Articles

Posts Tagged quackery

Of the Trial to Assess Chelation Therapy, Bayes, the NIH, and Human Studies Ethics

An experiment is ethical or not at its inception; it does not become ethical post hoc—ends do not justify means.
~ Henry K. Beecher

tact

A couple of weeks ago, Dr. Josephine Briggs, the Director of the National Center for Complementary and Alternative Medicine (NCCAM), posted a short essay on the NCCAM Research Blog touting the results of the Trial to Assess Chelation Therapy (TACT) (italics added):

The authors found that those receiving the active treatment clearly fared better than those receiving placebo. The accompanying editorial in the AHJ reminds readers about the value of equipoise and the need to “test our beliefs against evidence.”

Most physicians did not expect benefit from chelation treatment for cardiovascular disease. I readily admit, initially, I also did not expect we would find evidence that these treatments reduce heart attack, strokes, or death. So, the evidence of benefit coming from analyses of the TACT trial has been a surprise to many of us. The subgroup analyses are suggesting sizable benefit for diabetic patients—and also, importantly, no benefit for the non-diabetic patient. Clearly subgroup analyses, even if prespecified, do not give us the final answer. But it is also clear that more research is needed to test these important findings.

And TACT findings are indeed a reminder of the importance of retaining equipoise [sic], seeking further research aimed at replicating the findings, and neither accepting nor rejecting findings based on personal biases. The scientific process is designed to weed out our preconceived notions and replace them with evidence.

Dr. Briggs concluded:

So, TACT is a reminder—an open mind is at the center of the scientific method.

Dr. Briggs’s title was “Bayes’ Rule and Being Ready To Change Our Minds”, a reference to a recent editorial that had accompanied one of the TACT papers. That editorial, by Dr. Sanjay Kaul, a physician and statistician from UCLA, begins with this quotation:

Preconceived notions are the locks on the door to wisdom.
~ Merry Browne

Here is the relevant passage from Dr. Kaul’s editorial (italics added):

Sixth, it has been argued that the trial was unethical because there was no compelling clinical or preclinical evidence that chelation therapy has significant efficacy against atherosclerotic cardiovascular disease, and given that chelation therapy can cause harm, the risk was not minimal. A Bayesian analysis would not look kindly on the results because of the low prior probability of treatment effect (the so-called implausibility argument).6 This is an uncharitable (and unwarranted) interpretation of the data because previous systematic reviews concluded, “insufficient evidence to decide on the effectiveness or ineffectiveness of chelation therapy in improving clinical outcomes among people with atherosclerotic cardiovascular disease.” It is axiomatic that absence of evidence of efficacy is not the same as evidence of the absence of efficacy.

From a Bayesian perspective, the strength of evidence is often summarized using a Bayes factor, which is a measure of how well 2 competing hypotheses (the null and the alternate) predict the data. The Bayes factor and the corresponding strength of evidence for the primary end point result in TACT overall, and diabetic cohorts are shown in Table 1. The p-value of 0.035 for TACT overall cohort translates into a Bayes factor of 0.108, which means the evidence supports the null hypothesis ≈1/9th as strongly as it does the alternative. This reduces the null probability from 50% pretrial (justified by suspension of one’s belief in treatment effect) to 10% post-trial. Although this does not represent strong evidence against the null, it does reduce the level of skepticism surrounding chelation therapy. In the diabetic cohort, the nominal p-value of 0.0002 translates into a Bayes factor of 0.002 (1/500), which reduces the extremely skeptical prior null probability of 95% to 4% post- trial, indicating very strong evidence against the null.

In concluding, Dr. Kaul states:

Finally, TACT highlights the double standard when it comes to accepting inconvenient results not aligned with our preconceived notions on so-called dubious quack cures such as chelation…

Closed minds?

Dr. Kaul’s reference “6” above is to a lengthy article that we published in 2008 titled “Why the NIH Trial to Assess Chelation Therapy Should Be Abandoned”. So, it seems, both Drs. Briggs and Kaul were chastising us for our biased, preconceived beliefs about so-called dubious quack cures. Our minds were, apparently, not open. Let’s examine this contention. (more…)

Posted in: Clinical Trials, Health Fraud, Medical Academia, Medical Ethics, Politics and Regulation

Leave a Comment (54) →

Beware the Integrative Pharmacy

pharmacy window

Imagine a retail pharmacy where some of the medicines on the shelves have been replaced with similar-looking packages that contain no active ingredients at all. There is no easy way to distinguish between the real and the fake.

