Author Archive

Ancient Origins of Modern Dietary Demons

There are few aspects of daily existence, particularly in modern society, that are more pervasive than advice on what we should eat. Everyone, including friends, family, strangers on Twitter and self-proclaimed experts in nutrition and health, seems to have an opinion on how to eat in order to improve and prolong our lives. Even legitimate organizations dedicated to the health and well-being of the population add to the cacophony of recommendations on diet.

Readers of Science-Based Medicine should be well aware of the current popularity of avoiding gluten, even absent the diagnosis of celiac disease or thoughtful evaluation for another related condition. Gluten, we are told by gurus and authors of books like Wheat Belly and Grain Brain, is the one true cause of a host of medical complaints, even autism. Avoid gluten at all costs, they say, and watch the pounds melt away or experience the clearing of your “brain fog.” (more…)

Posted in: Science and Medicine

Leave a Comment (613) →

March Madness: Basketball, Brackets and Psi! Oh my!


A complicated graph, shown here mere moments before proving the existence of precognition

In 2011, psychologist Daryl Bem published a highly controversial series of nine experiments designed to tease out the potential existence of precognition, the ability to experience future events. In order to isolate the potential influence of future events on the present, Bem’s experimental design reversed the standard order of psychological investigations. In one experiment, for example, subjects were allowed to practice with random words after having already taken a memory test comprised of some of them.

Bem’s results were controversial for many reasons, mostly because they were positive. But the question of whether or not they should have even been published in the first place, regardless of the results, was raised by many in the scientific and skeptical community. As history has shown us repeatedly, the risk of falsely legitimizing nonsense by publishing positive but typically poorly-designed studies is very real. And negative studies tend to be ignored by believers and policy makers.

Bem’s experimental design was made available from the beginning of his research in 2002, and he encouraged others to perform their own studies. Unfortunately for Bem, attempts at replicating his findings were largely reported, if not always published, as negative. Apparently this was not enough to discourage the intrepid believer. In fact, he currently has a meta-analysis of 90 experiments using the same protocols as his original research under editorial review.

The conclusions of his new analysis [PDF] are, not surprisingly, supportive of the existence of precognition, and in his manuscript he attempts to address all of the skepticism regarding his findings. He even quotes Feynman and implies that physicists are taking the possibility of quantum-based explanations of psi seriously. It’s an interesting read to say the least.

What does NCAA basketball have to do with the topic of psi research?

A new name in the field of parapsychology research has been making headlines since going public with his efforts on the 1st of the month, and not surprisingly the media coverage is increasing now that his findings have been announced. Dr. Mort Fishman, a psychologist and paranormal researcher out of Tuono di Legno University in Florence, has ingeniously incorporated one of the world’s most popular sporting events, the NCAA Men’s Basketball Tournament, into a study of precognitive abilities. The results, if they are to be believed, may change the minds of even the hardiest psi skeptics.

In anticipation of March Madness each year, millions of basketball fans around the world fill out tournament brackets in an attempt to correctly predict which teams will win, and ultimately who will emerge victorious from the championship game. Many make a contest out of it, with office pools now a nearly ubiquitous aspect of life this time of year. ESPN even holds a Tournament Challenge, the winner of which is given a chance for $20,000 and a trip to Hawaii. It might even be Mitt Romney this year, leading some to regret their vote in the 2012 Presidential election.

The reasons people give for their choices are myriad, ranging from a thorough evaluation of the various teams’ stats to something as primitive and powerful as a gut feeling or how cute the mascot is. Fishman, an avid basketball fan who played three seasons for the European Basketball Federation’s Florence Nightingales, set out at the beginning of the NCAA college basketball season to determine if there might be a precognitive component to these choices. Inspired by Bem’s study designs, he also incorporated a reversal of standard protocols into his research.

