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Efforts to Encourage Breastfeeding Like the Baby-Friendly Hospital Initiative (BFHI) May Have Unintended Consequences

A brand-new newborn. According to BFHI rules, he must maintain continuous skin contact with Mom and start breastfeeding with in the first half hour.

A brand-new newborn. According to BFHI rules, he must maintain continuous skin contact with Mom and start breastfeeding within the first half hour.

“Breast is best,” but current efforts to increase the rate of breastfeeding may be misguided. A recent article in JAMA Pediatrics by pediatricians Joel Bass, Tina Gartley, and Ronald Kleinman is titled “Unintended Consequences of Current Breastfeeding Initiatives.” They criticize the Baby-Friendly Hospital Initiative (BFHI), saying “there is now emerging evidence that full compliance…may inadvertently be promoting potentially hazardous practices and/or having counterproductive outcomes.”

The BFHI

The Baby-Friendly Hospital Initiative was launched by WHO and UNICEF in 1991 and has been adopted in 152 countries. In the US it has been promoted as the standard of care by government agencies like the CDC and the Joint Commission, and has been implemented by a growing number of hospitals. The criteria for a hospital’s Baby Friendly accreditation include:

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within one half-hour of birth.
  5. Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.
  6. Give newborn infants no food or drink other than breastmilk, not even sips of water, unless medically indicated.
  7. Practice rooming in – that is, allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

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Posted in: Obstetrics & gynecology

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Genetic Testing: Does Knowing Risk of Disease Make a Difference?

Genetic variants may provide information you'd rather ignore

Genetic variants may provide information you’d rather ignore

The complete sequencing of the human genome by the Human Genome Project was a remarkable accomplishment and a cause for celebration. Several companies including 23andMe, Navigenics, and deCODE have capitalized on that scientific achievement by offering genomic testing directly to the public. They promise more than they can deliver, and consumers don’t understand the limitations of the test results. The subject has been covered in several SBM articles.

One of the expected benefits of genomic testing is that if people knew they were at high risk of a disease, they would take preventive steps to reduce their risk. That seems plausible; but a recent study, a systematic review in the BMJ (formerly the British Medical Journal) calls that assumption into question. It found that communicating DNA-based disease risk estimates did not increase risk-reducing health behaviors or motivation to engage in such behaviors.

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Posted in: Diagnostic tests & procedures

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Quackery: The 20 Million Dollar Duck

quackery
The publisher recently sent me a review copy of Quackery: The 20 Million Dollar Duck, by Tony Robertson. My first thought was “Do we really need another book on this subject? Don’t I know all this stuff already?” I was very pleasantly surprised. Robertson has ferreted out an impressive array of facts and details that I wasn’t aware of; and yes, we need as many good books on the subject as we can get. Each author has a somewhat different approach that may appeal to a different audience. Robertson’s book is a worthy addition to the canon. He is a retired gynecologist who practiced, taught, and still lives in Zimbabwe. He is a critical thinker who understands and promotes science-based medicine, and he brings a unique perspective, especially on subjects related to his specialty. The book is not just about charlatans, it’s about non-science-based practices wherever they are found, including in mainstream medicine and in Robertson’s own field of obstetrics and gynecology.

I expected to like the book after I read the Dedication “To those who appreciate the truth fairy rather than the toothed one” and the Acknowledgements: “To my teachers and mentors who encouraged me to think, always to question and only to accept where there is good evidence.” That could serve as a motto for all skeptics, scientists, and critical thinkers to live by: Think, question, and only accept where there is good evidence. (more…)

Posted in: Book & movie reviews, Critical Thinking, Obstetrics & gynecology

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If You Think Doctors Don’t Do Prevention, Think Again

Prevention has long been a priority of conventional medicine

Prevention has long been a priority of conventional medicine

One of the common criticisms we hear from alternative and integrative medicine proponents is that doctors don’t do anything to prevent illnesses and have no interest in prevention. They claim that doctors are only trained to hand out pills to treat existing illnesses. Sometimes they even accuse them of deliberately covering up cures and wanting to perpetuate illnesses like cancer so they can make more money by treating patients. Nothing could be more absurd. Every reputable doctor would rather prevent illnesses than treat them. In his book Heart 411, cardiologist Steven Nissen even said he would be glad to see his specialty become obsolete: “Don’t worry about us; we will gladly hang up our scalpel and stethoscope if we can find a better way to lead you to a heart-healthy life.”

Doctors own prevention. They invented it, from vaccines to clean water to preventive screening tests. Mainstream medicine was responsible for the greatest preventive achievement in history: the smallpox vaccine campaign succeeded in preventing anyone from ever getting smallpox again. I defy you to comb through historical records and find any doctor who ever said “Let’s stop vaccinating for smallpox so we can make more money treating its victims.”