Another section of the store offers a number of remedies with fantastic claims, such as “boosting” the immune system, “detoxifying” the body, or “cleansing” you of microscopic Candida. They look sciencey, unless you realize that they treat imaginary medical conditions.

A corner of the store offers unpurified drugs supplied as tinctures and teas. The active ingredients aren’t known, and the batch-to-batch consistency of the product is unclear. The store will suggest products for you based on your symptoms.

Walk past the enormous wall of vitamins and other supplements and you’ll find a nutritionist who will tell you what products you should be taking. You’ll also find a weight loss section. From a science-based perspective, this shouldn’t even exist, given no product has been shown to offer any meaningful benefit. But there are dozens of products for sale.

At the back of the store you’ll finally find the pharmacist. A sign on the counter offers blood- and saliva-based tests for food “intolerance” and adrenal “fatigue”, claiming to test for medical conditions that actually don’t exist or lack an evidence base. The pharmacy also offers a large compounding practice, advertising what it calls “personalized” approaches to hormone replacement with “bioidentical” hormones.

Welcome to the “integrative” pharmacy.

You may not see all these features in your local drug store, but they’re coming: claims of a new “integrative” way to provide health care that is changing the face of retail pharmacy. Unfortunately, it’s harkening back to the era of patent medicines and snake oil. It’s not good for the pharmacists and the profession of pharmacy, and it’s even worse for patients. (more…)

Posted in: Homeopathy, Medical Ethics, Politics and Regulation, Science and Medicine

Leave a Comment (99) →

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.

dr-hoe-is-that-a-fact

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.
(more…)

Posted in: Book & movie reviews

Leave a Comment (58) →

Naturopathy vs. Science: Vaccination Edition

evil-mr-vaccine

We saw it coming. The re-emergence of vaccine-preventable disease should surprise no-one that’s been following the anti-vaccine movement.

Rebutting anti-vaccine rhetoric feels like a Sisyphean struggle. Steven Novella likened it to a game of whack-a-mole, where the moles are the same old tropes that keep popping up, no matter how often they are refuted with facts. Vaccines are a remarkable success of modern medicine: They are health interventions that are both demonstrably effective and remarkably cost-effective. Vaccination has likely prevented more deaths in the past 50 years than any other health intervention. Smallpox was a ruthless killer that took 300 million lives, just in the 20th century alone. Today it’s gone – eliminated forever. And now there are now over two dozen diseases that are vaccine-preventable. They should be an easy sell, and to most people, they are. But the control of vaccine-preventable disease relies in part on herd immunity – sufficient immunization to stop the spread of infection (no vaccine offers 100% protection) and protect those that cannot be immunized. Even a modest number of unvaccinated individuals can lead to reemergence of disease. None of this matters to antivaccinationists, to whom vaccines are bad. Viewing anti-vaccine websites for only five to ten minutes can increase the perception of risk of vaccination, and decrease the perceived risk of omitting vaccines. It also lowers vaccination intentions. By changing perceptions of safety, the willingness to vaccinate decreases. Now imagine that someone you believe to be a health professional openly questioned the efficacy and safety of vaccines – would it reduce your willingness to vaccinate? The evidence says it does. And that’s why the modern practice of naturopathy or “naturopathic medicine” is so concerning. Naturopaths have opposed vaccinations since the invention of naturopathy – starting with smallpox: (more…)

Posted in: Naturopathy, Vaccines

Leave a Comment (81) →

pH Miracle Living “Dr.” Robert O. Young is finally arrested, but will it stop him?

pH Miracle Living “Dr.” Robert O. Young is finally arrested, but will it stop him?

