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“Motivated reasoning,” alternative medicine, and the anti-vaccine movement

One theme that we at Science-Based Medicine keep revisiting again and again is not so much a question of the science behind medical therapies (although we do discuss that issue arguably more than any other) but rather a question of why. Why is it that so many people cling so tenaciously to pseudoscience, quackery, and, frequently, conspiracy theories used by believers to justify why various pseudoscience and quackery are rejected by mainstream science and medicine? Certainly, I’ve touched on this issue before on several occasions, for example, with respect to the anti-vaccine movement, the claim that abortion causes breast cancer, and how we as humans crave certainty.

It turns out that science and science-based medicine are hard for humans to accept because they often conflict with what our senses perceive and brains interpret as irrefutable evidence. The pattern-seeking function of our brain, when evaluating questions of causation in medicine, frequently betrays us. For instance, when a parent sees her child regress into autism sometime not long after being vaccinated, the easiest, most instinctive, and most emotionally compelling conclusion is that the vaccine must have had something to do with it. When scientists tell her that, no, in large studies looking at hundreds of thousands of children, there is no good evidence that vaccination confers an increased risk of autism and a lot of evidence that it does not, it’s a very hard message to believe, because it goes against how the parent interprets what she’s seen with her own eyes. Indeed, how often have we seen believers in the vaccine-autism link pour derision on the concept that when something like autistic regression happens in close temporal proximity to vaccination that the correlation does not necessarily equal causation? Similarly, believers in “alternative medicine” who experience improvement in their symptoms also pour derision on the observation, explained so well by R. Barker Bausell in Snake Oil Science, that people frequently take remedies when their symptoms are at their worst, leading them to attribute natural regression to the mean to whatever nostrum they started taking at the time.

These issues have come to the fore again, thanks to an article by an acquaintance of mine, Chris Mooney, author of The Republican War on Science, Storm World: Hurricanes, Politics, and the Battle Over Global Warming, and Unscientific America: How Scientific Illiteracy Threatens our Future (co-authored with Sheril Kirshenbaum). The article appeared in a recent issue of Mother Jones and was entitled, rather ironically, The Science of Why We Don’t Believe Science. Chris made his name as an author primarily in writing about the science of anthropogenic global warming and the political battles over policies intended to mitigate it and, to a lesser extent, over creationism and evolution denial. Of late he has written about the anti-vaccine movement as an anti-science movement, leading predictably to his being attacked by the likes of J.B. Handley as viciously as I and others have. Also of note, although he was widely praised for The Republican War on Science and Storm World, Mooney has been widely criticized in some circles for being too critical of “new atheists” and for lack of substance. In his current article, he discusses some of the science thus far about why people can cling to beliefs that science doesn’t just cast doubt upon but shows convincingly are totally wrong.
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Posted in: Evolution, Neuroscience/Mental Health, Pharmaceuticals, Politics and Regulation, Science and the Media, Vaccines

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Dr. Oz on alternative medicine: Bread and circuses

NOTE: Dr. Novella has written up a detailed description of his experiences on The Dr. Oz Show. Please read it. Also note that the online video for Dr. Novella’s appearance is now available:

  1. Controversial Medicine: Alternative Health, Part 1
  2. Controversial Medicine: Alternative Health, Part 2
  3. Controversial Medicine: Alternative Health, Part 3

When I first learned that our fearless leader and partner in crime for this blog, Dr. Steve Novella, Yale neurologist, blogger, and host of the popular skeptical podcast the Skeptics’ Guide to the Universe was going to be on The Dr. Oz Show, I was concerned. After all, this is the same physician who had in essence given up science-based medicine in favor of media stardom based on the promotion of alternative medicine. Of late Dr. Oz has been getting worse, too, promoting pseudoscience and what can only be described, in my opinion, as quackery. The snake oil that Dr. Oz has promoted over the last several months includes Dr. Joe Mercola, one of the biggest promoters of “alternative” health, whom Dr. Oz first had on his show about a year ago and then defiantly defended in a return appearance in early 2011, to be followed by a rapid one-two punch in which Dr. Oz had an ayurvedic yogi named Cameron Alborzian, who promoted highly dubious medicine, including “tongue diagnosis,” to be followed a few days later by something I would never, even in my most cynical assessment of Dr. Oz, expected, namely the appearance of faith healer Issam Nemeh on his show. ext Dr. Oz endorsed a diet that he once eschewed as quackery and then, to top it all off, invited psychic John Edward onto his show, asking Is talking to the dead a new kind of therapy? All of these offenses contributed to the reasons why in 2011 the James Randi Educational Foundation awarded him the The Media Pigasus Award for the second year in a row.

