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An Overly Pessimistic View of Medicine

doctored book cover

Sandeep Jauhar wrote Doctored: The Disillusionment of an American Physician to express his frustration with the modern system of medical care in America. I found the book profoundly disturbing. If his experience is representative, I can understand why so many people have been criticizing doctors for only caring about money. His experience was so different from mine that I wondered if I had led a sheltered life as a military physician and was oblivious to what was going on in the civilian world. After further reflection, I think Jauhar is unduly pessimistic. Whatever the opposite of rose-colored glasses is, he’s wearing them.

His personal experience of medicine

Dr. Jauhar is a cardiologist who works in a large teaching hospital, where he had been hired to develop a program for patients with heart failure that would implement the most up-to-date medical knowledge and provide the best possible medical care. After long, grueling years of school, residency, and fellowship, he is elated to have finally finished his training and started a job where he can accomplish something good. But he soon sinks into despair. He is appalled by the realities of life as an attending physician, the many ways in which the “system” interferes with his efforts to provide the best care to patients, the unethical behavior of other doctors, and his inability to support his family.
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Posted in: Book & movie reviews

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What naturopaths say to each other when they think no one’s listening

herbs-nd1

The true test of a man’s character is what he does when no one is watching.

— John Wooden

 

Regular readers might have gathered from reading this blog that we are not particularly fond of naturopaths. Actually, naturopaths themselves might be perfectly nice people; rather it’s naturopathy we don’t like, mainly because it is a cornucopia of quackery based on prescientific vitalism mixed with a Chinese restaurant menu “one from column A, two from column B” approach to picking quackery and pseudoscience to apply to patients. Indeed, Scott Gavura features as an excellent recurring series “Naturopathy vs. Science,” which has included editions such as the Facts Edition, Prenatal Vitamins, Vaccination Edition, Allergy Edition, and, of course, the Infertility Edition. Of course, as I’ve pointed out, any “discipline” that counts homeopathy as an integral part of it, as naturopathy does to the point of requiring many hours of homeopathy instruction in naturopathy school and including it as part of its licensing examination, cannot ever be considered to be science-based, and this blog is, after all, Science-based Medicine. Not surprisingly, we oppose any licensing or expansion of the scope of practice of naturopaths, because, as we’ve explained time and time again, naturopathy is pseudoscience and quackery.

A couple of weeks ago, over at my not-so-super-secret other blog, I was “celebrating” (if you will) Naturopathy Week. During that week, one of my readers brought to my attention something that, more than anything else, shows the truth of the quote with which I started this post and another similar quote by J.C. Watts that goes, “Character is doing the right thing when nobody’s looking.” I’m referring to the contents of a subreddit posted by a user going by the ‘nym “Naturowhat,” Read what naturopaths say to one another. Conclusion: manipulative, poorly trained, and a threat to public health. Now, I’m not a big fan of Reddit, largely because I can’t figure out how to find things easily, and I hate the sheer ugly and user hostile format of it. However, beggars can’t be choosers; so Reddit it was to examine what naturopaths say to each other when they think no one is looking. I hadn’t planned to comment on this again, but Jann Bellamy thought that our readers would be interested, and who am I to question Jann’s judgment, particularly on a weekend when I was deep into grant writing?
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Posted in: Naturopathy, Vaccines

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Questions and Answers about Chiropractic: The Bottom Line

adjustment

I am often asked, “What do chiropractors do?” That’s not an easy question to answer. The answer is usually expected to be, “They treat back trouble.” But as alternative medicine practitioners, chiropractors do a lot of things, and they treat a variety of ailments, based largely on a scientifically-invalid vertebral subluxation theory which proposes that nerve interference resulting from a misaligned vertebra or a dysfunctional spinal segment can affect general health.

As a co-host of the Chirobase web site, I frequently answer questions about chiropractic, some of which are published in a section titled “Consumer Strategy/Consumer Protection.” In this post, I’ll focus on these:

  • Are Subluxations Causing My Health Problems?
  • Is a Misaligned Atlas Causing My Back Pain?
  • What is that “Thumper” My Chiropractor Uses on My Back?
  • How Does a Chiropractor Locate Subluxations?
  • Should I Let a Chiropractor Adjust My Baby?
  • Why Is Every Chiropractor’s Treatment Different?
  • Can Neck Manipulation Cause a Stroke?
  • Should I Go to a Chiropractic College?
  • Are There Any Good Chiropractors?
  • Is It Possible to Reform the Chiropractic Profession?