The typical approach to filling out a bracket is to do so before the first game of the tournament. In fact, most official contests require it in order to avoid any unfair advantage. Fishman, who had a league record foul-to-rebound ratio of 2.5 during his stint on the Nightingales, instead asked study participants to fill out their bracket after the completion of the championship game, which was won by beloved perennial tournament underdogs, the Duke Blue Devils. According to Fishman, the most challenging aspect of the study was preventing participants from being exposed to any potential contamination with information about the teams during the season.

We went to great expense to protect subjects from potential bias or even outright cheating by basing their bracket picks on outside information. They were sequestered in a reasonably priced hotel, without access to the internet, television, or radio from November 1st of last year through Monday night. They were not allowed to speak to anyone outside of each other and us. No family. No friends. I think there were a few old Reader’s Digests and maybe a Redbook in the room. Progress requires sacrifice.

Once the brackets were completed and turned over to the research team, the real science began. Each subject entered a sensory deprivation tank and was randomly exposed to the results of 25 of the tournament’s 67 total games. The brackets were analyzed using math to see if subject picks were retroactively impacted by knowing the result of games after the fact. Choosing to courageously forego the stifling process of peer review, Fishman announced the positive findings at a press conference held in the parking lot of a Buffalo Wild Wings eight minutes from Lucas Oil Stadium on East Washington Street in Indianapolis.


As believers in Science-Based Medicine, we must have open minds when it comes to fringe or even highly implausible claims because you never know when seemingly-incontrovertible assumptions about the natural world will be proven wrong. Science is imperfect and historically has been very wrong on many occasions. Experts used to believe that the Earth was flat and we still don’t know how Tylenol even works.

Intellectual humility is a key component of scientific skepticism. Sometimes ideas which were ridiculed turn out to be true. Having a closed mind might help prevent any untrue new idea from being accepted, but some of them are pretty interesting and already very popular with the public. Who are we to judge truth from fiction?

Though the existence of psi has now been proven by the Fishman study, it doesn’t mean that more studies aren’t needed. In fact, the hard part lies ahead. We need to figure out how best to harness its potential in order to improve patient outcomes, and only science can lead the way in that regard. But we must not be afraid of the unknown or of different approaches to discovery. As Endocrinologist Dr. Deepak Chopra said, “All great changes are preceded by chaos.”



Posted in: Humor, Science and Medicine

Leave a Comment (73) →

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


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

Leave a Comment (32) →

SSPE: A Deadly and Not-That-Rare Complication of Measles

From the CDC Public Health Image Library #132 via the Wikimedia commons.  Child with classic measles day-four rash.

From the CDC Public Health Image Library #132 via the Wikimedia commons. Child with classic measles day-four rash.

[Editor’s note: We have two posts today, this post by our regular contributor Dr. Clay Jones, and an excellent guest post by William London about a chiropractor’s dubious neuropathy treatment protocol. Enjoy today or over the weekend!]

As a pediatrician, even one who has spent the majority of his career caring only for hospitalized children, the death of a patient has been a rare occurrence. There are certainly some pediatric specialties, such as intensive care and oncology, that because of the nature of their patient population must develop a more intimate relationship with the end of life. But compared to the adult world, even their exposure pales in comparison. The most common form of pediatric cancer, acute lymphoblastic leukemia, has a cure rate that is over 90% for example – making the unnecessary death of Makayla Sault after some worthless “treatment” at the Hippocrates Health Institute all the more tragic.

A bit more common in pediatrics are the patients that require significant intervention, and who may come close to death, but recover thanks to advances in modern medicine. These patients, however, are dwarfed by the number of children who receive routine hospital care and recover fairly uneventfully. And most children emerge into adulthood having never had more than a few self-limited viral illnesses and maybe a cavity or two. This wasn’t always the case. In 1900, 10% of 1-year-old children would not make it to adulthood. (more…)

Posted in: Science and Medicine

Leave a Comment (39) →

Alternative Medical Alert Systems in the News

Belvidere, NE- Bref Albright was taking an unfamiliar route home from work because of a stalled 18-wheeler when he passed by the cell phone tower. As the electromagnetic field washed over him, symptoms of his sensitivity quickly set in. He first noticed a tingling sensation throughout his body and an odd dryness in his mouth and throat. Then nausea and headache. Once the palpitations and difficulty concentrating on the road began, he knew he had to pull over in order to avoid an accident.