So right from the start I wasn’t very optimistic about how this whole thing would turn out. Fortunately, however, I was pleasantly surprised. Steve managed to hold his own in a completely hostile environment with only minor stumbles, while Dr. Oz peppered him with “Have you stopped beating your wife?”-style questions. At one point, Steve even managed to hand Dr. Oz his posterior. Alas, I doubt it will make any difference to Dr. Oz’s viewers, but we can always hope to change a few minds. I also realize that, however a big deal being on Dr. Oz’s show was to Steve and many members of the skeptical movement (especially supporters of SBM), to Dr. Oz it was just one segment in one episode of one season of a daily talk show made up of 150 episodes, each containing four or so segments. Not to detract from Steve’s achievement at all (it’s truly amazing that he managed to get on the show and do as well as he did, given how badly the deck was stacked against him), but to us this is big; to Dr. Oz it’s just another segment of another episode. It’s entertainment. As giddy and anxious as we at SBM have been the last two weeks, we have to keep things in perspective.

So what happened?
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Posted in: Acupuncture, Herbs & Supplements, Science and the Media

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The trouble with Dr. Oz

UPDATE 4/27/2011: Here’s the online video of Dr. Novella’s appearance on The Dr. Oz Show:

  1. Controversial Medicine: Alternative Health, Part 1
  2. Controversial Medicine: Alternative Health, Part 2
  3. Controversial Medicine: Alternative Health, Part 3

Welcome, Dr. Oz viewers!

As managing editor of the Science-Based Medicine (SBM) blog, I am writing this post because our founder and exective editor Dr. Steven Novella was invited to be on The Doctor Oz Show. Later today, the episode in which he will appear will air in most of your local markets, and we wanted to make sure that any Dr. Oz viewer who sees the segment and as a result is intrigued (or angered) enough to wonder what it is that we are all about will have a convenient “primer,” so to speak, on the problem with Dr. Oz from a science-based perspective. In other words, who are these obnoxious upstart bloggers who are so critical of Dr. Oz are and, far more importantly, exactly why are we so critical? What is science-based medicine, anyway?

On to some of the answers!
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Posted in: Science and the Media

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The curious case of Poul Thorsen, fraud and embezzlement, and the Danish vaccine-autism studies

If there’s one thing about the anti-vaccine movement, it’s all about the ad hominem attack. Failing to win on science, clinical trials, epidemiology, and other objective evidence, with few exceptions, anti-vaccine propagandists fall back on attacking the person instead of the evidence. For example, as I’ve noted numerous times, Paul Offit has been the subject of unrelenting attacks from Generation Rescue and other anti-vaccine groups, having been dubbed “Dr. Proffit” and accused of being so in the pocket of big pharma that he’ll do and say anything for it. I personally have been accused by Jake Crosby of a conflict of interest that isn’t, based on conspiracy mongering and an utterly brain dead argument (which is much like every other argument Jake likes to make on this issue). Steve Novella, Paul Offit, Amy Wallace, Trine Tsouderos, and others were portrayed as cannibals sitting down to a Thanksgiving feast of baby. Meanwhile, anti-vaccine luminaries invoke the pharma shill gambit with abandon and try their best to smear journalists who write about how anti-vaccine views are endangering herd immunity, journalists such as Trine Tsouderos, Amy Wallace, Chris Mooney, and Seth Mnookin, to name a few.

