At SBM we are highly in favor of physicians and scientists interfacing with the public, using mainstream and new media to promote the public understanding of science and to explain the modern practice of medicine. Now that Dr. Dean Edell has retired (unfortunately) from his radio show, it is probable that Dr. Mehmet Oz has the highest exposure of any media physician. I have never personally been a fan of Oz – a product of Oprah Winfrey, he has always mixed reasonable medical advice with promotion of dubious alternative health care. Harsh critics of Oz have charged him with selling out in order to promote his media career.
Regardless of his motivations, Oz has recently gone beyond coyly flirting with pseudoscience by directly promoting Joseph Mercola – a notorious internet doctor who himself promotes all sorts of pseudoscience and fear-mongering on his website. In an interview on his show, Dr. Oz praises Mercola while refraining from directly mentioning any of the more controversial positions that he takes. I will discuss the interview itself below, but first some background on Mercola.
Mercola is infamous among promoters of SBM for a number of reasons. First his website is highly monetized. While he frequently resorts to the “Big Pharma” conspiracy talk, he himself prints information on his site that supports the sales of supplements and other products. In my opinion this makes him a snake oil salesman, and everything he writes can no longer be considered objective medical advice but rather is advertising copy. I have no problem with monetizing websites to pay for bandwidth, as long as it’s within reason. But at some point you cross a fuzzy line where the website content is there to support sales, rather than the other way around – and Mercola is way past that line.
But far more importantly, the information on Mercola’s website is not science-based. Mercola frequently engages in rank fear-mongering – promoting every preliminary study that may suggest a possible connection as if it were a proven health risk.
Journalist Gary Taubes created a stir in 2007 with his impressive but daunting 640-page tome Good Calories, Bad Calories. Now he has written a shorter, more accessible book Why We Get Fat: And What to Do About It to take his message to a wider audience. His basic thesis is that:
- The calories-in/calories-out model is wrong.
- Carbohydrates are the cause of obesity and are also important causes of heart disease, type 2 diabetes, cancer, Alzheimer’s, and most of the so-called diseases of civilization.
- A low-fat diet is not healthy.
- A low-carb diet is essential both for weight loss and for health.
- Dieters can satisfy their hunger pangs and eat as much as they want and still lose weight as long as they restrict carbohydrates.
He supports his thesis with data from the scientific literature and with persuasive theoretical arguments about insulin, blood sugar levels, glycemic index, insulin resistance, fat storage, inflammation, the metabolic syndrome, and other details of metabolism. Many readers will come away convinced that all we need to do to eliminate obesity, heart disease and many other diseases is to get people to limit carbohydrates in their diet. I’m not convinced, because I can see some flaws in his reasoning. (more…)
This week, I plan on taking on something that’s been sitting near the bottom of my “to do list” for several weeks now. Indeed, readers have been sending me links since November or so to what will be the topic of this week’s post, but something somehow has always managed to push it aside each weekend when the time came to sit down and start writing my weekly post for this blog. I was also motivated by noting that, even though we are now entering the fourth year of this blog’s existence (yes, as hard as it is to believe, we started way back in January 2008), no one has done a post specifically about this particular topic, although I have mentioned it in the past, in particular in my discussion of a movie about the Gerson protocol for pancreatic cancer over a year ago.
This time around, I will be discussing a movie as well. Unlike The Beautiful Truth, which was about the Gerson protocol and didn’t feature any big names, this movie, Simply Raw: Reversing Diabetes in 30 Days, features at least a couple of big names. These include Morgan Spurlock, who directed and starred in the 2004 documentary Super Size Me, which featured Spurlock eating nothing but McDonald’s food for 30 days and documented the effects that diet had on him, and actor and “raw food activist” Woody Harrelson. Both were interviewed for the movie, and a longer interview with Spurlock is featured as part of a promotional film series on the web that goes along with Simply Raw.