Prevention is one of the six fundamental principles of naturopathy. Alternative practitioners pride themselves on prevention, but they don’t actually do a very good job of it. In fact, there is evidence that their patients are less likely to get immunizations and some of the standard preventive screening tests recommended by the USPSTF. Instead of rigorously implementing evidence-based preventive strategies, they tend to offer other speculative, untested recommendations.
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Posted in: Naturopathy, Public Health, Vaccines

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Statistics Done Wrong, And How To Do Better

Statistics done wrong Alex Reinhart
Statistics is hard, often counterintuitive, and burdened with esoteric mathematical equations. Statistics classes can be boring and demanding; students might be tempted to call it “Sadistics.” Good statistics are essential to good research; unfortunately many scientists and even some statisticians are doing statistics wrong. Statistician Alex Reinhart has written a helpful book, Statistics Done Wrong: The Woefully Complete Guide, that every researcher and everyone who reads research would benefit from reading. The book contains a few graphs but is blissfully equation-free. It doesn’t teach how to calculate anything; it explains blunders in recent research and how to avoid them.

Inadequate education and self-deception

Most of us have little or no formal education in statistics and have picked up some knowledge in a haphazard fashion as we went along. Reinhart offers some discouraging facts. He says a doctor who takes one introductory statistics course would only be able to understand about a fifth of the articles in The New England Journal of Medicine. On a test of statistical methods commonly used in medicine, medical residents averaged less than 50% correct, medical school faculty averaged less than 75% correct, and even the experts who designed the study goofed: one question offered only a choice of four incorrect definitions.

There are plenty of examples of people deliberately lying with statistics, but that’s not what this book is about. It is about researchers who have fooled themselves by making errors they didn’t realize they were making. He cites Hanlon’s razor: “never attribute to malice that which is adequately explained by incompetence.” He says even conclusions based on properly done statistics can’t always be trusted, because it is trivially easy to “torture the data until it confesses.” (more…)

Posted in: Book & movie reviews, Critical Thinking

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Past Life Regression Therapy: Encouraging Fantasy

Buddhists believe in reincarnation. Some psychotherapists do too.

Buddhists believe in reincarnation. Some psychotherapists do too.

I recently got an e-mail from a PR firm about an “internationally certified regression therapist,” Ann Barham, who has written a book and who claims to help patients to “heal enduring challenges, release unhealthy patterns and beliefs, and find their way to more happiness and success.” They offered me the opportunity to review her book and/or interview her; I declined, but I was interested in learning more about past life regression therapy, so I elected to “interview Dr. Google” instead.

In past life regression therapy, therapists use hypnosis, leading questions, and strong suggestions to encourage patients to imagine that reincarnation is real and to imagine their past lives. Events and people from past lives are blamed for symptoms and problems in the patient’s current life. Finding a past life cause for current problems supposedly helps patients deal with them. The technique is also used in healthy people to promote spiritual advancement and self-understanding. There is no such thing as reincarnation, and the memories of past lives are nothing but fantasy. (more…)

Posted in: Neuroscience/Mental Health

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The Gene: An Intimate History

A superb writer, Siddhartha Mukherjee's books are easier to read than his name is to spell

A superb writer, Siddhartha Mukherjee’s books are easier to read than his name is to spell

Six years ago I reviewed Siddhartha Mukherjee’s book The Emperor of All Maladies: A Biography of Cancer. It was hands-down one of the best books I have ever read on a medical topic. Now he’s done it again. His new book is titled The Gene: An Intimate History.

Mukherjee is a superb writer. Much of what I said about his first book applies equally to his second, so I will quote myself:

It is a unique combination of insightful history, cutting edge science reporting, and vivid stories about the individuals involved: the scientists, the activists, the doctors, and the patients. It is also the story of science itself: how the scientific method works…

Beautifully written and informative

Reads like a detective story with an exciting plot.

He links this second book to his first by pointing out that cancer is an ultimate perversion of genetics, and that studying cancer means also studying its obverse: normalcy. He gives the subject a human face by interspersing anecdotes from his own family’s struggles with mental illness and its connection to inherited genes. He sets out to tell the story of the birth, growth, and future of one of the most powerful and dangerous ideas in the history of science: the gene. He says it is one of three destabilizing ideas that have transformed science: the concept that irreducible units underlie matter (the atom), digitized information (the byte or bit), and biological information (the gene). He explains how the consequences of these ideas have transformed our thinking, our language, our culture, politics, and society. (more…)

Posted in: Basic Science, Book & movie reviews, History, Medical devices

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Diatomaceous Earth? No Thank You!