Sometimes, however, for whatever reason karma, fate, God, or whatever you want to call it smiles on anti-vaccine activists, dropping a story into their laps that allow them to indulge the worst of their tendencies towards ad hominem attacks and seem superficially credible. So it was about a year ago when an financial fraud investigation was being undertaken in the case of Poul Thorsen, a Danish investigator who had contributed to two large Danish studies, one of which failed to find an association between the MMR and autism in the immediate wake of Andrew Wakefield’s falsified data suggesting such an assocation and one of which failed to find an association between mercury in the thimerosal preservative in vaccines and an increased incidence of autism. At the time longstanding anti-vaccine propagandist Robert F. Kennedy, Jr. tore into Thorsen with abandon before he was even indicted or charged (he was only under investigation at the time) as though, even if he actually did commit fraud, such fraud invalidated the two large studies regarding MMR and autism and thimerosal and autism with which he had been involved. Did it?

To find out, let’s hop into our SBM TARDIS and go back in time about a year, in order to see the genesis of this manufactorversy that AoA is currently flogging. Let’s look at the case of Danish investigator Poul Thorsen as it developed.
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Posted in: Science and the Media, Vaccines

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Watch Steve Novella on The Dr. Oz Show on Tuesday!

UPDATE 4/27/2011: Here’s the online video of Dr. Novella’s appearance on The Dr. Oz Show:

  1. Controversial Medicine: Alternative Health, Part 1
  2. Controversial Medicine: Alternative Health, Part 2
  3. Controversial Medicine: Alternative Health, Part 3

I can’t believe I’m saying this, but I want you all to tune in to The Dr. Oz Show on Tuesday, April 26. Either that, or DVR it. Why am I asking you to do this? Have I lost my mind? Have I suddenly gone woo? Of course not. The reason is that, an episode I’ve been waiting for since I learned it was in the works last week will air on that date.

That’s right. Our fearless leader Steve Novella will be on The Doctor Oz Show this Tuesday to do battle in the belly of the beast.

Unfortunately, I fear for the results. I know Steve acquitted himself quite well, at least as well or better than any skeptic and booster of SBM could hope to do in such a hostile environment, but get a load of the title of the segment, Controversial Medicine: Why your doctor is afraid of alternative health?

Afraid?

Afraid?

Afraid?

No, no, no, no! A thousand times no!

I do worry a bit how the producers edited Steve’s segment, though. Look at the promo. In it Dr. Oz is doing what I was afraid of, trying to portray himself as the voice of reason and accusing Steve of being “dismissive.” I was afraid Dr. Oz would play the “don’t be close-minded” or “you’re too dismissive” card, and he appears to have done it. Then get a load of the advertised segment that follows, showing Dr. Oz dictating what’s true and not in medicine, as in “Dr. Oz approved.”

Truly, the man has no shame.

I’ll have to wait until Tuesday to see what the final results are. Whatever happens, we at SBM are all incredibly proud of Steve for going into the proverbial lions’ den. As managing editor, I’m also enormously proud of our stable of bloggers; after all, it is a collective effort that got us noticed by the producers of The Dr. Oz Show. Also, now that Dr. Oz and his producers have noticed us, however the segment turns out we promise to keep holding Dr. Oz’s feet to the fire when he starts promoting nonsense like faith healers, psychic mediums, dubious diabetes treatments, and über-quacks like Joe Mercola. This should be facilitated by our new partnership with the James Randi Educational Foundation that was announced earlier this week.

You can also rest assured that Steve will blog about his experience after the episode airs, and I hope our readers will dive into the discussion forums after the show.

Posted in: Announcements, Science and the Media

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Coming to an emergency room near you in 2030?

I’ve frequently lamented what might happen if the current trend towards quackademic medicine continues unabated, and quackery becomes fully “integrated” with science-based medicine as a co-equal. Interestingly, this concept has provided fodder for several comedians. For example, the first comedy sketch I discovered on this theme was homeopathic e.r. Then a couple of years ago, Mitchell and Webb brought us the British version of essentially the same idea (but done so much better), namely Homeopathic A&E. What I didn’t realize is that predating both of these was…Holistic E.R. (Embedding disabled, unfortunately.)