Here are two trailers for the movie. First, trailer #1:
Then, trailer #2:
And here is the introduction to the Raw for Life DVD, a companion “A-Z encyclopedia” of “live food” veganism that is being sold as a companion piece to Simply Raw:
As you can see, Simply Raw follows the story of six people, four of whom have type II diabetes, one of whom has type I diabetes, and one of whom is presented as having initially been diagnosed with type II diabetes but then diagnosed with type I diabetes. These six show up at The Tree of Life Rejuvenation Center in Arizona to try to reverse their diabetes “naturally” with a “raw food” diet, having answered an advertisement for subjects in a “raw food challenge” to reverse diabetes. The center is described thusly on its website:
It always somewhat surprises me how some interventions never seem to die. Theophylline seems to have disappeared in the medical pantheon, but what comes around, goes around. I predict a resurgence of theophylline this century. Despite the recent study that shows, yet again, echinacea has no effect on colds, I predict the study will neither decrease the sales of echinacea nor prevent further funds being spent on clinical trials on its efficacy. Hear that JREF? I made predictions. I will await my million dollar check. Make it out to Mark Crislip.
Another therapy that refuses to be put to rest, or even to be clarified, is the use of cranberry juice for urinary tract infections. Pubmed references go back to 1962, and there are over 100 references. Firm conclusions are still lacking.
There is a reasonable, but incomplete, basic science behind the use of the cranberry juice for urinary tract infections. (more…)
All the world sees us
In grand style wherever we are;
The big and the small
Are infatuated with us:
They run to our remedies
And regard us as gods
And to our prescriptions
Principles and regimens, they submit themselves.
Molière, The Imaginary Invalid (1673)1
The passage above is part of a burlesque doctoral conferment ceremony, where the French playwright Molière (1622-1673) mocks the unscrupulous physicians of his time. “All the excellency of their art consists in pompous gibberish, in a specious babbling, which gives you words instead of reasons, and promises instead of results,” he writes. In Moliere’s plays doctors never cure anyone; they are put on stage just to display their own vanity and ignorance.2 The Spanish painter Francisco de Goya (1746-1828) also took on the same issue by painting in 1799 a well attired jackass taking the pulse of a dying man, in a pose that accentuates the large gem on his hoof.
Image 1. De qué mal morirá (Of what illness will he die?) by Francisco de Goya is held at the Biblioteca Nacional, Madrid, and The Metropolitan Museum of Art, New York.
But if the asinine doctors of Molière and de Goya’s time never cured anyone, it is because they held prescientific views, and believed that disease was caused by imbalances in “humors,” and by malefic influences of the Heavens. Even the most educated among them treated illnesses in good faith by purging, bloodletting and enema at astrologically auspicious times. In contrast, current physicians who for the sake of funding embrace and endorse unscientific views and practices under the guise of CAM or integrative medicine, do so knowing that they often contradict the established principles of physics, chemistry, and biology. Therefore, in addition to promoting “snake oil science”3 (as R. Barker Bausell calls it), these physicians are also guilty of bad faith. Most of this takes place at large academic centers, where funding seems to outweigh the concern for science. As Val Jones, MD, writes in 2009′s Top 5 Threats To Science In Medicine:
Often referred to by David Gorski as “Quackademic” Medical Centers – there is a growing trend among these centers to accept endowments for “integrative” approaches to medical care. Because of the economic realities of decreasing healthcare reimbursements – these once proud defenders of science are now accepting money to “study” implausible and often disproven medical treatments because they’re trendy. Scientists at these centers are forced to look the other way while patients (who trust the center’s reputation that took tens of decades to build) are exposed to placebo medicine under the guise of “holistic” healthcare.
The 1023 campaign is a UK based organization whose purpose is to raise awareness of the actual claims of homeopathy. The name is a reference to Avogadro’s number (6.02214179×10^23), which is the number of atoms or molecules of a substance in one unit called a mole. This is an important basic concept in chemistry, for it means that there are a finite number of bits of a substance in any solution, which further means that solutions cannot be infinitely diluted. You cannot have fractions of a molecule of any substance. There is therefore a dilutional limit – a point beyond which if you further dilute a solution you are increasingly likely to have removed all of the original substance.
Homeopathic preparations frequently use serial dilutions that vastly exceed this dilutional limit. This is a central fallacy of homeopathy (what homeopaths call a “law” of homeopathy). Samuel Hahnemann, who invented the fiction of homeopathy, knew about the dilutional limit but believed that substances gave their magical essence to water when diluted. Modern homeopaths believe this too, but in order to make their nonsense more marketable to a 21st century culture a tad more used to science (or at least scientific jargon) than Hahnemann’s, they have desperately tried to wrap “magical essence” in sciencey technobabble.
