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Angelina Jolie, surgical strategies for cancer prevention, and genetics denialism (revisited)

Angelina Jolie

Angelina Jolie

Sometimes, weird things happen when I’m at meetings. For example, I just got home from the Society of Surgical Oncology (SSO) meeting in Houston over the weekend. Now, one thing I like about this meeting is that, unlike so many other meetings these days—cough, cough, ASCO, I’m looking at you—at the SSO there wasn’t a single talk I could find about “complementary and alternative medicine” (CAM) or, as its proponents like to call it now, “integrative medicine.” It’s also a great chance to get caught up on new science and clinical guidelines in cancer surgery, as well as to see people I tend only to see at these meetings.

However, I must admit that by the last day I tend to be “meeting-ed” out and sometimes my attention wanders. Unfortunately, there are ample ways to indulge that attention deficit. Actually, it’s my iPhone. And it’s Twitter. So it was an odd coincidence that right after a talk by Dr. Deanna Attai about whether surgical oncologists can or should offer genetic counseling services to their patients, when I somehow let myself get into an exchange with Sayer Ji, the “natural health expert” responsible for GreenMedInfo, over BRCA1 mutations and the risk of breast and ovarian cancer, in other words, exactly the sort of thing that Dr. Attai had just discussed. For example:

After a bit of back-and-forth, I got fed up:

This minor Twitter exchange came about because of Angelina Jolie’s announcement in a New York Times op-ed last week entitled “Diary of a Surgery” that she had had her ovaries removed to prevent ovarian cancer due to her being a carrier of a high-risk mutation in BRCA1. As you might recall, I wrote about Jolie’s case two years ago, when she first announced in a NYT op-ed entitled “My Medical Choice” that she had undergone a bilateral mastectomy with reconstruction to decrease her BRCA1-related risk of breast cancer. Although I had discussed the story before, I thought it worth doing again here in a bit more detail. (more…)

Posted in: Basic Science, Cancer, Surgical Procedures

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NECSS and SfSBM: A weekend of science and skepticism

Screen Shot 2015-01-09 at 1.35.26 PM

A day of Science-Based Medicine, a weekend of science and skepticism

NECSS, the North-East Conference on Science and Skepticism, is upon us. Included in the program will be a day of Science-Based Medicine.

Full Conference schedule here with Bill Nye as the Keynote speaker.

SfSBM speakers will be Harriet Hall, Jann Bellamy, David Gorski, Steve Novella and Mark Crislip.

SfSBM speakers will also participate in panels on the 11th and 12th.

NECSS will be held April 9th–12th, 2015, in New York City at the Fashion Institute of Technology.

Description: NECSS welcomes over 400 attendees to New York City for a celebration of science and critical thinking. Through individual presentations, panel discussions, and performances, attendees are informed and inspired by leading scientists, educators, activists, and performers – each bringing their own perspective and passion to the goal of fostering a more rational world.

The SfSBM program will be Friday, April 10 and you can attend one or more of the days. $95 for one day or $195 for the entire conference.  The target audience of the SfSBM presentations will be the general population.

SfSBM Program

09:00 – 10:00 60 minutes Registration/Will Call
10:00 – 10:10 10 minutes OPENING: Steve Novella and David Gorski
10:10 – 10:45 35 minutes: Steve Novella. SBM – Going Beyond Evidence-Based Medicine.
10:45 – 11:20 35 minutes: Harriet Hall. Chiropractic: Not All It’s Cracked Up To Be.
11:20 – 11:55 35 minutes: David Gorski. Integrative Medicine: Integrating Cow Pie with Apple Pie
11:55 – 12:30 35 minutes: Mark Crislip. How Acupuncture ‘Works’
12:30 – 02:00 90 minutes LUNCH
02:00 – 02:35 35 minutes Speaker 4: Jann Bellamy. Political Pseudoscience
02:35 – 03:35 60 minutes Panel  Placebo Effect and More
03:35 – 03:50 15 minutes BREAK
03:50 – 04:35 45 minutes Q&A from Twitter & Audience
04:35 – 05:20 45 minutes SBM Jeopardy
05:20 – 05:30 10 minutes CLOSING
05:30 – 06:00 30 minutes SBM Business Meeting

For more information and to register, go to NECSS or this registration page.

The Society for Science-Based Medicine is a co-sponsor of NECSS and paid SfSBM members can get a 15% discount using the code SFSBM2015.