By far, most of the questions I receive express concern about questionable methods and advice offered in the offices of chiropractors. Many questions are generated by the suspicions of patients who initially visited a chiropractor for treatment of back pain and who were then offered spinal adjustments as a treatment for health problems unrelated to the spine. Patients are often concerned about the expense involved in such care, usually extended over a long period of time, followed by “maintenance care” to correct or prevent “vertebral subluxations” after symptoms have resolved. I generally advise patients to refuse chiropractic care for anything other than a musculoskeletal problem, to seek treatment only when symptoms are present, never pay for treatment in advance, and to discontinue treatment and see an orthopedic specialist if symptoms worsen after a few days or have not subsided after a week or so.

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Posted in: Chiropractic

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Ebola conspiracy theories: Same as it ever was

tinfoilhatbrigade

Does anyone remember the H1N1 influenza pandemic? As hard as it is to believe, that was five years ago. One thing I remember about the whole thing is just how crazy both the antivaccine movement and conspiracy theorists (but I repeat myself) went attacking reasonable public health campaigns to vaccinate people against H1N1. It was truly an eye-opener, surpassing even what I expected based on my then-five-year experience dealing with the antivaccine movement and quacks. Besides the usual antivaccine paranoia that misrepresented and demonized the vaccine as, alternately, ineffective, full of “toxins,” a mass depopulation plot, and many other equally ridiculous fever dream nonsense, there was the quackery. One I remember quite well was the one where it was claimed that baking soda would cure H1N1. Then there was one of the usual suspects, colloidal silver, being sold as a treatment for H1N1. Then who could forget the story of Desiree Jennings, the young woman who claimed to have developed dystonia from the H1N1 vaccine but was a fraud? Truly, pandemics bring out the crazy, particularly the conspiracy theories, such as the one claiming that the H1N1 pandemic was a socialist plot by President Obama to poison Wall Street executives, which was truly weapons-grade conspiracy mongering stupidity. Oh, wait. That last one was a joke. It’s so hard to tell sometimes with these things.

Yes, pandemics and epidemics do bring out the worst in people in many ways, but particularly in terms of losing critical-thinking abilities. This time around, five years later, it’s Ebola virus disease. To the average person, Ebola is way more scary than H1N1, even though H1N1, given its mode of transmission, had the potential to potentially kill far more people. Now that cases of Ebola virus disease have been reported in the US, the panic has been cranked up to 10 in certain quarters, even though the risk of an outbreak in the US comparable to what is happening in West Africa is minimal. We’ve seen quackery, too, such as homeopaths seriously claiming that they can treat it and quacks advocating high-dose vitamin C to “cure” Ebola. The über-quack Mike Adams is selling a “natural biopreparedness” kit to combat Ebola and pandemics, while the FDA is hard-pressed to track down all the quacks, such as hawkers of “essential oils,” who—of course!—also think that their wares can cure Ebola. (more…)

Posted in: Critical Thinking, Politics and Regulation, Vaccines

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Placebo Speculations

From the Wikimedia Commons.

From the Wikimedia Commons.

 

I have a new term to add to the English language, ebolasmacked, a derivative of the British term gobsmacked. Ebolasmacked defines my life the last few weeks since Ebola, or at last preparations for Ebola, have taken a huge bite out of my time with many interesting twists and turns. I think this is maybe the 9th outbreak (HIV, MERS, SARS, Legionella, H1N1, Avian flu, West Nile, MRSA) of my career and it has certainly generated more hysteria relative to the risk than any to date. Many of my usual pastimes, like SBM (as this essay will no doubt demonstrate), have had to take a back seat to preparing for what should be a very unlikely, but very disruptive, event. We do not want to get caught with our hazmats down should a case of Ebola come through the door.

What makes life interesting, among other things, is the constant realization that the more you know the more there is to know. I like Richard Dawkins’ metaphor in Climbing Mount Improbable where he pictures scientific progress as a series of false summits extending into infinity. It sure seems that way. Every time I think I understand a topic, I find there is still more to learn.

My Dad told me when I graduated from medical school that half of everything I had just learned was probably not true, the only problem is that you didn’t know which half. It was partially true. There have been ideas that have been abandoned since I was an intern, the most famous being that ulcers were due to stress and diet. But a new paradigm has been the exception, not the rule.