The 1023 campaign’s main purpose is public awareness. It appears that the best tool defenders of science-based medicine have against homeopathy is simply to make the public aware of what it actually is. I have not found any good surveys that quantify public beliefs on the subject (sounds like a good project) but it is my subjective experience (and that of many of my colleagues) from talking to countless patients and acquaintances that many if not most people are simply not aware of what homeopathy actually is. The term is often conflated with herbal or “natural” remedies. Shock and disbelief is a common reaction to explanations of what homeopaths actually claim.
A November letter to the editor in American Family Physician chastises that publication for misusing the term “secondary prevention,” even using it in the title of an article that was actually about tertiary prevention.
I am guilty of the same sin. I had been influenced by simplistic explanations that distinguished only two kinds of prevention: primary and secondary. I thought primary prevention was for those who didn’t yet have a disease, and secondary prevention was for those who already had the disease, to prevent recurrence or exacerbation. For example, vaccinations would be primary prevention and treatment of risk factors to prevent a second myocardial infarct would be secondary prevention.
No, there are three kinds of prevention: primary, secondary and tertiary. Primary prevention aims to prevent disease from developing in the first place. Secondary prevention aims to detect and treat disease that has not yet become symptomatic. Tertiary prevention is directed at those who already have symptomatic disease, in an attempt to prevent further deterioration, recurrent symptoms and subsequent events. (more…)
Last week, the British Medical Journal (BMJ) published an expose by investigative journalist Brian Deer that enumerated in detail the specifics of how a British gastroenterologist turned hero of the anti-vaccine movement had committed scientific fraud by falsifying key aspects of case reports that he used as the basis of his now infamous 1998 Lancet article suggesting a link between the MMR vaccine and a syndrome consisting of regressive autism and enterocolitis. Indeed, Deer even went so far as to describe Wakefield’s fraud as “Piltdown medicine,” comparing it explicitly to the infamous “Piltdown man” hoax, and in an accompanying editorial the editors of the BMJ agreed. These revelations were not by any means new. Scientists had suspected that something wasn’t quite right about Wakefield’s work almost as soon as it had been published, and by 2004 Brian Deer had uncovered clear evidence of major undisclosed conflicts of interest on Wakefield’s part. Unfortunately, by that time the proverbial cat was out of the proverbial bag, and Wakefield’s fraudulent research, aided and abetted by his flair for self-promotion in the media and some truly execrable, credulous, and sensationalistic coverage by the British press, had ignited a major scare over the MMR vaccine. MMR uptake rates plummeted below levels necessary for herd immunity, and measles came roaring back with a vengeance in the U.K. By the time the British General Medical Council finally ruled about a year ago that Wakefield had committed research fraud and violated research ethics in the work reported in his 1998 Lancet article and recommended that he be “struck off” (i.e., have his license to practice medicine in the U.K. revoked), the damage had been done.
As important as Wakefield is to the genesis of the modern anti-vaccine movement, however, there is another force that acts far more “where the rubber hits the road,” so to speak. This force comes in the form of publications and online discussion forums that cater to new mothers, offering all manner of advice and support. Some of these are very good, but all too many of them are hotbeds of anti-vaccine pseudoscience, confidently proclaimed by “elder statesman” members of these forums and included in articles published in glossy, attractive magazines. As a rather ironic coincidence, just as news of Andrew Wakefield’s latest humiliation was finding its way out into multiple news outlets last week, the first issue of 2011 of just such a glossy publication hit the shelves. I’m referring to Mothering, whose tagline is “Inspiring Natural Families Since 1976.” In reality, it should read: “Inspiring quackery and anti-vaccine views since 1976.” Of course, in the world of “alt-med,” the two often go hand-in-hand. In any case, one of our readers sent me a link to the latest issue of Mothering. Unfortunately, I can’t supply you with that link, because it’s for subscribers. I will, however, describe and quote articles and passages that demonstrate just what a wretched hive of scum and quackery Mothering is, particularly with respect to vaccines but not limited to vaccines. Taking into account its large and vigorous online forums, Mothering is major force for the promotion of anti-vaccine views and quackery among new mothers.
This is the third post in this series*; please see Part II for a review. Part II offered several arguments against the assertion that it is a good idea to perform efficacy trials of medical claims that have been refuted by basic science or by other, pre-trial evidence. This post will add to those arguments, continuing to identify the inadequacies of the tools of Evidence-Based Medicine (EBM) as applied to such claims.