Also at NECSS

 SGU Skeptical Extravaganza with guest star Bill Nye

 April 10, 2015 @ 7:30PM

Haft Auditorium, 227 W. 27th St., NY, NY 10001

Cost: $25 general public / $15 NECSS attendees

Website: www.necss.org/extravaganza

Special guest Bill Nye joins multi-talented musician George Hrab and the award-winning Skeptics’ Guide to the Universe podcast for a two-hour stage show celebrating science, skepticism, and everything geeky (including the ever-popular quiz show). Best of all, tickets are open to the general public; conference registration is not required to attend!

Posted in: Announcements

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Separating Fact from Fiction in the Not-So-Normal Newborn Nursery: Chiropractic and Craniosynostosis

cranialsutures

Pediatricians, particularly those who spend a significant amount of time caring for newborns, see a lot of babies with unusually-shaped heads. Although to be fair, the fact that the overwhelming majority of vaginally-delivered babies, and quite a few born via Caesarean section, will have a transient and abnormal shape to their heads makes it, well, not unusual. In fact, I rarely make it out of the room without some discussion and reassurance regarding the lumps and bumps of a new arrival’s head.

The potentially lumpy and misshapen head of the newborn occurs for a variety of reasons, some common and some extremely rare. It often is related to the development of the bones of the skull but can also involve the surrounding tissues of the scalp. A vaginal delivery, and some difficult Caesarean births, subject a baby’s head to a lot of pressure. This pressure frequently results in swelling of the scalp that can be quite impressive, but tends to resolve in a day or two.

This same pressure can also cause bleeding, perhaps because of an insufficient amount of vitamin K available to optimally activate clotting, that collects under the top layer of one or more of the bones of the skull. These cephalohematomas can also be impressive and may take weeks to completely resolve. Rarely the trapped blood becomes calcified and requires surgical correction to remove the otherwise-permanent lump and restore a normal contour to the head.

Newborns very frequently have a molded skull. Depending on the timing and severity of the pressure experienced during delivery, the shape and size of the uterus and positioning of the baby in the womb, the newborn can emerge with a variety of head shapes. The most common one that I see is a cone. If you’re thinking of a classic Saturday Night Live sketch right now, you’ve got the correct mental image.

Babies who are breech also have a distinct pattern of molding which involves a flattened and elongated top of the head because of pressure against the uterine wall. Abnormal positioning in the womb can also result in asymmetric molding of the head and facial structures like the jaw, nose and ear. Fortunately these pressure-induced and positional deformities usually resolve without intervention, often within a few days, but some are serious enough to require intervention and even surgical correction.

Why are the cranial bones of newborns so easily molded by the pressure of birth? This is a question I answer frequently for new parents and inexperienced medical students. The answer will segue us into the primary topic of this post, but before I discuss craniosynostosis, and the sadly unsurprising claims of some in the chiropractic community, a review of normal cranial anatomy is in order. (more…)

Posted in: Science and Medicine

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Should the FDA crack down on homeopathic “remedies”?

In the category of potentially dangerous complementary or alternative medicine, I can think of few products worse than ones claimed to relieve asthma, yet don’t actually contain any medicine. Yet these products exist and are widely sold. Just over a year ago I described what might be the most irresponsible homeopathic treatment ever: A homeopathic asthma spray. If there was ever a complementary or alternative product that could cause serious harm, this is it:

oral-asthma-spray

Photo Credit Ryan Meylon

 

Among the different treatments and remedies that are considered “alternative” medicine, homeopathy is the most implausible of all. Homeopathy is an elaborate placebo system, where the “remedies” lack any actual medicine. Based on the idea that “like cures like” (which is sympathetic magic, not science), proponents of homeopathy believe that any substance can be an effective remedy if it’s diluted enough: cancer, boar testicles, crude oil, oxygen, and skim milk are all homeopathic “remedies”. (I think Berlin Wall may be my favorite, though vacuum cleaner dust is a runner-up). The dilution in the case of homeopathy is so significant that there’s mathematically no possibility of even a trace of the original ingredient in the typical remedy – they are chemically indistinguishable from a placebo. To homeopaths, this is a good thing, as dilution is claimed to make the medicine-free “remedy” more potent, not less. As would be expected with inert products, rigorous clinical trials confirm what basic science (and math) predicts: homeopathy’s effects are placebo effects. Recently Steven Novella blogged about the Australian Government’s National Health and Medical Research Council’s (NHMRC) comprehensive report on homeopathy which concluded the following: (more…)

Posted in: Homeopathy, Politics and Regulation

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What Is Brain Death?

Of course, any story illustrating the issues surrounding brain death is going to be a sad and tragic tale. In December of 2013, Jahi McMath suffered bleeding complications following a tonsillectomy and tissue removal for sleep apnea. This resulted in a cardiac arrest with an apparent prolonged period of lack of blood flow to the brain. While her heart function was brought back, Jahi suffered severe brain anoxia (damage due to lack of oxygen) and was declared brain dead on December 12, 2013.

Jahi’s tragic story is not over, however, because her family refused to accept the diagnosis of brain death. They took legal action to keep the hospital from pulling life support, and eventually worked out a compromise where the family was able to remove Jahi to their own care. At present Jahi is apparently being cared for in an apartment in New Jersey, on a ventilator and fed through a feeding tube.

There is often some confusion as to what brain death actually is. The term is unfortunately often used to refer to a persistent vegetative state or other severe impairment of consciousness, but this is not accurate. Brain death refers to a complete lack of function of the brain, including basic reflexes in the brain stem. There is a specific protocol for declaring a person brain dead, requiring detailed examination by at least two attending physicians to document the complete absence of any brain function. If the slightest pupillary reflex is present, then the patient cannot be declared brain dead. The criteria also include provisions that there are no medications in the person’s system that can suppress neurological function and their core body temperature is sufficiently high (being too cold can also suppress neurological function).

(more…)

Posted in: Neuroscience/Mental Health

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Ken Burns Presents Cancer

Note: I wrote two posts today to alert readers to two upcoming television events in time for them to plan their viewing. See the second post for an announcement about a film on scientology, along with an article about Scientology’s War on Medicine that I wrote for Skeptic magazine.

Ken Burns

Filmmaker Ken Burns

Ken Burns has made a lot of outstanding films. His The Civil War has been listed as second only to Nanook of the North as the most influential documentary of all time. I was delighted to learn that he had applied his exceptional skills to a topic that is very important to us on the Science-Based medicine blog, cancer. His film is based on the Pulitzer Prize-winning book by Siddhartha Mukherjee, The Emperor of all Maladies: A Biography of Cancer.

I reviewed Mukherjee’s book in 2010. He is an oncologist and cancer researcher and also a superb writer. I characterized his book as:

a unique combination of insightful history, cutting edge science reporting, and vivid stories about the individuals involved: the scientists, the activists, the doctors, and the patients. It is also the story of science itself: how the scientific method works and how it developed, how we learned to randomize, do controlled trials, get informed consent, use statistics appropriately, and how science can go wrong.

I continue to think it is the best book ever written on cancer.

The film interviews Mukherjee and many of the researchers and patients whose stories appear in the book. If you haven’t read the book, it will give you an idea what it’s about. If you have read the book, you will enjoy it even more as you meet the people you have read about. It covers the history of cancer as well as the most recent scientific developments and is very optimistic about the future.

The movie is scheduled to premiere March 30 – April 1 at 9 PM EST on PBS, in 3 parts with a total duration of 6 hours. You can watch the trailer online. The producers sent me a press preview 1-hour highlight reel and I was very impressed. I can’t wait to watch the whole thing. I hope you will be able to watch it too.

Posted in: Announcements, Book & movie reviews, Cancer

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Scientology’s War on Medicine

Note: The film Going Clear: Scientology and the Prison of Belief will be available on HBO starting March 29th. I haven’t seen it yet, but apparently it profiles former members who reveal details that have elicited a very angry response from the Church of Scientology. I thought I would use the occasion to reprint a SkepDoc column that originally appeared in Skeptic magazine (Volume 18: Number 3) titled “Scientology’s War on Medicine.”

Scientology has openly declared war on psychiatry and is ambivalent if not openly hostile towards the rest of medicine. Its “mind over matter” philosophy promises that attaining the “Clear” state will eliminate illness.

Recently there has been a spate of exposés of Scientology, ably reviewed by Jim Lippard on eSkeptic. They offer some shocking revelations. Defectors from Scientology have described kidnappings, deliberate lying, unnecessary deaths, human trafficking, thought control (“brainwashing”), coercion, violations of labor standards, violations of human and civil rights, and other crimes. Scientology has been protected from prosecution by its designation as a religion and its vast wealth and influence; but if even a fraction of these accusations are true, Scientology has much to answer for.

Initially people are attracted to Scientology because it provides answers. Your problems are due to past experiences holding you back. Scientology can help you deal with those problems and the upper levels will reveal the secret of life itself.