Would you eat this? It might look like a crunchy new breakfast cereal, but it's a close-up of diatomaceous earth, the fossilized microscopic skeletons of diatoms.

Would you eat this? It might look like a crunchy new breakfast cereal, but it’s a close-up of diatomaceous earth, the fossilized microscopic skeletons of diatoms.

Diatoms are unicellular algae, one of the two major classes of the phytoplankton that constitute the bottom of the food chain in oceans and freshwater. Diatomaceous earth is a soft, siliceous sedimentary rock containing the fossilized skeletal remains of diatoms. It has been used as a bug killer: it is hypothesized that the sharp particles physically cut up the insects and also damage their waxy protective layer, causing dehydration. It is also used as an abrasive, a filter, an anticaking agent, and in various other industrial and agricultural applications. It contains silica, mainly in the form of amorphous silicon dioxide but with some crystalline silica. Silica is dangerous when inhaled, causing lung disease in workers exposed to silica dust. Silicosis is the most common occupational disease worldwide.

Those are the indisputable facts. So far, so good. Now for the unsupported claims. Diatomaceous earth is being sold as a dietary supplement and is being promoted as “one of the cheapest and most versatile health products on the market.” One of the red flags for quack remedies is the claim that the remedy works for a long list of disparate ailments. Another is that the claims are supported only by testimonials, not by scientific studies. Another is the claim that it “detoxifies.” And most of those who claim it works just happen to have their own brand that they want to sell you. Diatomaceous earth fits the bill, on all counts. But just because it walks like a duck doesn’t mean we can summarily dismiss it. To be fair, we must examine the claims and the evidence. (more…)

Posted in: Herbs & Supplements, Nutrition

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Vegan Betrayal: The Myths vs. the Realities of a Plants-Only Diet

If vegans really followed these guidelines, they could get adequate nutrition; but all to often they don't.

If vegans really followed these guidelines, they could get adequate nutrition; but all too often they don’t.

 

NOTE: The original version of this book review was criticized for not making it clear when I was simply reporting the book’s content and when I was expressing support for one of its arguments. I have revised it to make it more clear. The additions are marked by brackets.

 

Vegetarians come in several flavors. Ovo-vegetarians eat eggs, lacto-vegetarians eat dairy products but not eggs, ovo-lacto-vegetarians eat both eggs and dairy products. Pescatarians eat fish but no other animals. Vegans eat nothing derived from animals. Vegans have claimed that a plants-only diet offers a multitude of health benefits, is better for the environment, and is the only ethical choice. While some of them respect the dietary choices of others, some of them proselytize with religious-like fervor and are working to get their diet adopted by all of humanity. In her new book, Vegan Betrayal: Love, Lies, And Hunger In A Plants-Only World, Mara Kahn questions those beliefs, pointing out that no human population has ever endured on a plants-only diet; that while some studies have shown short-term health benefits, long-term follow-up is missing; that long-term vegans frequently experience “failure to thrive,” go off their diet, and feel better when they return to eating meat; and that veganism might actually harm the environment and might not even save animal lives overall.

The book is really three books interleaved into one:

  • The story of her own experiences as a vegan.
  • An evidence-supported analysis of veganism and vegetarianism
  • Some rather woo-woo ideas about finding a unique diet for each individual

I can highly recommend the first two, but I deplore the third. (more…)

Posted in: Book & movie reviews, Nutrition

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The THRIVE Experience: Masterful Marketing, Short on Substance

One of the few things that aren't in THRIVE products

One of the few things that aren’t in THRIVE products

My daughter told me about the latest health fad among her group of acquaintances. She knows people who are spending $300 a month on the THRIVE program and claiming miraculous results. With a skeptic for a mother, my daughter knew enough to question the claims and do her own research; she was not impressed. She concluded that THRIVE was essentially selling caffeine and vitamins at exorbitant prices.

Claims on the website

THRIVE is offered by Le-Vel Brands, LLC. A slick video on the website asks:

Are you ready to hear about the hottest weight loss, nutrition and fitness plan sweeping North America? It’s called the THRIVE 8-week experience. The only premium lifestyle transformation plan. People from all walks of life are accomplishing their physical goals with THRIVE, and many are also accomplishing their financial goals by choosing to promote the experience.

  • Weight management
  • Joint support
  • Pain management
  • Antioxidant support
  • Cognitive performance
  • Lean muscle support
  • Anti-aging
  • Digestive and immune support
  • Calms general discomfort

“You’re going to live, look, and feel Ultra Premium like never before.”

Testimonials: yes. Hype: yes. Evidence: no. (more…)

Posted in: Herbs & Supplements

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