Prof. Simon Replies
Prior to the posting of Part II, statistician Steve Simon, whose views had been the impetus for this series, posted another article on his blog, responding to Part I of this series. He agreed with some of what both Dr. Gorski and I had written:
The blog post by Dr. Atwood points out a critical distinction between “biologically implausible” and “no known mechanism of action” and I must concede this point. There are certain therapies in CAM that take the claim of biological plausibility to an extreme. It’s not as if those therapies are just implausible. It is that those therapies must posit a mechanism that “would necessarily violate scientific principles that rest on far more solid ground than any number of equivocal, bias-and-error-prone clinical trials could hope to overturn.” Examples of such therapies are homeopathy, energy medicine, chiropractic subluxations, craniosacral rhythms, and coffee enemas.
The Science Based Medicine site would argue that randomized trials for these therapies are never justified. And it bothers Dr. Atwood when a systematic review from the Cochrane Collaboration states that no conclusions can be drawn about homeopathy as a treatment for asthma because of a lack of evidence from well conducted clinical trials. There’s plenty of evidence from basic physics and chemistry that can allow you to draw strong conclusions about whether homeopathy is an effective treatment for asthma. So the Cochrane Collaboration is ignoring this evidence, and worse still, is implicitly (and sometimes explicitly) calling for more research in this area.
On the other hand:
There are a host of issues worth discussing here, but let me limit myself for now to one very basic issue. Is any research justified for a therapy like homeopathy when basic physics and chemistry will provide more than enough evidence by itself to suggest that such research is futile(?) Worse still, the randomized trial is subject to numerous biases that can lead to erroneous conclusions.
I disagree for a variety of reasons.
Pity poor Andrew Wakefield. Well, not really. I tend to view what’s happening to him yet again as the chickens coming home to roost.
Let’s put it this way. 2010 was a terrible year for him, and 2011 is starting out almost as bad. In February 2010, the General Medical Council in the U.K. recommended that Wakefield be stripped of his license to practice medicine in the U.K. because of scientific misconduct related to his infamous 1998 case series published in The Lancet, even going so far as to refer to him as irresponsible and dishonest, and in May 2010 he was. This case series, thanks to Wakefield’s scientific incompetence and fraud, coupled with his flair for self-promotion and enabled by the sensationalistic credulity of the British press, ignited a scare about the measles-mumps-rubella (MMR) vaccine in which, afraid that the MMR vaccine causes autism, parents in the U.K. eschewed vaccinating their children in droves. As a result, vaccination rates plummeted far below the level necessary for herd immunity, with the entirely predictable result of massive measles outbreaks in the U.K. Measles, which as of the mid-1990s had been declared under control by British and European health authorities, came roaring back to the point where in 2008 it was declared once again endemic in the British Isles. In a mere decade and a half, several decades of progress in controlling this scourge had been unravelled like a thread hanging off a cheap dress, all thanks to Andrew Wakefield and scandal mongers in the British press.
True, Wakefield had long since moved to Texas, the better to be the founding “scientific director” of a house of autism woo known as Thoughtful House. Thus, the removal of his license to practice had little practical import (or effect on his ability to earn a living), or so it seemed at the time, given that Wakefield did not treat patients and hauled in quite the hefty salary for his promotion of anti-vaccine pseudoscience. Fortunately, karma’s a bitch, and, as a result of the GMC’s action, in short order The Lancet retracted Wakefield’s 1998 paper; Wakefield was pushed out of Thoughtful House; and his latest attempt to “prove” that vaccines cause autism in an animal study was also retracted. Investigative reporter Brian Deer’s investigation finding that Andrew Wakefield had committed scientific fraud in carrying out his Lancet study joined prior findings that Wakefield had been in the pocket of trial lawyers (to the tune of £435 643, plus expenses) seeking to sue the vaccine industry at the time he carried out his “research” and the allegations by renowned PCR expert Stephen Bustin during the Autism Omnibus as to how shoddily Wakefield’s other research was carried out. Finally, the mainstream media started to back away from its previous embrace of Wakefield and his claims. As a result, for a while at least, Wakefield was reduced to lame appearances at sparsely attended anti-vaccine rallies last spring.