As some may know I am infectious disease doctor. Urinary tract infections (UTI) butter my bread. Figuratively speaking. There is an enormous amount known about the pathophysiology of UTI’s. It is both a common and complex problem. But for all our knowledge, chronic and recurrent UTI’s remain a vexing issue for the patient and the doctor.
One reason people develop recurrent UTI’s is not because of altered chi along meridians altered by needles stuck in the skin distant from the bladder. That would be ridiculous. I like reasoning from basic principles. Given what we know about anatomy, physiology and microbiology, how might acupuncture interfere with the development of a urinary tract infection? Would it prevent colonization with pathogenic E. coli? Prevent retrograde travel of bacteria up the urethra into the bladder? Stop E. coli from binding to uroepithelial cells? Have a bactericidal or bacteriostatic effect?
None of the above seem likely. To my mind, postulating any of the above as a potential mechanism for acupuncture as a preventative for UTI’s would be ludicrous. And spare me your Boosting the Immune System, a concept that exists as a marketing tool, not a useful therapeutic intervention. My boss used to say that many an academic career floundered on attempting to prevent and treat UTI’s using an immune system approach. With some exceptions, and there are always exceptions, recurrent UTI’s in normal humans are usually due to anatomic or microbiological anomalies.
Despite its popularity, it is clear that acupuncture is not based on reality and, like all pseudo-medicine, only has demonstrable efficacy in poorly-designed studies. Acupuncture displays the usual progression of all pseudo-medicines. Increasingly-well-done studies show decreasing effect until a study that removes all bias shows it to be no better than placebo. Which one would expect for an intervention based on fantasy. Prior plausibility (the toy boat of SBM, try saying it three times very fast) would predict that acupuncture is worthless. And that should be acupunctures, all 6 styles are an elaborate ritual with no more likelihood of efficacy than the superstitions in a Budweiser commercial. (more…)
Ngram is a Google analytic tool/way to waste lots of time on the internet, a byproduct of Google’s scanning millions of books into its database. In a matter of seconds, Ngram scans words from about 7.5 million books, an estimated 6 percent of all books ever published. Type a word or phrase in the Ngram Viewer search box and in seconds a chart of its yearly frequency will appear. You can also search for a series of words or phrases and the Viewer will provide a color-coded chart comparing frequency of use. More sophisticated searches (e.g., making the search case sensitive, or not) are also possible.
As explained in the New York Times, researchers “have used this system to analyze centuries of word use, examining the spread of scientific concepts, technological innovations, political repression, and even celebrity fame.” Erez Aiden, a computer scientist who helped create the word frequency tool, says he and his co-researcher, Jean-Baptiste Michel, wanted “to create a scientific measuring instrument, something like a telescope, but instead of pointing it at a star, you point it at human culture.” In fact, the title of their new book is Uncharted: Big Data as a Lens on Human Culture. Still, they caution that, like other scientific tools, Ngram’s results can be misinterpreted. An example: the fax machine. If you query that term, it looks as if the fax appears almost instantaneously in the 1980s. In reality, the machine was invented in the 1840s but was then called the “telefax.”
If Ngram can search for scientific concepts, how about unscientific concepts? What might a search of unscientific concepts tell us about our human culture? Let’s find out. (more…)
Poorly done acupuncture studies are published every week, so I can’t write about every one that comes out. I probably would have passed this one by, except for the New York Times article using it to tout the effectiveness of acupuncture.
The headline reads: “Acupuncture, Real or Not, Eases Side Effects of Cancer Drugs.”
I know that authors, in this case Nicholas Bakalar, often do not write their own headlines, but in this case the article itself is just as bad. It begins:
Both acupuncture and sham acupuncture were effective in reducing menopausal symptoms in women being treated with aromatase inhibitors for breast cancer, a small randomized trial found.
ChiroNexus recently listed the top 10 chiropractic studies of 2013. In my experience, chiropractic studies tend to be of poor quality. A media report says “study shows chiropractic works for X,” and when I look for the study it turns out to be a single case report or an uncontrolled study. When Simon Singh was sued by the British Chiropractic Association for saying chiropractic treatment for certain childhood ailments was bogus, the BCA responded with a list of 29 studies they said provided evidence for their claims. Steven Novella showed that out of 29 studies on the list, only 17 actually constituted evidence for 4 clinical claims, and those 17 were poor quality, cherry-picked, and too weak to support the claims. I have a copy of a chiropractic textbook entitled Somatovisceral Aspects of Chiropractic: An Evidence-Based Approach and there is nothing in it that would qualify as credible evidence to a science-based thinker. Chiropractic commenters on SBM have told us that modern chiropractic rejects the “subluxation” paradigm and relies on evidence, and I am always willing to look at new evidence and give chiropractors another chance to convince me that a reform movement is really underway, so I looked up the top 10 studies and read them. I was not impressed.
Note: This is a long article with mind-numbing details that will not be of interest to most readers. Feel free to scroll down to the Summary section. You can just read the bold-faced headings describing the claims of each study on the way down.
Also note: For those who want more detail, the “Study #” headings are links to the full text when available online, or to the PubMed citation.
The following post is a collaborative effort between myself and science-based dentist Grant Ritchey DDS. Dr. Ritchey is a co-host of the always excellent The Prism Podcast, most recently interviewing Dr. Robert Weyant and discussing how to teach critical thinking to dental and medical students. He can also be found on Twitter at @SkepticalDDS. Dr. Ritchey has written for SBM before on the topic of cranial osteopathy in dentistry.
