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.
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.
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.
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…)
THE 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.
“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).
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.
Polypharmacy essentially means taking too many pills. It’s a real problem, especially in the elderly.
A family doctor gives an elderly patient one pill for diabetes, another for high blood pressure, and another to lower cholesterol. The patient sees a rheumatologist for his arthritis and gets arthritis pills. Then he sees a psychiatrist for depression and gets an antidepressant. He takes a sleeping pill. He takes a laxative. He buys some over-the-counter cold medicine and Tylenol. Then he goes to his local GNC store and buys a smorgasbord of vitamins, minerals, supplements and herbal products. It would be surprising if some of these didn’t interact with each other to cause some problems.
One doctor may not know what the other doctors have prescribed. The patient may not think to tell his doctors about the non-prescription products he’s taking. Or he may not want to admit it for fear the doctors will disapprove. (more…)
The first thing that struck me about him was that he was orange.
It was not a shade of orange I had ever ever encountered before in a patient. It was a yellowish orange, an almost artificial-looking color. At first I wondered if he was suffering from liver failure with jaundice, but this orange was just not the right shade of yellow for jaundice, and his sclerae were not yellow. I also considered whether he was suffering from renal failure, but the orange color of his skin didn’t quite match the rather coppery color that some patients suffering from longstanding renal failure necessitating dialysis sometimes acquire. I was puzzled. His chart said that he was being admitted for surgery for rectal cancer. So I sent the intern in to get the story, do the history and physical, and get him all plugged in for his bowel prep. Believe it or not, there was actually a time when it was not all that uncommon for patients to come into the hospital the night before major abdominal surgery in order to undergo a preoperative bowel prep, rather than being forced by their insurance companies to undergo the torture of drinking four liters of the purgative known as Go-Lytely–a misnomer, if ever there was one!–at home and spending the next several hours having to rush periodically to the toilet, waiting in vain for the liquid exploding out of their hind end to run clear.
My Discussion with Dr. P
After last week’s post, Dr. Peter Moran answered with more salient points. I’ll spend this week discussing those, because I share Dr. Moran’s “interest in examining the kind of messages we are putting out.” Acknowledging the inequality inherent in his not being the blog author, I’ll offer the last word to Dr. Moran by ending this series* and letting whatever comments he may have in response to today’s post be the last, at least for now.
Here is Dr. Moran’s response to my response: