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A formal request for retraction of a Cancer article

I am formally requesting that Cancer retract an article claiming that psychotherapy delays recurrence and extends survival time for breast cancer patients. Regardless of whether I succeed in getting a retraction, I hope I will prompt other efforts to retract such articles. My letter appears later in this post.

In seeking retraction, I cite the standards of the Committee on Publication Ethics (COPE) for retraction. Claims in the article are not borne out in simple analyses that were not provided in the article, but should have been. The authors instead took refuge in inappropriate multivariate analyses that have a high likelihood of being spurious and of capitalizing on chance.

The article exemplifies a much larger problem. Claims about innovative cancer treatments are often unsubstantiated, hyped, lacking in a plausible mechanism, or are simply voodoo science. We don’t have to go to dubious websites to find evidence of this. All we have to do is search the peer-reviewed literature with Google Scholar or PubMed. Try looking up therapeutic touch (TT).

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I uncovered unsubstantiated claims and implausible mechanisms that persisted after peer review in another blog post about the respected, high journal-impact-factor (JIF = 18.03) Journal of Clinical Oncology. We obviously cannot depend on the peer review processes to filter out this misinformation. The Science-Based Medicine blog provides tools and cultivates skepticism not only in laypersons, but in professionals, including, hopefully, reviewers who seem to have deficiencies in both. However, we need to be alert to opportunities not just to educate, but to directly challenge and remove bad science from the literature. (more…)

Posted in: Cancer, Clinical Trials, Neuroscience/Mental Health

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Separating Fact from Fiction in the Not-So-Normal Newborn Nursery: Newborn Jaundice

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Photo by Mike Blyth

By far the most common medical problem in newborn infants is jaundice, typically appreciated as a yellowish discoloration of the skin caused by increased blood levels of a pigment called bilirubin. In my role as a newborn hospitalist, I manage jaundice every day. If I am not treating jaundice, in every single baby I see I am at least determining the risk of the child developing jaundice severe enough to require treatment. I then use that assessment to help guide my recommendations on when the infant should follow up with their primary care pediatrician after discharge home.

Fortunately for the millions of infants who develop jaundice every year, in the vast majority it is a self-limited process and often considered to be just a normal part of the first few days of life. But in a significant minority of them, careful management is required in order to prevent complications. Some infants need treatment to prevent neurological symptoms from developing, and to reverse them when they do occur. And in a very small percentage of babies who develop severe jaundice, permanent brain damage and even death can occur.

Because newborn jaundice tends to resolve without any intervention, and complications are now uncommon, it isn’t surprising that a variety of myths and superstitions have arisen that involve preventing or curing the condition. And naturally there are practitioners of unproven alternative medical modalities that can be found claiming to be able to manage it as well. As expected, if you’ve spent any time reading Science-Based Medicine or researching the nonsensical claims of chiropractors, homeopaths and their ilk, their understanding is limited and their recommendations potentially dangerous.

But first a crash course on newborn jaundice. (more…)

Posted in: Science and Medicine

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We’re a drug-taking, supplement-taking nation. So how do we do so safely?

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Do you take a vitamin or dietary supplement? It’s increasingly likely that you do, as over half of all American adults took some sort of supplement over the past 30 days. Now there’s evidence to suggest that about one-third of all Americans are taking supplements and prescription drug at the same time, which is renewing questions about risks and benefits. The same study reveals that combining supplements and prescription drugs is more common among those with certain medical conditions, compared to those without.

Many of us supplement in the absence of evidence of benefit, or even medical need. For example, there is little persuasive evidence to suggest that routine supplementation with products like multivitamins is necessary. There are exceptions of course: Those potentially becoming pregnant, those on dietary restrictions (e.g., vegans), and those with demonstrable medical need are among the cases where there is a clear benefit to vitamin supplementation, for example. The majority of us take supplements, like multivitamins, for “insurance” rather than because we have a deficiency or medical need. The evidence for non-vitamin supplements, like herbal products, is just as questionable as it is for vitamins, with few products showing meaningful health benefits. Ultimately decisions about supplements come down to evaluations of risk and benefits. Since I started working as a pharmacist, I’ve always cautioned consumers about the quality concerns and efficacy with herbal products and supplements, and the resultant risks that make me very hesitant to suggest their routine use – especially when they’re combined with prescription drugs. Yet the evidence suggests that it’s occurring – with increasing frequency. (more…)

Posted in: Herbs & Supplements, Pharmaceuticals

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CureCrowd – Crowdsourcing Science

curecrowd-HAA new website came to my attention that promises to “Discover what truly works.” The idea is to essentially crowdsource anecdotal reports about what treatments work for specific conditions.

This is an interesting idea, that can harness the power of information flow over the internet to do what is essentially an observational, uncontrolled, and unscientific study about treatment effects. At its best, this type of information would consist of what we call a pragmatic study – an open-label study of the real-world application of specific treatments.

Pragmatic studies have their place – they add information about the practical applicability of various treatments. Pragmatic studies, however, are not efficacy trials – they cannot and should not be used to make efficacy claims. It has recently come into vogue for proponents of various CAM treatments to rely on pragmatic studies to make efficacy claims, when actual efficacy trials have failed to show effectiveness. (more…)

Posted in: Clinical Trials, Computers & Internet

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Lice

If you have children, there’s a good chance you’ve had experience with head lice. Head lice affects as many as 12 million people in the US each year, mostly children. Compared to other health conditions, it is a trivial problem; but it is common and annoying. It can cause itching, notes sent home from school, and often a strong “yuck” reaction. Fortunately, several effective treatments are available, including enough “natural” options to please any critic of Big Pharma.

Louse diagram, Micrographia, Robert Hooke, 1667

Louse diagram, Micrographia, Robert Hooke, 1667

The critter

Pediculosis humanus var capitis is a bloodsucking parasitic insect specific to humans. It is 2.5-3 mm long and flattish. It can’t jump or fly or even walk efficiently, but is easily transferred, usually by head-to-head contact with an infected person or less often with an infected person’s headgear, comb, towel, or other object. Infestation is not a sign of poor hygiene.  Lice bite and suck blood 4-5 times daily, injecting an anti-coagulant in their saliva. Mommy lice live for up to 3 months and lay up to 300 eggs at a rate of 3-4 a day. They glue the eggs individually to a hair shaft, usually close to the scalp but in warm climates as far as 6 inches from the scalp. They hatch in 6-10 days, after which the empty egg cases move further and further from the scalp as the hair grows out. The diagnosis can be made by seeing live, moving lice and finding nits (the egg or young lice) on the hair. The best place to look for them is behind the ear and at the nape of the neck. Nits can be confused with dandruff and debris, but these can usually be brushed away while nits remain firmly stuck to the hair shaft. Nits alone are not enough to make the diagnosis of active infestation. They may be either alive or dead: empty or nonviable egg cases may still be present long after the infestation has resolved. (more…)

Posted in: Pharmaceuticals

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The false dilemma of David Katz: Abandon patients or abandon science

Dr. David L. Katz is apparently unhappy with me. You remember Dr. Katz, don’t you? If you don’t, I’ll remind you momentarily. If you do, you won’t be surprised. Let me explain a bit first how Dr. Katz recently became aware of me again.

Last week, I posted a short (for me) piece about something that disturbed both Steve Novella and myself, namely Traditional Chinese herbalism at the Cleveland Clinic? What happened to science-based medicine? Steve had blogged about it as well a couple of days earlier. In actuality, it was a post that had originally appeared at my not-so-super-secret other blog, and, in my characteristically slightly arrogant way, I thought it was good enough that it deserved to be showcased here at Science-Based Medicine. To my surprise, Maithri Vengala over at The Healthcare Blog noticed and asked me if I would mind letting her post it over there. Never being one to turn down a request to showcase my work to a wider (or at least different) audience, I gave her my permission. The result was that my post ended up being published here, and I thought nothing more of it.

Until yesterday, that is.

Yesterday, thanks to the magic of Google Alerts, I became aware that Dr. David Katz was very unhappy with my post. At the very least, he strongly disagreed with it, so much so that he felt the need to respond. Naturally, he chose as his venue The Huffington Post, which is well known as a bastion of quackery, antivaccine pseudoscience, and Deepak Chopra-inspired magical thinking, to respond. Indeed, so bad is HuffPo (as it’s “nicknamed”) that Steve Novella and I have both referred to it as waging a “war on medical science,” and HuffPo has been a frequent topic of discussion on this very blog for its abysmal record of publishing pseudoscience, a record that goes back to its very beginning in 2005, when antivaccinationists flocked to the fledgling blog and news site. And that doesn’t even count all the nonsense from Deepak Chopra and even promotion of outright cancer quackery.
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Posted in: Critical Thinking, Energy Medicine, Herbs & Supplements, Traditional Chinese Medicine

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Cochrane Reviews: The Food Babe of Medicine?

There are two topics about which I know a fair amount. The first is Infectious Disease. I am expert in ID, Board Certified and certified bored, by the ABIM. The other, although to a lesser extent, is SCAMs.

When I read the literature on these topics, I do so with extensive knowledge and, in the case of ID, 30 years of clinical experience. The extensive knowledge, and, one hopes, understanding, has led me to read meta-analyses with a grain of salt substitute. They average meta-analysis and systematic review is good for gaining a general understanding of the topic within, as well as, and here is the key phrase, the limitations of the included studies.

And like all the published literature, when writing a meta-analysis, those with an axe to grind will grind it. Even, or perhaps especially, the Cochrane reviews.