Being a cancer surgeon and researcher, naturally I tend to write about cancer a lot more than other areas of medicine and science. It’s what I know best. Also, cancer is a very common area for unscientific practices to insinuate themselves, something that’s been true for a very long time. The ideas don’t change very rapidly, either. Drop a cancer quack from 2014 into 1979, and he would probably be right at home. Of course, part of the reason is because the “elder statesmen” of cancer quackery today were getting their starts in 1979. Still, the same ideas keep recurring even as far back as a century ago and even older, and if you broaden your criteria, these ideas exist on a continuum, either having descended directly from various ancient ideas such as vitalism, miasmas, or humoral theory or branched off somewhere along the way. Others branch off from the progress of science, taking a germ of a seemingly reasonable idea and turning it into quackery. It is the latter with which I plan on concerning myself today, the reason being that over the weekend I heard some truly awesome news. One of the most egregiously practicing non-physicians who claim to be able to cure cancer that I’ve ever encountered was arrested—yes, arrested!—and arraigned on criminal charges. I’m referring to “Dr. Alkaline” himself, he of the pH Miracle Living program and his Articles of Health blog, “Dr.” Robert O. Young. Behold:
(more…)

Posted in: Cancer, Naturopathy, Politics and Regulation

Leave a Comment (592) →

“Low T”: The triumph of marketing over science

A man on TV is selling me a miracle cure that will keep me young forever. It’s called Androgel…for treating something called Low T, a pharmaceutical company–recognized condition affecting millions of men with low testosterone, previously known as getting older.

The Colbert Report, December 2012

 

And now for something completely different…sort of.

After writing so much about the latest developments in the ongoing saga of the cancer doctor who is not an oncologist and not a legitimate cancer researcher, plus a rumination on what’s up with President Obama’s nominee for Surgeon General and our favorite form of unscientific medicine, so-called complementary and alternative medicine (CAM), also known as “integrative medicine,” I thought it was time for a change of pace. I wasn’t sure what I was going to write about as Sunday rolled around, but fortunately, as sometimes happens, the New York Times dropped a topic right in my lap, so to speak, both figuratively and literally. It comes in the form of a long article on something that directly concerns men of a certain age, which unfortunately happens to mean men of my age and older. I’m referring to what pharmaceutical company advertising campaigns have dubbed “low T,” short for low testosterone. It’s not clear how the term “low T” originated but Dr. Abraham Morgentaler, founder of Men’s Health Boston, claims to have coined the term when his patients were embarrassed by their difficulty pronouncing the word “testosterone.” Other sources report that it was Solvay Pharmaceuticals that coined the phrase. It doesn’t really matter where the term “low T” came from. The term has stuck, even though the more “correct” medical term would be hypogonadism, as in a man’s testes not working.
(more…)

Posted in: Clinical Trials, Pharmaceuticals, Science and the Media

Leave a Comment (67) →

Yes, Chris beat cancer, but it wasn’t quackery that cured him

Editor’s note: Due to technical difficulties, SBM experienced considerable downtime yesterday. I therefore decided to delay publishing this post until now. Harriet’s normally scheduled Tuesday post will also appear later.

I like to think that one of the more important public services I provide here at Science-Based Medicine is my deconstructions of alternative cancer cure testimonials. After all, one of the most powerful marketing tools purveyors of cancer quackery have in their arsenal is a collection of stories of “real patients” with cancer who used their nostrums and are still alive and well. These sorts of analyses of alternative cancer cure testimonials began right near the very beginning of my not-so-super-secret other blog way back in 2004, metastasized—if you’ll excuse my use of the term—to SBM in 2008, and have continued intermittently to this very day, most recently with a bevy of posts showing why the testimonials of Stanislaw Burzynski’s patients do not constitute good evidence that he can cure cancers considered incurable by “standard” medicine. In other words, Burzynski’s “success stories” aren’t the slam-dunk evidence he and Eric Merola want you to believe them to be regarding the use of antineoplastons to cure brain cancers.

Sometimes, these patients who believe that alternative medicine somehow cured their cancers are so transformed, so energized, that they basically devote their lives to selling, in essence, their story, along with all the stuff they did to “cure” their cancer. I just came across one such person, a man by the name of Chris Wark, whose website and blog Chris Beat Cancer sells the idea that he beat his cancer with nutrition and “natural therapies” that he used to “heal himself.” All of this wouldn’t be quite so horrible—after all, there are lots of people who believe in woo and say so publicly—except that Wark is now also selling all sorts of misinformation about cancer, at $175 for a two hour phone consultation. Regular readers will recognize right away where Mr. Wark goes wrong in his story. Even so, I think it’s worthwhile to take a look because since discovering Mr. Wark’s site I’ve seen his name popping up all over the place promoting “natural” cures, and his site has become a repository of all sorts of “alternative cancer cure” testimonials, as well as credulously promotional material for quackery like Gerson therapy, the Beck protocol, and the Gonzalez protocol.