The last thirty years have been more about refining knowledge about the complexity of disease and its treatment and, perhaps equally importantly, having a better understanding of the all slings and arrows of outrageous fortune that can make the results of a clinical trial suspect. (more…)

Posted in: Acupuncture, Basic Science, Science and Medicine

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Connecticut “modernizes” naturopathic scope of practice

Naturopathy has been legal in Connecticut for almost 90 years, but with a scope of practice limited to counseling and a few treatments like physiotherapy, colonic hydrotherapy and “natural substances.” There was no specific authority to diagnose and treat. All of that changed on October 1, 2014, courtesy of the Connecticut legislature, which, in the words of the American Association of Naturopathic Physicians (AANP), “modernized” the naturopathic scope of practice.

Actually, the legislature did nothing of the sort. Naturopathy is based on the prescientific concept of vitalism, and we find it right there in the very first paragraph of the new law. Naturopathy is defined as:

diagnosis, prevention and treatment of disease and health optimization by stimulation and support of the body’s natural healing processes, as approved by the State Board of Natureopathic [sic] Examiners, with the consent of the Commissioner of Public Health. . .

Also included in the expanded scope of practice are:

ordering diagnostic tests and other diagnostic procedures, . . . ordering medical devices, including continuous glucose monitors, glucose meters, glucose test strips, barrier contraceptives and durable medical equipment; and . . . removing ear wax, removing foreign bodies from the ear, nose and skin, shaving corns and calluses, spirometry, tuberculosis testing, vaccine administration, venipuncture for blood testing and minor wound repair, including suturing.

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Posted in: Diagnostic tests & procedures, Herbs & Supplements, Homeopathy, Legal, Naturopathy, Politics and Regulation, Vaccines

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Neuro-Acupuncture and Stroke

On the home page of Zhu’s Neuro-Acupuncture Center there is a video relaying a testimonial of how scalp acupuncture helped a patient recover from acute stroke. The use of testimonials is very common in the promotion of dubious health treatments. A personal story and endorsement is psychologically more compelling than dry data. Testimonials are completely unreliable, however, and in fact I would argue that they are ethically questionable. I would even go as far as saying that the presence of testimonials is almost a sure sign that the treatment being promoted is not legitimate.

Webpage screenshot (click picture to embiggen)

Webpage screenshot (click picture to embiggen)

What I could not find on Zhu’s website were links to published scientific researcher establishing the safety and efficacy of his treatments. You would think if they existed, he would display them prominently.

Acupuncture for stroke is a common claim, contradicting the notion that acupuncture is primarily used for the symptomatic treatment of subjective symptoms. That, in my experience, is part of the promotional strategy for many CAM treatments. They are presented as benign treatments for symptomatic treatment only, so what’s the possible harm. In reality, proponents will claim they can actually treat diseases whenever given the chance.

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Posted in: Acupuncture

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Does the Movie Fed Up Make Sense?

fed up movie

The 2014 film Fed Up is an advocacy documentary. Its message:

  • There is a worldwide epidemic of obesity.
  • It is endangering our children.
  • Increased sugar consumption is responsible.
  • The food industry is responsible for our increased sugar consumption because it puts hidden sugar in processed foods, bombards us with advertising, favors profits over health, and lobbies against regulation.
  • The government is responsible because it has failed to control the food industry.

The film has received mostly positive reviews and has been called the Inconvenient Truth of the health movement. It was written and directed by Stephanie Soechtig, whose earlier films attacked GMO foods and the bottled water industry, and narrated by Katie Couric, who “gave anti-vaccine ideas a shot” on her talk show in late 2013.

The film shows families struggling with childhood obesity and “experts” expressing their opinions. Their selection of “experts” is heavy on politicians and journalists and light on nutrition scientists.
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Posted in: Book & movie reviews, Nutrition

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Andrew Wakefield, the MMR, and a “mother warrior’s” fabricated vaccine injury story

AWakefield

As the time came to do my usual weekly post for this blog, I was torn over what to write about. Regular readers might have noticed that a certain dubious cancer doctor about whom I’ve written twice before has been agitating in the comments for me to pay attention to him, after having sent more e-mails to me and various deans at my medical school “challenging” me to publish a link to his results and threatening to go to the local press to see if he can drum up interest in this “battle.” I’ve been assiduously ignoring him, but over time the irritation factor made me want to tell him, “Be very careful what you ask for. You might just get it.” Then I’d make this week’s post about him, even though I wasn’t thrilled with the idea of giving in to his harassment and giving him what he wants.