This sketch comes from an old sketch comedy show known as Almost Live!, which I had never heard of before, but if this sketch is any indication, it was brilliant. Favorite bits from Holistic E.R.: The part about vitamin C, the use of visualization, and, of course, the crystals. Sadly, with the way academic medicine is being infused with quackery such as energy healing, homeopathy, and even anthroposophic medicine at my medical alma mater, I could see this happening within my lifetime.

Posted in: Homeopathy, Humor, Medical Academia

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The Free Speech About Science Act (H.R. 1364), “health freedom,” and misinformed consent

“Health freedom.” It’s a battle cry frequently used by supporters of “alternative” medicine against what they perceive to be persecution by the medical and scientific establishment that uses the Food and Drug Administration, the Federal Trade Commission, and other federal agencies charged with regulating pharmaceuticals, food, cosmetics, and medical devices in order to protect the public against fraud, adulterated food, and quackery. It’s a potent argument to those not versed in skepticism and science-based medicine, and even to many who are. After all, Who could argue with “health freedom”? How dare the government tell me what I can and can’t use to treat my own body? Of couse, as I (and others) have said many times before, in reality “health freedom” is a sham. In reality, “health freedom” is not an argument made for the benefit of the consumer; it’s an argument made for the benefit of the sellers of supplements. In practice “health freedom” really means freedom for quacks from any pesky laws and regulations that would prevent them from exercising their quackery.

So it was last week when I saw two websites known for anything but science-based medicine (SBM), namely the quackery-promoting website NaturalNews.com and the quackery apologist blog Vitamin Lawyer Health Freedom Blog promoting a bill that I hadn’t heard of before, namely H.R. 1364, entitled the “Free Speech About Science” (FSAS) Act of 2011. This bill is being touted in all the usual “health freedom” venues as an antidote to what supplement manufacturers apparently see as the “overreach” of the FDA. For example, Ethan A. Huff of NaturalNews.com (where’s Mike Adams, one wonders?) urges his readers to tell Congress to support the Free Speech about Science Act of 2011., while “vitamin lawyer” Ralph Fucetola subtitles his post HR 1364, S.216 and the Struggle for Health and Food Freedom Action Item. So what do these advocates for dubious supplements say?
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Posted in: Herbs & Supplements, Pharmaceuticals, Politics and Regulation

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Hope and hype in genomics and “personalized medicine”

“Personalized medicine.” You’ve probably heard the term. It’s a bit of a buzzword these days and refers to a vision of future medicine in which therapies are much more tightly tailored to individual patients than they currently are. That’s not to say that as physicians we haven’t practiced personalized medicine before; certainly we have. However it has only been in the last decade or so that our understanding of genomics, systems biology, and cell signaling have evolved to the point where the vision of personalized medicine based on each patient’s genome and biology might be achievable within my lifetime.

I was thinking about personalized medicine recently because of the confluence of several events. First, I remembered a post I wrote late last year about integrating patient values and experience into the decision process regarding treatment plans. Second, a couple of months ago, Skeptical Inquirer published an execrably nihilistic article by Dr. Reynold Spector in Skeptical Inquirer in which he declared personalized medicine to be one of his “seven deadly medical hypotheses,” even though he never actually demonstrated why it is deadly or that it’s even really a hypothesis. Come to think of it, with maybe–and I’m being very generous here–one exception, that pretty much describes all of Dr. Spector’s “seven deadly medical hypotheses”: Each is either not a hypothesis, not deadly, or is neither of the two. Third, this time last week I was attending the American Association for Cancer Research (AACR) meeting in Orlando. I don’t really like Orlando much (if you’re not into Disney and tourist traps, it’s not the greatest town to hang out in for four days), but I do love me some good cancer science. One thing that was immediately apparent to me from the first sessions on Sunday and perusing the educational sessions on Saturday was that currently the primary wave in cancer research is all about harnessing the advances in genomics, proteomics, metabolomics, and systems and computational biology, as well as the technologies such as next generation sequencing (NGS) techniques to understand the biology of each cancer and thereby target therapies more closely to what biological abnormalities drive each cancer. You can get an idea of this from the promotional video the AACR played between its plenary sessions:

Which is actually a fairly good short, optimistic version of my post Why haven’t we cured cancer yet? As I mentioned before, with this year being the 40th anniversary of the National Cancer Act, as December approaches expect a lot of articles and press stories asking that very question, and I’m sure this won’t be the last time I write about this this year.
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Posted in: Basic Science, Cancer, Clinical Trials, Diagnostic tests & procedures, Politics and Regulation

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Can Vitamin C Induce Abortion?