As a pediatric hospitalist, I don’t deal with issues of dental health very frequently. Sure I see plenty of oral mucosal lesions, as occur during a primary herpes outbreak or a case of Kawasaki disease, but not many problems with the teeth themselves. I do admit a few dental abscesses here and there that need to be cooled down with IV antibiotics prior to definitive surgical drainage. And as a hospitalist that sees a fair amount of newborns, I also discover the occasional natal tooth. That’s when a baby is born with a tooth, usually a central mandibular incisor, having already erupted.
But as a pediatrician, I care deeply about the overall health of children and the network of caregivers that surround them. I guess you could say that I take a holistic approach, but I would prefer that you didn’t. Although we aren’t dentists, pediatricians recognize that oral health is integral to the well-being of a child and that many long-term dental maladies develop during the first two decades of life, often before the first tooth even appears. The most common, and one which non-dentist health care providers can have a major impact on, is the development of dental caries, or “cavities”. (more…)
It’s the time of year where if you’re not sick, someone you know probably is. The influenza season in the Northern hemisphere started out slowly, but seems to be accelerating and hasn’t peaked yet. Add that to cold viruses circulating, and you get the peak purchasing period for cough and cold remedies. John Snyder gave a nice summary of the evidence base for the common treatments a few weeks ago. In short, despite all the advertising, there is little evidence to suggest that most of the “tried and true” products we’ve used for decades have any effect on our symptoms. One of the most sensible developments that’s occurred over the past few years has been the discontinuation or relabeling (depending on your country) of cough and cold products for children. The rationale to pull these products is compelling: Cough and cold remedies have a long history of use, and were sold without prescriptions before current regulatory standards were in place. They were effectively grandfathered onto the marketplace. When it comes to their use in children, the data are even more limited. There are few published trials and the results are complicated by different age groups, irregular dosing, lack of placebo control, and very small patient numbers. What’s even harder to believe was that doses were based mainly on expert opinion, not data, and generally didn’t consider that children don’t handle drugs the way adults do. So why withdraw them from pediatric use, but not adult use? Like most regulation, it comes down to risk and benefit. Both are troubling for pediatric use. (more…)
Let’s conduct a little thought experiment. First, for the sake of this thought experiment let’s assume that you have no morals, ethics, or conscience. You are comfortable lying to people, even if they are sick, and even if it will harm their health.
Your task is to get as many people as possible to believe that small bits of plastic can improve their health and treat their symptoms. This is not as difficult as it may at first appear, and the payout can be huge. Small plastic stickers can be mass produced for pennies. The primary investment will be creating and maintaining a website. Then, if you can get people to believe that the plastic stickers are magical, the money will come rolling in.
What claims should we make for the stickers? Let’s stay away from anything that has an objective outcome, so we won’t claim that they can be used as an antibiotic to treat pneumonia, or as a way to treat heart attacks. I also understand that in the US and other countries, they take a close look at claims made to treat specific diseases, but you can make vague “structure function” claims with abandon, so let’s go with those. We can always imply that they are effective for diseases, even serious ones like cancer. (more…)
Science is intended to discover the “is”, not the “ought;” facts, not values. Science can’t tell us whether an action is moral; it can only provide evidence to help inform moral decisions. For instance, some people who believe abortion is immoral reject birth control methods that prevent implantation of a fertilized ovum on the grounds that it constitutes abortion; science can determine that a particular birth control method prevents fertilization rather than preventing implantation of a fertilized ovum. A new book, Moral Tribes: Emotion, Reason, and the Gap Between Us and Them, by Joshua Greene, provides some intriguing insights that are pertinent to medical ethics.
He thinks tribalism is the central tragedy of modern life. Evolution equipped us for cooperation within our own tribe but not for cooperation with other tribes. Cooperation with related individuals helps spread our own genes, but we are in competition with other tribes and cooperating with them might help spread their genes to the detriment of our own. It boils down to Us vs. Me and Us vs. Them. He uses the word “tribes” not in the original sense (Hutus vs. Tutsis), but to include Democrats vs. Republicans, Catholics vs. Protestants, CAM vs. science-based medicine, Arabs vs. Israelis, climate change activists vs. climate change deniers, and any other ideological or nationalistic group. (more…)
Here we go again. I once said that, in the wake of study after study that fails to find activity of various “complementary and alternative medicine” (CAM) beyond that of placebo, CAM advocates are now in the midst of a “rebranding” campaign in which CAM is said to work through the “power of placebo.” Personally, I’ve argued that in reality this new focus on placebo effects as the “mechanism” through which CAM “works” is in reality more a manifestation of the common fantasy that wishing makes it so.
None of this, of course, can stop everybody’s favorite apologist for “complementary and alternative medicine” (CAM) and, in particular, using placebo effects therapeutically, from continuing to do what he does with a study that’s been widely reported in the news and even featured on Science Friday last week. Basically, it’s a study in Science Translational Medicine, in which our old friend Ted Kaptchuk teamed up with an investigator interested in migraines, Rami Burstein, to do a study that finds that believing a medicine will work can have a strong effect on its actual activity on migraine. As is the case with most studies in which Kaptchuk is involved, it’s mildly interesting from a scientific standpoint. Unlike most studies in which he is involved, Kaptchuk seems a bit more able to tone down the hyperbole, which is a good thing. Unfortunately, this study, as much as it’s being touted by the press as providing new information on placebo effects, really doesn’t tell us much that is new. (more…)