An elderly woman, shown here about to be strangled by a conventional doctor and/or pharmaceutical industry representative, is wearing an EmergenQi pendant

An elderly woman, shown here about to be strangled by a conventional doctor and/or pharmaceutical industry representative, is wearing an EmergenQi pendant

“Getting off the road was the right thing to do,” Albright explained. “I couldn’t risk injuring somebody else if I lost control of my truck, but it left me vulnerable. I was a sitting duck!” As expected, Albright’s condition worsened because of continued exposure to the deadly yet fundamental force of nature. Despite blurry vision and difficulty remembering his wife’s cell phone number, he managed to place a call. No answer. His wife, home brewing kombucha, had left her phone in another room.

Albright, a 53-year-old taxidermist for the Belvidere Parks Commission, then pressed the red button that activated his alternative medical emergency alert system. Within seconds, a satellite had pinpointed the location of Albright’s pendant and a team of emergency alternative medicine experts was soon on its way. While on route, a member of the team was even able to contact Albright’s wife Norleen and ask a few questions about Bref’s alternative medical history.

Posted in: Acupuncture, Diagnostic tests & procedures, Humor

Leave a Comment (81) →

Does a Common Treatment for Childhood Constipation Cause Autism?


Last week an article published by the New York Times entitled “Scrutiny for Laxatives as a Childhood Remedy” made the rounds. The article raised the question of a possible link between the use of a popular over-the-counter laxative, PEG (polyethylene glycol) 3350, and neurological or psychiatric problems in children. This wasn’t the first time this particular journalist wrote a piece on this topic, however. In 2012, she wrote about the popularity of the treatment among pediatricians despite a lack of FDA approval for use by children, a fact which applies to many if not most of the drugs commonly prescribed by pediatricians. (more…)

Posted in: Science and Medicine

Leave a Comment (72) →

Acupuncture for Withdrawal Symptoms in Critically Ill Infants


Like acupuncture, Weebles wobble, but they don’t fall down.

The practice of medicine, particularly our pharmaceutical and surgical interventions, involves a constant struggle between risk and benefit. If the physiology or anatomy of the human body is altered, even with the best of intentions, there is always a potential downside. There are certainly instances where the risk to benefit ratio is extremely favorable or unfavorable and the right recommendation is obvious, and unfortunately there are times when it isn’t entirely obvious what the next step should be. But there has been a trend of steady progress in regards to improved safety and efficacy over the past several decades.

The treatment of pain has of late been one of those areas where the picture is becoming a bit less cloudy. We are learning more and more about the potential negative outcomes related to the long term use of opioid medications, such as physical dependence, addiction and even chronic pain. The way that these drugs have been prescribed in many patients has caused more harm than expected, and in some instances more hurt than help. Doctors generally strive to alleviate pain and suffering but, once again, good intentions don’t decrease risk.

In the neonatal and young infant population, the management of pain has had a rocky history. I’ve written about pediatric pain in the past, in particular the potential difficulties in managing acute pain. I won’t go into detail (read my prior post), but we have truly come a long way since the days of performing major surgery on newborns without any analgesia at all. There are areas where we need to do better, however. Children are still less likely than adults to be adequately treated for pain.

But things have improved. And as more children receive appropriate management for pain, the side effects of that management must increasingly be dealt with by healthcare professionals, the patients and their families. One of the issues that is typically observed and managed in neonatal and pediatric intensive care units is physical dependence and the subsequent occurrence of withdrawal symptoms.

