There is an obvious survival advantage to the emotion of disgust – we should fear putting unhealthy, tainted, contaminated, or poisonous substances into our bodies. Emotions, however, are a double-edged sword. They are an effective evolutionary mechanism for motivating creatures to engage in certain behavior, but they also tend to be crude and undiscriminating – inadequate to deal with our complex modern society.
A dispassionate consideration of objective scientific evidence is the optimal strategy for deciding on which foods and substances are safe to consume, but it is far easier to scare people about toxins than to reassure them with data. We see this frequently with the anti-vaccine movement, and also with anti-fluoridation attitudes. It is easy to scare people with the idea that there are “chemicals” in our drinking water.
One company, San Diego Pure Water, seems to have made such scaremongering into a marketing strategy. Their website is full of articles and videos claiming that fluoride is the “the greatest fraud that has ever been perpetrated.”
On my recent trip to Nashville for CSICon, I took advantage of the long hours on the plane to read Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle, by Thea Cooper and Arthur Ainsberg. One of our commenters recommended it. I’m not sure who (was it Chris?), but I want to thank you.
It’s the history of insulin told from the perspective of the scientists and of a typical patient, and it touches on a number of issues that we have addressed on SBM. It shows how science works to save lives, in stark contrast to the empty promises of CAM. (more…)
It’s one of the most common quackeries out there, used by a wide variety of practitioners for a wide variety of ailments blamed on “heavy metal toxicity.” Chelation therapy, which involves using chemicals that can bind to the metal ions and allow them to be excreted by the kidneys, is actually standard therapy for certain types of acute heavy metal poisoning, such as iron overload due to transfusion, aluminum overload due to hemodialysis, copper toxicity due to Wilson’s disease, acute heavy metal toxicity, and a handful of other indications.
My personal interest in chelation therapy developed out of its use by unscrupulous practitioners who blamed autism on the mercury-containing thimerosal preservative that used to be in many childhood vaccines until 2001 but has since all but disappeared from such vaccines except for one vaccine (the flu vaccine, for which a thimerosal-free alternative is available) and in trace amounts in some other vaccines. Mercury became a convenient bogeyman to add to the list of “toxins” antivaccinationists hype in vaccines. In fact, my very first post after I introduced myself on this very blog discussed the idea that mercury in vaccines was a significant cause of autism and autism spectrum disorders, and I’ve periodically written about such things ever since, in particular the bad science of Mark and David Geier, whose idea that chemical castration of children with Lupron “works” against “mercury-induced” autism is based on a chemically ridiculous idea that somehow testosterone binds mercury and makes it harder to chelate. Unfortunately, this particular autism quackery has real consequences and has been responsible for the death of a child.
Chelation isn’t just for autism, however. Despite many practitioners advertising it for autism, cancer (often with dubious studies that I might have to take a look at), Alzheimer’s disease (which Hugh Fudenberg has blamed on the flu vaccine, a claim parroted by Bill Maher, of course!), and just about every ailment under the sun, it’s easy to forget that the original use for chelation therapy promoted by “alternative medicine” practitioners was for cardiovascular disease. When it is used for coronary artery disease or autism, on a strictly stoichiometric and pharmacological basis, it is extremely implausible. Moreover, it is not without potential complications, including renal damage and cardiac arrhythmias due to sudden drops in calcium levels. Such arrhythmias can and have led to death in children, and in adults complications such as renal failure and death.
The ill-advised, NIH-sponsored Trial to Assess Chelation Therapy (TACT) is finally over. 839 human subjects were randomized to receive Na2EDTA infusions; 869 were randomized to receive placebo infusions. The results were announced at this weekend’s American Heart Association meeting in Los Angeles. In summary, the TACT authors report a slight advantage for chelation over placebo in the “primary composite endpoint,” a combination of five separate outcomes: death, myocardial infarction, stroke, coronary revascularization, and hospitalization for angina:
Although that result may seem intriguing, it becomes less so when the data are examined more carefully. First, it barely achieved the pre-ordained level of statistical significance, which was P=.036. Second, none of the individual components of the composite endpoint achieved statistical significance, and most of the absolute difference was in coronary revascularization–which is puzzling:
What would you do if your swimming pool was dirty? Clean it of course. But how? Would you take out a few pails of water, treat the water in the buckets, then toss the water back into the pool and declare the pool clean? And if it were the bathroom that needed cleaning, would you clean it by treating a few bucket fulls of water from the pool? Seems an odd approach to me, but, metaphorically speaking, it is the approach used by ultraviolet (UV) and laser treatment of blood.
A weird bit medical therapy, I get the occasional ‘Hey Dr. Smartypants, what do you think of this treatment?’ email. UV blood irradiation is an odd treatment, with an peculiar history.
UV light does have many effects on tissues, as a trip to Hawaii can rapidly demonstrate to a pasty Oregonian. In my world UV is used to sterilize the environment and UV kills off everything from MRSA to C. difficile to tuberculosis. We vent potentially microbially contaminated air to the outside in part to dilute any infection but more importantly we know that most pathogens will die when exposed to solar UV light. Do not use UV light on people as a rule, since it causes tissue damage and we fret about injury to eyes and skin.
