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Puritan’s Pride Vitamin Advisor Gives Questionable Advice

puritan's
The Puritan’s Pride website has a Vitamin Advisor that claims to provide a personalized supplement plan, with expert recommendations chosen just for you. In my opinion it is deceptive, designed not to provide evidence-based personalized health advice, but to sell their products; and one can only wonder what kind of “experts” would support such ill-advised recommendations. Stephen Barrett and I have just co-authored an article on the Quackwatch site analyzing the Vitamin Advisor’s advice. I wanted to share what we found with our SBM readers, with some further comments.

Their recommendations are based on a series of questions like age, sex, health concerns, whether you are exposed to cigarette smoke, etc. The full list can be found in our Quackwatch article. The one-size-fits-all questions are useless because “eye concerns” might mean anything from needing glasses to glaucoma. (more…)

Posted in: Herbs & Supplements

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Prenatal Multivitamins and Iron: Not Evidence-Based

prenatal-vitamins small
When I was pregnant, I obediently took the iron pills and prenatal vitamins prescribed by my obstetrician. And I prescribed them for every pregnant patient I took care of as a family physician. I never questioned the practice. It seemed intuitively obvious that it was a good thing; we know pregnancy makes extra nutritional demands and depletes iron stores. It never occurred to me to question what I had been taught, because it seemed perfectly logical. I did question other things I was taught that didn’t seem so logical. In my internship, we were ordered to do episiotomies on every patient (the rationale was that it made birth less traumatic for the baby and prevented uncontrolled perineal tearing in the mother). I was severely chastised for omitting an episiotomy on a patient who begged me not to do one. She had had several babies and was stretchy enough to deliver easily without an episiotomy. In this case, my common-sense clinical judgment was vindicated by further research in the years after my internship; new evidence showed that routine episiotomies were of no benefit, practice changed in response to the new evidence, and episiotomies are no longer done routinely.

That was a long time ago. I have long since learned that even the most reasonable assumptions can be wrong. I happened to be right about episiotomies, but I might just as well have been wrong; and the only way to know whether a belief is true is to test it in controlled scientific trials. As Will Rogers said, “It isn’t what we don’t know that gives us trouble, it’s what we know that ain’t so.” It turns out that routine multivitamin and iron supplementation is not supported by any convincing evidence from scientific studies. And practice is changing. Recently, when one woman asked her OB what she should do about prenatal vitamins he pulled his wastebasket out from under his desk and said “put them there.” (more…)

Posted in: Herbs & Supplements, Nutrition, Obstetrics & gynecology

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Cure Is About Caring, Not Curing: Placebos, Alternative Medicine, and Patient Comfort

cure
In a recent post, Dr. Gorski criticized two articles by Jo Marchant on placebos and alternative medicine. He mentioned that she had a book coming out and suggested I might want to review it. The title is Cure: A Journey into the Science of Mind Over Body.

I don’t know of any evidence that the mind has ever cured a disease, so I would have been prejudiced against this book just from its title, and Dr. Gorski’s post prejudiced me even more. But I was willing to give it a fair trial. The publisher sent me a review copy of the book and I read it. I was expecting to hate it, but I was pleasantly surprised. I enjoyed reading it. I found it fascinating. I found myself agreeing with much of what Marchant says, and I was intrigued by some of the recent research she reports that I was not yet aware of. Preliminary studies, to be sure, but thought-provoking. The book challenged me to think more deeply about placebos, alternative medicine, and patient comfort. (more…)

Posted in: Book & movie reviews

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Chronic Fatigue Syndrome: Rituximab Revisited

rituximabThree years ago I wrote about an experimental treatment for chronic fatigue syndrome (CFS): rituximab (brand name Rituxan). I was concerned that doctors who offered it, like Andreas Kogelnik, were jumping the gun by offering it before the evidence was in, and that they might be putting patients at risk.

A correspondent who has been following the CFS forums asked me to revisit this issue. She sent me links to forum posts indicating that Dr. Kogelnik is treating CFS patients with the drug, that they are not being enrolled in clinical trials, that information about results is not available, and that at least one patient may have developed a life-threatening side effect. I want to stress that I don’t have any evidence that those statements are true. These are only posts on a forum, and I have no way to verify the information. I tried to get more information from Dr. Kogelnik’s clinic, but was unsuccessful. Nevertheless, even if everything in those forum posts is false, I think the issue is serious enough to bring it to the attention of the public again. My purpose is to provide accurate information about rituximab and to get people to think about the principles involved, not to make claims or accusations or cast any blame. (more…)

Posted in: Pharmaceuticals

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Vaginal Birth After C-Section: How Safe Is It?

Post-partum

What’s the best route to this happy outcome?

Doctors used to insist “once a C-section, always a C-section.” Today it is standard practice to allow vaginal births after C-section (VBAC) for appropriately selected patients. The American Congress of Obstetricians and Gynecologists (ACOG) has issued a Practice Bulletin to guide obstetricians in determining which patients are appropriate candidates for VBAC.

