the BRAIN initiative – Brain Research through Advancing Innovative Neurotechnologies, committing 100 million dollars to brain research. The goal of this initiative is to accomplish with the brain what the Human Genome Project accomplished with the human genome.
The BRAIN project came after a similar, and larger, initiative in Europe – the European Union’s Human Brain Project (HBP), which was given 1.3 billion dollars in funding. The HBP came under some controversy this summer when neuroscientists complained about how the money was being awarded.
The serious commitment to brain research on both sides of the Atlantic reflects the general recognition that the brain is an important and complex organ (arguably the most complex thing we know about in the universe) and there is tremendous opportunity to reap benefits from new research.
The comparison to the Human Genome Project is quite deliberate. The HGP is generally perceived to have been incredibly successful, the biological equivalent of announcing that we will send people to the moon by the end of the decade, then doing it.
Typical example of a Vitamin K supplement.
Science is complicated. Simple concepts that appear at first to be obviously true or untrue usually turn out to be more nuanced than we thought. Newtonian physics was taken as “the truth” until we learned in the 20th century that it didn’t apply on cosmological or subatomic scales. Medicine and human physiology are more complicated than most people realize or want to believe. A case in point is the recent realization that vitamin K is not a single chemical compound, but a whole family of them, and that vitamin K2 has unique properties that vitamin K1 lacks.
Recently, there has been some interesting preclinical research on K2 that warrants further study to tease out its implications for human health, diet, and supplementation. There has also been a lot of hype that warrants taking its claims not with a grain but with a large bolus of salt. According to Canadian naturopath Kate Rhéaume-Bleue, author of Vitamin K2 and the Calcium Paradox:
- It could save your life
- It is missing from the modern diet
- It is the most important anti-aging nutrient for fighting wrinkles, Alzheimer’s, heart disease, osteoporosis and more
- It promotes straight, cavity-free teeth
- It is needed to get the benefits from calcium and vitamin D supplements; without it, those nutrients will increase the risk of heart attack and stroke
- It is the only vitamin known to prevent and reverse atherosclerosis
The old adage is still true: if something sounds too good to be true, it probably is. There is only weak evidence behind these strong claims. (more…)
Quackery has been steadily infiltrating academic medicine for at least two decades now in the form of what was once called “complementary and alternative medicine” but is now more commonly referred to as “integrative medicine.” Of course, as I’ve written many times before, what “integrative medicine” really means is the “integration” of quackery with science- and evidence-based medicine, to the detriment of SBM. As my good bud Mark Crislip once put it, “integrating” cow pie with apple pie does not improve the apple pie. Yet that is what’s going on in medical academia these days—with a vengeance. It’s a phenomenon that I like to call quackademic medicine, something that’s fast turning medical academia into medical quackademia. It is not, as its proponents claim, the “best of both worlds.”
In fact, it was my two recent publications bemoaning the infiltration of quackademic medicine into medical academia, one in Nature Reviews Cancer and one with Steve Novella in Trends in Molecular Medicine, that got me thinking again about this phenomenon. Actually, it was more my learning of yet another step deeper into quackademia by a once well-respected academic medical institution, occurring so soon after having just published two articles bemoaning that very tendency, that served as a harsh reminder of just what we’re up against. So I decided to greatly expand a post that I did for my not-so-super-secret other blog recently beyond a focus on just one institution, in order to try to demonstrate for you a bit more how and why quackery has found a comfortable place in medical academia and how, just when I thought things can’t get worse, they do. There is also room for hope in that I also found evidence that our criticisms are at least starting to be noticed. I begin with the sad tale of the Cleveland Clinic Foundation, which has gone one step beyond its previous embrace of traditional Chinese medicine. I’ll then discuss another unfortunate example, after which I’ll look a bit at the pushback and marketing of “integrative” medicine.