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Bogus Diagnostic Tests

A few years ago a friend asked me to comment on advice given to her adult daughter by a psychiatrist whom she’d consulted for depression. The psychiatrist had recommended testing samples of saliva and urine for hormone and neurotransmitter levels, the results of which would likely indicate a need for supplements to correct deficiencies or imbalances. According to the psychiatrist, who had an academic appointment at a medical school in New York City, “I have been using these supplements with a great deal of success.” My friend is not medically or scientifically sophisticated, but this made her a little uncomfortable. In that, she was entirely justified.

During our recent panel discussion at the NECSS, a member of the audience identified himself as a clinical pathologist at a major medical center, and wondered what he might do to become involved in the good fight against encroaching pseudoscience in medical schools. Clinical pathology is the medical specialty that concerns itself, in summary, with laboratory tests—their development, their validity, their interpretation, their usefulness and, by implication, their misuse. A topic that we haven’t much featured on SBM (we touched upon it here, here and here, and probably elsewhere) is that of bogus laboratory or other diagnostic tests.

Early in my own education in modern quackery, I found it particularly distasteful not merely that quacks misuse laboratory tests, but that several commercial laboratories market misleading tests. To the untrained eye these laboratories appear to be legitimate, even to the point of their being approved by apparently legitimate certifying bodies. We’ll discuss that below, but first let’s look more closely at the psychiatrist’s recommendations to my friend’s daughter and at other examples of bogus tests.

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Posted in: Diagnostic tests & procedures, Health Fraud, Medical Ethics, Politics and Regulation

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Tactless About TACT: Critiques Without Substance Should Be Abandoned

In May 2008, the article “Why the NIH Trial to Assess Chelation Therapy (TACT) Should Be Abandoned” was published online in the Medscape Journal of Medicine. The authors included two of our own SBM bloggers, Kimball Atwood and Wallace Sampson, along with Elizabeth Woeckner and Robert Baratz. It showed that the existing evidence on treating heart disease with IV chelation did not justify further study, and that the TACT trial was questionable on several ethical points. Their ethical concerns were taken seriously enough that enrollment in the trial was put on hold pending an investigation. It has now been re-opened after a few band-aids were applied to the ethical concerns. The scientific concerns were never addressed.

I have seen many critiques of the Atwood study, and not a single one has offered any cogent criticism of its factual content or reasoning. Most of them could have been written by someone who had not bothered to read beyond the title. Their arguments can be boiled down to a few puerile points that can be further simplified to:

(1) I believe the testimonial evidence that chelation works.
(2) Atwood and his co-authors are bad guys.

Now Beth Clay has chimed in with an article entitled “Study of Chelation Therapy Should Not Be Abandoned.” I found it truly painful to read, but even the worst has some value as a bad example. Clay’s article could be used for a game of “Count the Errors.” I will point out some of them below. (more…)

Posted in: Clinical Trials, Politics and Regulation, Science and Medicine

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Mercury emissions from coal-burning power plants and autism: Is there a correlation?

ResearchBlogging.orgOn April 30, outside the courthouse in Dallas, a press conference/rally was held. This particular rally was in response to a new study published by a group led by Dr. Raymond F. Palmer in the Department of Family and Community Medicine at the University of Texas Health Science Center in San Antonio, whose conclusion was that autism prevalence correlates strongly with proximity to mercury-emitting coal-burning power plants and other industrial sources of airborne mercury, the implication being that such sources of mercury may be causal or contributory to the development of autism. Unfortunately, the rally was reported by the media as though this study were slam dunk evidence that mercury environmental mercury is a definite contributor to the development of autism. For example, there is some video (also here) from local news sources of the rally, in the first of which it is stated as fact that mercury caused autism in the child featured in the story and in the second of which a mother who thinks that mercury causes autism is quoted credulously. This study has had much less play in the national news, but antivaccination activists, such as the ones at the Age of Autism website, a site whose main theme is that either mercury in the thimerosal preservative that used to be in childhood vaccines before 2002 or vaccines themselves cause autism, both promoted the rally and posted a glowing and credulous take on the study, as did “alternative medicine” and antivaccinationist website NaturalNews.com.

My first thought upon reading of this is that it is yet more vindication of the science showing that the claim that mercury in thimerosal-containing vaccines is a failed hypothesis. After all, as I have predicted time and time again, as the scientific and epidemiological evidence continued to mount that thimerosal is just plain not associated with autism or autism spectrum disorders, even the most diehard adherents to this belief are starting to realize that they were backing a losing horse, especially since thimerosal was removed from all childhood vaccines other than the flu vaccine in 2001, leaving only trace amounts from the manufacturing process and there is no sign that autism prevalence is falling. That’s why lately, their effort has shifted from primarily demonizing mercury to blaming other “toxins” in vaccines, even to the point that their efforts to demonize some ingredient–any ingredient–in vaccines often reaches ridiculous levels of blatant silliness, such as touting sucrose as one of those “toxins.” Indeed, I was puzzled. If environmental mercury is the new cause of autism, then the rationale antivaccinationists use to demonize vaccines and portray their children as “vaccine-damaged” is much less potent. Why on earth would they tout this study, which, even if a good study (and it’s not), would weaken their arguments against vaccines immeasurably and take power away from their whole new propaganda slogan “Green Our Vaccines”? The only reason I could think of is that perhaps they somehow think that if mercury in the environment can be linked to autism that maybe–just maybe–they can convince people that they were right about mercury in vaccines all along. Indeed, this seems to be the sort of tack that David Kirby took a year ago when he started arguing that mercury emissions from coal-burning power plants in China (which do reach California), coupled with mercury emission from crematoria in which cadavers with mercury fillings were burned, were contributing to the continued increase in the autism caseload in California despite the elimination of thimerosal in 2001.

But what does the study say itself? Is it good evidence that airborne mercury from coal-fueled power plants is an important contributor to the development of autism? I will argue no, because the study’s flaws are so innumerable that it is well nigh uninterpretable. For simplicity’s sake, to summarize its findings, I’ll quote a Science Daily press release about it:
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Posted in: Neuroscience/Mental Health, Public Health, Science and the Media, Vaccines

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