Back in the 1930’s a physician named Knott had two patients, one with a brain abscess and one with sepsis, who he evidently cured by irradiating the patients’ blood and returning it to them.* His rationale was since cutaneous TB can be cured by UV light (the discovery resulted in the 1903 Nobel Prize in medicine and physiology), perhaps other infections would be amenable to the therapy as well (1). (more…)
Over the past weekend, I had the opportunity to attend CSICon in Nashville, Tennessee. The Committee for Skeptical Inquiry (“CSI”) combats all sorts of pseudoscience, including creationism/creation science/intelligent design and alternative/complementary/integrative medicine. Our own Team SBM was ably represented by Harriet Hall, David Gorski and Kimball Atwood, whose presentation highlighted the credulous acceptance of CAM in some medical schools, and by Steve Novella, who gave a talk on the placebo effect and its exploitation by CAM proponents. Among many other presentations were those on the Mayan calendar and the end of the world, unmasking of (supposedly) paranormal events, and the neurobiology of memory. Pseudoscience was given a well-deserved thrashing by rational minds.
On Saturday, I once again had the pleasure of hearing Eugenie Scott ,Ph.D., the virtually one-woman anti-creationism campaign who founded and heads the National Center for Science Education (NCSE). As I listened to her talk I couldn’t help but being struck by a number of similarities in the weaknesses apparent in arguments for creationism/ creation science/intelligent design (or “ID”)and those for alternative/complementary/integrative medicine (or “CAM”). I doubt the two groups like to think of themselves as ideological twins, but gosh, they sure do look alike.
It appears that we are near the beginning of a new modality in medicine – the use of computer controlled and powered robotics for therapeutic purposes. At present such technology is in its infancy, but is giving us a glimpse of what it will become.
Recently Vanderbilt University announced that its team at the Center for Intelligent Mechatronics has developed an exoskeleton that paraplegics can wear on their legs to allow them to sit, stand, and walk. This is essentially a mechanized orthotic that paraplegics can wear on their legs. The researchers describe it as a “Segway with legs” – referring to the computer technology that controls the exoskeleton, which responds to the user’s movement. If the user leans forward, then the legs will walk. If they lean back, then they will sit.
Like any technology, you can take either a glass half-full or half-empty view of this device. I will cover both – first the good.
Their system has some advantages over previous systems. It is about half the weight, coming in at 27 pounds while other lower extremity exoskeletons weigh 45 pounds. The exoskeleton is also small enough to fit in a standard wheelchair while being worn, and can be put on and taken off by the user alone. As described above, this system also incorporates intelligent control technology. Users with partial paralysis can have their own movements augmented, while for those with complete plegia the exoskeleton can do all the work.
I was asked to write an article for Slate, the on-line magazine, about Andrew Weil’s selection as the keynote speaker for the 2012 AAFP annual scientific assembly. The science and health editor, Laura Helmuth, was initially enthusiastic about what I wrote, but eventually decided not to publish it. Here is the initial draft of my article. My comments follow.
Original Draft of Article for Slate
The American Academy of Family Physicians picked Andrew Weil to be the keynote speaker at its annual scientific assembly October 16-20 in Philadelphia. What were they thinking? That’s like having an astrologer give the keynote speech at an astronomy meeting.
The AAFP stands for the best in conventional medicine, for the standard of care as determined by physicians and scientists. Weil doesn’t. The AAFP stands for evidence-based medicine. Weil doesn’t. (more…)
Editor’s note: Because of Dr. Gorski’s appearance at CSICon over the weekend, he will be taking this Monday off. Fortunately, Dr. Coyne will more than ably substitute. Enjoy!
NIH is funding free training in the delivery of the Cancer to Health (C2H) intervention package, billed as “the first evidence-based behavioral intervention designed to patients newly diagnosed with cancer that is available for specialty training.” The announcement for the training claims that C2H “yielded robust and enduring gains, including reductions in patients’ emotional distress, improvements in social support, treatment adherence (chemotherapy), health behaviors (diet, smoking), and symptoms and functional status, and reduced risk for cancer recurrence.” Is this really an “empirically supported treatment” and does it reduce risk of cancer recurrence?
Apparently the NIH peer review committee thought there was sufficient evidence fund this R25 training grant. Let’s look at the level of evidence for this intervention, an exercise that will highlight some of the pseudoscience and heavy-handed professional politics in promoting psychoneuroimmunological (PNI) interventions.
Preamble: When my book Bonesetting, Chiropractic, and Cultism [full text] was published in 1963, renouncing chiropractic vertebral subluxation theory and recommending that chiropractic be developed as a subspecialty of medicine in the treatment of mechanical-type back pain, the chiropractic profession refused to acknowledge or review the book. I was labeled “an enemy of chiropractic.” If it had not been for the support I received from the science-based community, I might have had doubts about my mind set and my motives. Favorable reviews by members of the science-based community sustained me over the years; for that, I am deeply grateful. Today, still unheard by the chiropractic profession, the message of my Bonesetting book remains relevant in describing the problems of chiropractic. Although out of print, the entire book can be read online on Chirobase.org.
The Aftermath of Bonesetting, Chiropractic, and Cultism, 1963
In view of the absence of any extensive histories of chiropractic, this book has a place in medical collections and reference libraries. ─ Eric Meyerhoff, Director, The Medical Library Center of New York, N.Y.C., Library Journal, February 1, 1964
In regard to your recent application for membership in the American Chiropractic Association and insurance in the National Chiropractic Insurance Company, please be advised that the ACA membership committee has rejected your application. ─ H.W. Pruitt, D.C., Executive Secretary, American Chiropractic Association, May 17, 1965
I purchased your book some months ago on Bonesetting, Chiropractic, and Cultism. I found it to be a most intriguing and enlightening publication which has been of value to me in some of my own studies in medical anthropology. ─ James G. Roney, M.D., Ph.D., Stanford Research Institute, November 11, 1965