That’s why I have to thank the ever-intrepid investigative reporter Brian Deer for providing me an alternative topic that is way more important than some self-important little quack and a compelling topic to blog about in its own right. Brian Deer, as you might recall, remains the one journalist who was able to crack the facade of seeming scientific legitimacy built up by antivaccine guru Andrew Wakefield and demonstrate that (1) Wakefield’s work concluding that the MMR vaccine was associated with “autistic enterocolitis” was bought and paid for by a solicitor named Richard Barr, who represented British parents looking to sue vaccine manufacturers, to the tune of over £400,000; (2) Wakefield expected to make over £72 million a year selling a test for which Wakefield had filed a patent application in March 1995 claiming that “Crohn’s disease or ulcerative colitis may be diagnosed by detecting measles virus in bowel tissue, bowel products or body fluids”; and Wakefield’s case series published in The Lancet in 1998 was fraudulent, the equivalent of what Deer correctly characterized as “Piltdown medicine.” Ultimately, these revelations led to Wakefield’s being completely discredited to the point where The Lancet retracted his paper and even Thoughtful House, the autism quackery clinic in Austin, TX where Wakefield had a cushy, well-paid position as scientific director, had to give him the boot. Yes, Wakefield is a fraud, and it’s only a shame that it took over a decade for it to be demonstrated.

As much as I hate how it took discrediting Wakefield the man as a fraud rather than just discrediting his bogus science to really begin to turn the tide against the annoying propensity of journalists to look to Wakefield or his acolytes for “equal time” and “balance” whenever stories about autism and vaccines reared their ugly heads, I can’t argue with the results. Wakefield is well and truly discredited now, so much so that, as I noted, his prominent involvement probably ruined any chance promoters of the “CDC whistleblower” scam ever had to get any traction from the mainstream press.

What is sometimes forgotten is the effect Wakefield’s message has had on parents. These are the sorts of parents who tend to congregate into groups designed to promote the idea that vaccines are dangerous and cause autism, such as the bloggers at the antivaccine crank blog Age of Autism, the equally cranky blog The Thinking Moms’ Revolution, or groups like The Canary Party. It is Wakefield’s message and the “autism biomed” quackery that it spawned that have led to unknown numbers of autistic children being subjected to the rankest form of quackery in order to “recover” them, up to and including dubious stem cell therapies and bleach enemas.
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Posted in: Health Fraud, Homeopathy, Neuroscience/Mental Health, Vaccines

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Brain-Based Learning, Myth versus Reality: Testing Learning Styles and Dual Coding 

Ed. Note: Today we present a guest post from Josh Cuevas, a cognitive psychologist and assistant professor in the College of Education at the University of North Georgia. Enjoy!

Breaking the Cycle

Since early on in graduate school when I began studying cognition, I’ve followed the learning styles movement because it was such a powerful phenomenon. It took hold rapidly, seemingly overnight, at all levels of education. And, like so many fads in education and science, it created a big-money industry involving conferences, training seminars, paid speakers, how-to manuals, and a variety of other mediums, inevitably linked to a profit in some way. Yet in the peer reviewed studies I was sifting through, evidence for learning styles was nowhere to be found. And more than a decade later I’m still looking for it.

Today when I suggest to students that learning styles are no more than a myth, I can hear their collective jaws drop, regardless of whether they’re undergraduates or graduate students, because learning styles have been preached to them the entire time they’ve been in school. The graduate students concern me the most because they’re supposed to know the research. And I used the term “preached” because these students have been convinced via no more than word of mouth, are asked to accept the information based on faith, and many come to hold a strange religious-like fervor for the concept. That’s not how science works and it shouldn’t be how education works.

It has been no easy task combating this common misconception in college classrooms, particularly when it is reinforced in textbooks, by other professors (who are also supposed to know the research), and in public schools where students do their internships. The research we’re doing at the University of North Georgia on learning styles has two purposes- it allows us to collect data on the effects of learning styles and contrast it to a stronger model, dual coding, but it also lets us demonstrate, in real time, to students who will one day be teachers how what they’ve long believed to be true simply does not work when put to the test.

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Posted in: Neuroscience/Mental Health

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