Editors Note: This is a guest contribution from two medical students, one from Chicago and one from Queensland. If you like their work, we’ll consider having them write more for us.

Authors:

Andrey Pavlov Jr.
UQ-Ochsner
University of Queensland School of Medicine

Igor Irvin Bussel
Chicago Medical School
Rosalind Franklin University of Medicine and Science

In hopes of joining the SBM movement as medical students, we wanted to take aim at a topic that has yet been finely dissected a la Novella or logorrheicly dismembered a la Gorski. Having realized that a fellow medical student, Tim Kreider, is already addressing integrative medicine on campus, we decided that we would attempt to find a controversial topic that has yet to be addressed on SBM. A serendipitous question from a friend sent us on a mission to explore the pseudo-scientific underbelly of the web and science-based rationale of the claim that vitamin C can induce abortion.

The World Wide Web is a stranger place than we can ever imagine. Most users are aware that they can’t believe everything they read on the Internet, yet they often feel like Sherlock Holmes when they find an esoteric and isolated clue to their own unique health puzzle. Recently, we were asked if there was a connection between vitamin C, menstruation and abortion. We were caught off guard by the question, finding it such a strange connection to make. The story, it seems, is that our friend had come down with a cold and taken mega doses of vitamin C to stave it off (another false belief, but not the subject here). A couple of days later her menses began and she was surprised since it was 4 days earlier than normal. She of course turned to Dr. Google and was quickly provided with numerous sources indicating that indeed, vitamin C would induce the start of a menstrual cycle and can even act as a “natural” abortefacient and a substitute for the ‘morning after’ pill. Being a bit more keen than your average Dr. Google user, she was surprised and continued searching, trying to find evidence to contradict these claims. Alas, she found nothingexcept more sites parroting and corroborating the claim. Then she realized she knew a couple of medical students and asked us what we thought. Our literature review turned up a slew of websites using the standard repertoire of trite pseudo-scientific tactics. Any attempt to find a credible source, validated claim, or independent consensus proved futile.
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Posted in: Clinical Trials, Science and Medicine

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Anti-vaccine propaganda from Sharyl Attkisson of CBS News

I’m not infrequently asked why the myth that vaccines cause autism and other anti-vaccine myths are so stubbornly resistant to the science that time and time again fails to support them. Certainly useful celebrity idiots like Jenny McCarthy are one reason. So, too, are anti-vaccine propaganda websites and blogs such as Age of Autism and anti-vaccine organizations like Generation Rescue, the National Vaccine Information Center, and SafeMinds and the organizations that publish them. However, these are clearly not the only reason. Alone, these people and organizations are in general quite rightly viewed as fringe, although they are very popular among the anti-vaccine movement. It is when such groups find a willing conduit for their pseudoscience in the “mainstream media” that they see the opportunity to attain a degree of seeming respectability that they can’t achieve on their own based on science. Worse, when mainstream news organizations or reporters fall for the pseudoscience claiming that vaccines cause autism, they contribute to the persistence of this myth outside the activist core of the anti-vaccine movement in the public at large.

In the past, anti-vaccine activists tried to accomplish this with the help of formerly respectable journalists such as David Kirby and Dan Olmsted, the former of whom wrote Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Mystery and the latter of whom wrote and promoted the Age of Autism series when he was an editor at UPI. However, although Kirby was never really that prominent or trusted, Olmsted was an editor of UPI. Now that he’s given up his UPI gig to become full time editor of AoA and to team up with Mark Blaxill to write a book (Age of Autism: Mercury, Medicine and a Manmade Epidemic) that regurgitated all the old misinformation about thimerosal and autism in a way that’s so 2005, Olmsted’s lost all credibility as a serious reporter. That’s a good thing.

The bad thing is that he has a replacement. Or at least so it would appear.
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Posted in: Science and the Media, Vaccines

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