We frequently hear criticisms of practice guidelines like these. The doctors who write the guidelines are accused of conflict of interest, turf protection, and biased evaluation of the evidence. For those who believe doctors put profits before patients, this should be an eye-opener. It would presumably be in the best financial interests of obstetricians to do as many C-sections as possible, since they can charge more for them than for vaginal births. It would have been easy for the ACOG to put a spin on the data to make repeat C-sections look like a better choice. The fact that they offer VBACs despite their conflict of interest makes me think that their evaluation of the evidence was probably fair and unbiased.

So just how safe is VBAC? What are the pros and cons? What does the evidence say? (more…)

Posted in: Guidelines, Obstetrics & gynecology

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Colonoscopy: More Misinformation from Mercola

colonoscopy
Joseph Mercola, D.O., runs the website mercola.com which is full of misinformation, advocates all kinds of questionable alternative treatments including homeopathy, and discourages vaccination and other aspects of conventional medicine.

Like Dr. Oz and Andrew Weil, he is more dangerous than easily recognizable quacks in that he combines some good medical information with egregious misinformation, and readers who know he is right about the good information are likely to wrongly assume everything else he says must be equally true. He’s right about some things, but the safest course is to assume that anything on his website is false unless you can verify it as true by consulting other sources that are reliable. I tried to verify the information in his recent article on colonoscopy. I found outright errors along with fear-mongering and bias. (more…)

Posted in: Diagnostic tests & procedures, Science and Medicine

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Statins: The Impact of Negative Media Reports and the Risks of Discontinuing Treatment

image courtesy of www.kevinmd.com

Image courtesy of www.kevinmd.com

The evidence is clear: statin drugs are effective in reducing the rate of heart attacks and death in people who have already had a heart attack as well as in people who are at high risk of having one. Some people refuse to believe that evidence; they are statin deniers, similar to the climate change deniers and AIDS deniers (and there are even germ theory deniers!) who manage to disregard the strong evidence that proves their opinions wrong. The deniers demonize statins, cherry-picking studies to minimize the benefits and exaggerate the side effects.

A new study found that negative media reports about statins were correlated with patients discontinuing statin therapy. It also found that discontinuing statin therapy was correlated with an increase in heart attacks and death.
(more…)

Posted in: Pharmaceuticals, Science and the Media

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Neurotribes: A Better Understanding of Autism

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What is autism? What causes it? Is it genetic? Is it a consequence of something in our environment or lifestyle? What’s an “idiot savant” or an “autistic savant”? What happens when autistic children become adults? Why are so many of their parents scientists, academics, and engineers? If your grandfather’s Uncle Fred was a socially inept inventor with a lot of strange quirks, do you think he might have been autistic? Is autism really becoming more prevalent, or are we just getting better at diagnosing it? What’s happening with these people and what can be done to give them a better life?

Sorry to burden the list of recommended reading with yet another book, but if you are on the autism spectrum, if you know anyone who is autistic, if you think there is an epidemic of autism, if you think vaccines or environmental toxins cause autism, or if you are just interested in autism and want to understand it better, you will benefit from reading this new book by Steve Silberman: NeuroTribes: The Legacy of Autism and the Future of Neurodiversity. You will walk away from the book with new insights and a new appreciation of the “neurodiverse.” (more…)

Posted in: Book & movie reviews, Neuroscience/Mental Health

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Intermittent Fasting

fasting
Fasting can mean anything from total abstinence from food and beverages to restricting specific foods or the hours of food intake. Many religions have traditions of fasting, with various restrictions. There is a good summary of those traditions on Wikipedia. The reason for religious fasting is not to improve health, but for other reasons like improving discipline and demonstrating devotion.

There are many health claims for different fasting regimens. Daily calorie restriction has been demonstrated to prolong lifespans in several organisms, from yeast and worms to mice and monkeys, although the evidence for monkeys is equivocal and there is no evidence for humans. There is some evidence that intermittent fasting can forestall and even reverse cancer, cardiovascular disease, diabetes, and neurodegenerative disorders in mice. In humans, there is some evidence that it might help reduce obesity, hypertension, asthma, and rheumatoid arthritis. How good is the evidence? (more…)

Posted in: Nutrition

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Misinterpreting TACT: No, Chelation Does Not Outperform Statins for Heart Disease

chelation
Chelation with intravenous EDTA (disodium ethylene diamine tetra-acetic acid) has long been used for heavy metal poisoning. It binds the metal ions and facilitates their excretion from the body. In recent years it has been used for many other indications that are not evidence-based, such as autism and coronary heart disease.

The Trial to Assess Chelation Therapy (TACT) was done to assess the effectiveness and safety of EDTA plus high-dose oral vitamins for preventing second heart attacks in patients who had already had one. An article on The People’s Pharmacy website portrays the study as strongly positive. The Graedons, authors of the website, claim that science supports the use of chelation. They report that for every 12 patients undergoing chelation, one heart attack will be prevented over a five-year period. They cite a 5-year NNT (number needed to treat) of 16 for statin therapy and they conclude that:

EDTA chelation outperformed statins because fewer people needed to receive treatment to achieve a desirable outcome.

(more…)

Posted in: Clinical Trials, Science and Medicine

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