Posted in: Clinical Trials

Leave a Comment (246) →

Reflexology for Babies?

In the fascinating, if not rational, world of so-called complementary and alternative medicine, the age of the patient rarely seems to matter. This stands in stark contrast to the practice of science-based medicine. Sure, there is some physiological overlap across the spectrum of age, but caring for children often requires a vastly-different approach and there are numerous conditions not seen or only seen in kids.

Alternative medicine is more about the underlying belief system rather than the actual physiology, however. Chiropractic is chiropractic whether the subluxation belongs to a neonate or a nonagenarian. In traditional Chinese medicine, the flow of chi is obstructed in youngsters and old fogeys alike. No matter the length of our telomeres in fact, every major form of alternative medicine appears to contain a subset of practitioners that claim unique expertise in maximizing health and wellbeing at any age. But for kids, they simply do the same thing they would do for an older patient.

Newborns appear to be an increasingly-popular target of irregular medical practitioners. Even the unborn baby still in their mother’s womb isn’t safe. A generous interpretation would be that these true believers simply wish to aid in establishing health early in a child’s life, while the cynic in me worries that establishing a lifetime of billing opportunities might be the primary motivating factor. (more…)

Posted in: Science and Medicine

Leave a Comment (27) →

Outcome Bias in Clinical Decision Making and the Assessment of Our Peers


There are many mental pitfalls and logical stumbling blocks faced by healthcare professionals when attempting to untangle the complex web of patient history and physical exam findings. They can impede our ability to practice high quality medicine at every step in the process, interfering with our ability to establish an accurate diagnosis and to provide comfort or cure. And we are all susceptible, even the most intelligent and experienced among us. In fact, having more intelligence and experience may even enlarge our bias blind spots.

Steven Novella discussed the complexities of clinical decision making in early 2013, specifically tackling some of the more common ways that physicians can come to a faulty conclusion in the third installment of the series. One cognitive bias yet to be specifically addressed on the pages of Science-Based Medicine, and it is one that I encounter regularly in practice, is outcome bias. Simply put, outcome bias in medicine occurs when the assessment of the quality of a clinical decision, such as the ordering of a particular test or treatment, is affected by knowledge of the outcome of that decision. We are prone to assigning more positive significance to a decision when the outcome is positive, and we often react more harshly when the outcome is negative. This bias is particularly obvious when the result of a decision largely comes down to chance.

I see outcome bias rear its ugly head in two contexts for the most part: the Lucky Catch and the Bad Call.


Posted in: Science and Medicine

Leave a Comment (104) →

Energy Drinks are Risky, Especially for Kids


This is not for kids?

Last month I wrote a post on the causes of poor sleep in adolescents, as well as the myriad problems that can result in this high-risk population. Fortunately there is a system-wide public health measure proven to work, and now groups like the American Academy of Pediatrics are fully endorsing it. In that post, I briefly mentioned the increasing popularity of energy drinks and shots as caffeine delivery devices, and their role as both a potential cause of sleep deprivation and a means of temporarily ameliorating the effects.

I have been planning on addressing in greater detail the intentional, and unfortunately often accidental, ingestion of energy drinks in the pediatric population and the various associated risks for quite a while. What finally motivated me to get to work on this topic was the recent spate of media coverage regarding the results of a study presented this week at the American Heart Association’s Scientific Sessions 2014. The research, which involved the analysis of data obtained from the National Poison Data System for October 2010 through September 2013, supports concerns that pediatricians and other pediatric healthcare professionals have had for a very long time. Energy drinks are dangerous, particularly in young children, and a large part of the blame falls on the shoulders of manufacturers as well as the 1994 Dietary Supplement Health and Education Act (DSHEA) so frequently discussed on SBM.

Before I break down the scary numbers from the study, first a little background on energy drinks. (more…)

Posted in: Science and Medicine

Leave a Comment (132) →
Page 2 of 6 12345...»