First, let’s take a look at Mr. Wark’s story. Since his story is so simple to deconstruct, I’ll then look at more of the material on his website. Right on the front page of Mr. Wark’s website, there is a brief blurb about him that reads:
(more…)

Posted in: Cancer

Leave a Comment (58) →

Naturopathic Medicine Week 2013, or: Quackery Week 2013

[Ed. Note: This is an extra "bonus" post from Dr. Gorski's not-so-super-secret other blog. He thought the topic would be of interest to SBM readers as well. Fear not. There will be a post on Monday, as usual.]

The vast majority of ideas and treatments that make up the “complementary and alternative medicine” (CAM) specialty known as naturopathy are quackery. There, I said it. No doubt I will be castigated for being too “blunt,” “dismissive,” or “insulting,” but I don’t care. It is my opinion based on science, and I’m sticking to it.

The problem with naturopathy, of course, is that it is so diffuse and encompasses so many different forms of quackery that it’s hard to categorize. Basically, it’s anything that can be portrayed as “natural,” be it traditional Chinese medicine, homeopathy (which is an integral component of naturopathy, something that should tell you all you need to know about naturopathy), herbalism, energy healing, Ayurvedic medicine, the four humors, or whatever. Add to that a number of bogus diagnostic modalities, such as applied kinesiology, live blood cell analysis, iridology, tests for imaginary “food allergies” and “nutrient deficiencies” that conventional medicine doesn’t recognize, plus an overwhelming emphasis on purging the body of “toxins,” unnamed and named but all unvalidated by science, and it rapidly becomes apparent that naturopathy is a veritable cornucopia of pseudoscience and quackery. Seemingly, there is no quackery that naturopathy does not credulously embrace, which is why the success of recent efforts of naturopaths to achieve licensure in several states and even obtain limited privileges to prescribe real pharmaceutical drugs is so alarming, as are their efforts to become recognized as primary care providers under the Affordable Care Act. Basically, naturopathy is a hodge-podge of quackery mixed with science-based modalities magically “rebranded” as “alternative” and “natural.” In that, naturopathy is the ultimate in “integrative medicine,” in which quackery is “integrated” with science-based medicine. As I’ve pointed out many times before, integrating quackery and pseudoscience with real medicine does not elevate the quackery and pseudoscience, but it does contaminate the real medicine with quackery to no good benefit. Unfortunately, it’s insinuating itself into the law.

With that introduction in mind, did you know that the week of October 7 through 13 is Quackery Week in the U.S.? No, seriously, it is. The Senate just passed a resolution declaring that this is so. Oh, it’s true that the Senate didn’t actually call it that. Instead, the resolution (S.Res. 221) was passed, and it declares the week of October 7 to 13, 2013 to be Naturopathic Medicine Week, which is the same thing as declaring it Quackery Week:

S.Res.221 – A resolution designating the week of October 7 through October 13, 2013, as “Naturopathic Medicine Week” to recognize the value of naturopathic medicine in providing safe, effective, and affordable health care.

(more…)

Posted in: Homeopathy, Naturopathy, Science and the Media

Leave a Comment (124) →

Sharyl Attkisson and CBS News: An epic fail in reporting on the murder of autistic teen Alex Spourdalakis

An antivaccine reporter strikes again

The damaged done by the antivaccine movement is primarily in how it frightens parents out of vaccinating using classic denialist tactics of spreading fear, uncertainty and doubt (FUD). Indeed, as has been pointed out many times before, antivaccinationists are often proud of their success in discouraging parents from vaccinating, with one leader of the antivaccine movement even going so far as to characterize his antivaccine “community, held together with duct tape and bailing wire,” as being in the “early to middle stages of bringing the U.S. vaccine program to its knees.” Meanwhile, just last week Anne Dachel, “media editor” for the antivaccine crank blog Age of Autism, gloated about basically the same thing, how although overall vaccination rates remain high, vaccine exemption rates are up in many areas of the country and how her movement has provided plenty of information to “scare [parents] out of vaccinating.”