Mark VIII E-Meter, from the Wikimedia Commons

Mark VIII E-Meter, from the Wikimedia Commons by Colliric

Members are audited with an E-Meter (similar to a lie detector) and one-on-one attention. The auditing process is similar to psychotherapy in that it encourages people to think about their problems and work to overcome them. In Scientology, ideas are not immaterial: they have weight and solidity. The E-Meter locates and discharges mental masses that are blocking the free flow of energy. Memories are blamed and traced back in time even into past lives. Patients keep repeating the details of the experience until they are drained of any emotional charge. Once the painful experiences and associations are drained off, there are astonishing results: asthma, headaches, arthritis, menstrual cramps, astigmatism, and ulcers simply disappear. The reactive mind is replaced by the rational mind. In one case a boy’s IQ supposedly rose from 83 to 212. (more…)

Posted in: Announcements, Book & movie reviews, Religion

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On the “right” to challenge a medical or scientific consensus

Jenny McCarthy flaunting her "expertise" at the antivaccine "Green Our Vaccines" rally in Washington, DC in 2008

Jenny McCarthy flaunting her “expertise” at the antivaccine “Green Our Vaccines” rally in Washington, DC in 2008

The major theme of the Science-Based Medicine blog is that the application of good science to medicine is the best way to maintain and improve the quality of patient care. Consequently, we spend considerable time dissecting medical treatments based on pseudoscience, bad science, and no science, and trying to prevent their contaminating existing medicine with unscientific claims and treatments. Often these claims and treatments are represented as “challenging” the scientific consensus and end up being presented in the media—or, sadly, sometimes even in the scientific literature—as valid alternatives to existing medicine. Think homeopathy. Think antivaccine views. Think various alternative cancer treatments. When such pseudoscientific medicine is criticized, frequently the reaction from its proponents is to attack “consensus science.” Indeed, I’ve argued that one red flag identifying a crank or a quack is a hostility towards the very concept of a scientific consensus.

Indeed, I even cited as an example of this attitude a Tweet by Jane Orient, MD, executive director of the American Association of Physicians and Surgeons (AAPS). This is an organization of physicians that values “mavericky-ness” above all else, in the process rejecting the scientific consensus that vaccines are safe and effective and do not cause autism or sudden infant death syndrome (SIDS), that HIV causes AIDS, and that abortion doesn’t cause breast cancer, to name a few. Along the way the AAPS embraces some seriously wacky far right wing viewpoints such as that Medicare is unconstitutional and that doctors should not be bound by evidence-based practice guidelines because they are an affront to the primacy of the doctor-patient relationship and—or so it seems to me—the “freedom” of a doctor to do pretty much damned well anything he pleases to treat a patient.
(more…)

Posted in: Critical Thinking, Science and the Media, Vaccines

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Lyme: Two Worlds Compared and Contrasted

The Lyme tick

The western black-legged tick, carrier of the Borrelia burgdorferi bacteria which causes Lyme disease.

The practice of infectious disease (ID) is both easy and difficult. If you read my ID blog on Medscape you are aware of my trials and tribulations in diagnosing and treating infections.

ID is easy since, at least in theory, diseases have patterns and an infecting organism has a predictable epidemiology and life cycle. So if you can recognize the pattern and relate it to the life cycle and exposure history, you can often make a diagnosis before the cultures come back.

My favorite story is the time I was asked to see a young girl with endocarditis. The history was she had a week of fevers, headache and myalgia that went away for five days, returned for a week, went away for five days and returned yet again.

So I asked her “How was your vacation at Black Butte?”

The look of astonishment on her face as she asked how I knew she had been to Black Butte was so satisfying. (more…)

Posted in: Legal, Naturopathy, Politics and Regulation, Public Health, Science and Medicine

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The DC as PCP? Drug Wars Resume

Coming soon, to a chiropractor's office near you?

Coming soon, to a chiropractor’s office near you?

Chiropractors are once again engaged in intra-fraternal warfare over the chiropractic scope of practice, a saga we’ve chronicled before on SBM. (See the references at end of this post.) Every time it looks like the warring factions have buried their differences, they come rising to the surface like zombies.

The International Chiropractors Association (ICA), representing the “straight” faction, wants chiropractic to continue as a drugless profession. They are happy to detect and correct subluxations, thereby removing “nerve interference” and “allowing the body to heal itself” in the tradition of Daniel David Palmer. But the American Chiropractic Association (ACA) has bigger fish to fry.

This time, the ICA is upset that the ACA House of Delegates up and decided to establish a “College of Pharmacology and Toxicology,” which would operate under the auspices of the ACA Council on Diagnosis and Internal Disorders. The ACA’s announcement of the “College” is rather vague on details:

The purpose of the College is to further educate the chiropractic profession on clinical matters related to the widespread use of both prescription and over-the-counter medications and nutritional supplements.

I e-mailed the ACA several days ago asking for more information but have yet to receive a reply.

The ICA sees this move as yet another attempt by:

forces at work within some organizations actively promoting incorporating drugs into the chiropractic scope of practice.

(more…)

Posted in: Chiropractic, Herbs & Supplements, Humor, Legal, Nutrition, Pharmaceuticals, Politics and Regulation

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