Just because something is labelled as a systematic review does not mean it is any good. We have to be just as vigilant now as ever. Even a review with a Cochrane label does not make its true. Four out of 12 Cochrane reviews on acupuncture were wrong. Caveat lector rules, OK? (more…)

Posted in: Basic Science, Clinical Trials, Critical Thinking, Pharmaceuticals, Science and Medicine

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Telemedicine: Click and the doctor will see you now

Think you need to see a doctor? How about seeing him (or her) on your computer (or tablet or smart phone) screen instead of in the doctor’s office?

The technology of telemedicine, or telehealth, is here. So far, there is no single definition of what it does, and does not, encompass. For example, in some definitions, one of which we discuss today, it includes only video communication. Other definitions are broader, including fax, telephone, and e-mail. Here, we focus mainly on the direct patient-physician telemedicine encounter, unmediated by the presence of a physician who has actually seen the patient face-to-face. This is unlike, for example, the more common specialist consultation, in which the patient and physician have met face-to-face and the specialist is brought in via technology. A typical example of this is the radiologist who reads x-rays from a remote location. (Sometimes so remote that the radiologist isn’t even in the same country.) There is some evidence, but not much yet, that certain kinds of physician-mediated telemedicine can benefit the patient.

One can think of many ways a patient’s accessing a doctor via computer might improve access to healthcare. This could be a godsend for patients in rural areas who must drive an hour or more to find a doctor’s office. For example, here’s a program from the University of Mississippi Medical Center:

The Diabetes Telehealth Network will [put telemedicine] technology in the hands of the patients themselves in the form of Internet-capable tablets equipped with the Care Innovations™ Guide platform.

The Care Innovations™ Guide platform enables health-care providers to offer a clinically driven, fully integrated remote care management solution for populations with chronic conditions. The project will recruit up to 200 patients in Sunflower County, MS, who will use Care Innovations technology to share health data, such as weight, blood pressure, and glucose levels, daily with clinicians.

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Posted in: Acupuncture, Chiropractic, Computers & Internet, Herbs & Supplements, Homeopathy, Legal, Medical Ethics, Naturopathy, Pharmaceuticals, Politics and Regulation

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Microwaves and Nutrition

Microwave-OvenScience-based medicine is a concept that is larger than the analysis of any specific topic. It is, essentially, an approach to answering health and medical questions, one that involves careful and thorough analysis of scientific evidence within a framework of understanding of critical thinking, mechanisms of self-deception, and the process of science itself. We feel this creates the best opportunity to arrive at tentative conclusions that are most likely to be reliable.

We often address claims that are the result of a very different process. In fact there seems to be a thriving subculture on the internet that emphasizes the naturalistic fallacy, fear of anything technological (including irrational chemophobia), paranoia about the government, corporations, and mainstream medicine, and embracing anything perceived as being contrarian, exotic, or radical. To this subculture science is either the enemy, or it is used (as Andrew Lang famously quipped) like a drunk uses a lamppost, for support rather than illumination. This approach is simultaneously gullible and cynical.

It is no surprise that those who follow this fatally flawed approach consistently arrive at the wrong conclusion, especially on any controversial scientific topic. The two most prominent netizens following this approach, in my opinion, are Joseph Mercola and Mike Adams. I do believe, however, that there is another hoping to join their ranks – Vani Hari, who blogs under the name Food Babe. (Mark Crislip also blogged about her here.)

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Posted in: Nutrition, Science and Medicine

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Dr. Joe Writes About Quackery

Not long ago I wrote about the free online “Food for Thought” course. Joe Schwarcz (“Dr. Joe”) was one of the three professors teaching that course. He also has a radio show, a blog, a podcast, and he writes books. His newest book will be of particular interest to SBM readers: Is That a Fact? Frauds, Quacks, and the Real Science of Everyday Life.

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I reviewed an earlier book of his, The Right Chemistry, for Skeptic magazine. You can read my review online here. I called him “The Carl Sagan of Chemistry” for his ability to popularize science and make it not only palatable but fascinating and entertaining. In the new book, Dr. Joe turns his attention to exactly the kind of subjects we cover on this blog. He is a chemist and most of us are physicians, but we reach the same conclusions because we look at the evidence from the same rigorous scientific viewpoint.

In The Right Chemistry, Dr. Joe explains that “chemical” does not mean “bad stuff” — chemicals make up the entire world, and we are made of chemicals that our own body manufactures. He shares his encyclopedic store of obscure and intriguing scientific facts. Have you ever heard of kangatarians? Did you know asparagus can grow up to 10 inches a day? Can you explain why crystals of Epsom salts crumble if you yell at them? Do you think explosives can’t be made on a plane with small amounts of liquids? (Dr. Joe thinks they can, but for obvious reasons he’s not divulging the recipe.) You probably didn’t know that in World War II the U.S. military developed a mixture called “Who Me?” that smelled like feces and was dispensed with an atomizer. French Resistance fighters were supposed to surreptitiously spray it on German officers to embarrass them, but it wasn’t a great success since the sprayer ended up as stinky as the sprayee.
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Posted in: Book & movie reviews

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