And it is the very same antivaccine propaganda blog, Age of Autism, that is promoting a different, more insidious message, specifically how the brutal murder of an autistic teen nearly three months ago “illumines the autism nightmare.” What do I mean by “insidious message”? It’s the hijacking of the autism advocacy movement, which tries to advocate for more services for autistic children and adults and more awareness and understanding of autism, by the antivaccine message that autistic people are somehow “damaged,” be it by vaccines or unnamed “toxins,” that the “real child” has been “stolen” by autism, and that any manner of biomedical quackery to “recover” autistics is justified by the horror of autism. Although Attkisson, the reporter for the story discussed below, never specifically mentions vaccines, if you know the background of the case, that message is quite obvious and not very far under the surface of her report on the murder of Alex Spourdalakis:

Not surprisingly, this story was reported by Sharyl Attkisson, who is CBS News’ resident antivaccine reporter. I’ve known her to promote antivaccine views in a manner that gave Robert F. Kennedy, Jr. a run for his money as far back as 2007. Since then, she’s smeared Paul Offit as a “pharma shill,” very likely fed information to someone at AoA to help them portray Lisa Randall at Voices for Vaccines as an “industry group,” done a puff piece about antivaccine physician and hero to the antivaccine movement Andrew Wakefield, and misreported the significance of the Hannah Poling case (which was really just the rebranding of autism). Most recently, Attkisson promoted a truly execrable “review article” summarizing the evidence relating vaccines to autism. The review article, by Helen Ratajczak, cited lots of pseudoscience from antivaccine literature in the service of supporting a truly dumb hypothesis, namely that DNA from vaccines could recombine in the brains of children to result in autism. Attkisson was quite smitten with the idea. As you might imagine, I was not. Along the way, Attkisson also indulged in promoting breast cancer misinformation. No wonder she is the perfect reporter to do this story promoting the viewpoint that autism is so horrible and the system provides so little help that we should understand why a mother like Alex’s might become so desperate that she would poison her son and then, when that failed to kill him, try to slash his wrist, and then, when that failed, stab him in the heart with a kitchen knife.
(more…)

Posted in: Neuroscience/Mental Health, Science and the Media, Vaccines

Leave a Comment (30) →

Preventing autism? Not so fast, Dr. Mumper…

Dug the Dog strikes again, as he did three weeks ago. I had a couple of ideas for a post this week, but none of them were time-sensitive or timely. Then, over the weekend, I saw a post on the antivaccine crank blog Age of Autism by Dan “Where are the Autistic Amish” Olmsted entitled Weekly Wrap: Another Medical Practice with a Sane Vaccine Schedule – and No Autism. Given the tendency towards a—shall we say?—lack of accuracy of Olmsted’s previous reporting, it’s no surprise that he’d latch on to this study. I’m also seeing it appear around other antivaccine websites. I had gotten wind of it late last week, a few of my readers having sent it to me but hadn’t decided yet whether to blog about it. Then it appeared on AoA. Thanks, Dan.

So let’s see how this study is being spun by the antivaccine movement:

When we at Age of Autism talk about ending the epidemic, the “to do” list seems almost overwhelming – funding a vax-unvaxed study, getting mercury out of flu shots, proving the HepB shot is nuts, wresting control of the agenda from pharma, fixing Vaccine Court (this time in the good sense of “fix”), establishing that biomedical treatments help kids recover, and on and on.

But there’s a shortcut to all this, and it goes straight through pediatricians’ offices. The evidence is growing that where a sane alternative to the CDC’s bloated vaccine schedule is offered, and other reasonable changes adopted, autism is either non-existent or so infrequent that it doesn’t constitute an epidemic at all.

The latest example comes from Lynchburg, Va., and the pediatric practice of Dr. Elizabeth Mumper. She noticed a frightening rise in autism in the 1990s. Concerned that vaccines and other medical interventions might be playing a role – concerned in other words that SHE was playing a role — Mumper changed course.

Fewer vaccines. Fewer antibiotics. No Tylenol. Breast-feeding. Probiotics. Good, pesticide free diets.

Since then, hundreds more children have been seen in her practice, Advocates For Children. But no more autism.

(more…)

Posted in: Neuroscience/Mental Health, Public Health, Vaccines

Leave a Comment (28) →
Page 1 of 6 12345...»