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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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Book Review Lagniappe

bookworm
Lagniappe, a word often heard in New Orleans, refers to a bonus or extra gift, like the thirteenth donut in a baker’s dozen. You may have noticed that I write a lot of book reviews. I read far more books than I review, and I have always loved to read about the experiences of doctors and the interesting patients and intriguing illnesses they have encountered. I thought I would write an extra post this week to share some titles that SBM readers might also enjoy.

I value these books for several reasons. They are entertaining. They prove that doctors are not all evil Big Pharma shills just in it for the money. They let readers vicariously experience what it is like to be a doctor in a particular specialty or setting. They highlight the joys of helping patients, as well as the many frustrations doctors struggle with. They put a human face on the practice of medicine. (more…)

Posted in: Book & movie reviews

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The ROCA Screening Test for Ovarian Cancer: Not Ready for Prime Time

Ovarian cancer

Ovarian cancer

Ovarian cancer is relatively rare but deadly. The lifetime risk of ovarian cancer is 1.5% compared to 12% for breast cancer, but it is the 5th most common cause of cancer death for women. Since the ovaries are hidden deep in the pelvis and the symptoms of ovarian cancer are non-specific, the cancer is often advanced by the time it is diagnosed and survival rates are low. Early detection by screening would be expected to improve outcomes. Two screening methods have been proposed: the cancer antigen CA-125 blood test, and pelvic ultrasound. The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) found that screening with CA-125 and ultrasound did not reduce ovarian cancer mortality. The USPSTF recommends against screening for ovarian cancer because it does not reduce mortality and carries important potential harms from false positives and unnecessary surgeries.

Ovarian cancer screening is being re-considered in the light of a recent study, the UKCTOCS trial, published in The Lancet in December 2015. On the basis of that study, a test called ROCA is being offered directly to the public for $295. It’s important to understand what the study actually found, and why experts have questioned the wisdom of offering this test to the public at this time. (more…)

Posted in: Cancer, Diagnostic tests & procedures

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The Blood Cleaner: Invented by Ray Jardine

Imaginary germs awaiting imaginary electrocution by Ray Jardine's Blood Cleaner device.

Imaginary germs awaiting imaginary electrocution by Ray Jardine’s Blood Cleaner device.

I recently heard about a man who was planning a hike in a tick-infested area and thought he could avoid Lyme disease by using Ray Jardine’s Blood Cleaner. Ray Jardine is a well-known mountaineer, rock climber, long-distance hiker, and outdoor adventurer. A lightweight hiking enthusiast, he has branched out into selling lightweight equipment like backpack kits, tarps, and insulated hats. Most of his products are reasonable, but one is not: the Blood Cleaner. It is a micro electronic device that allegedly kills or disables pathogens in a person’s bloodstream. It is worn on the wrist in a pocket on a wristband that has another pocket holding a 9-volt battery. He and his wife make the devices themselves at home and sell them for $78.95. It could not possibly work as claimed. It is as useless as Hulda Clark’s infamous zappers.

How Ray’s Blood Cleaner supposedly works

It sends pulsed micro-currents through the skin and into the blood vessels. The micro-currents are claimed to electrocute the germs in the bloodstream, killing bacteria, protozoa, and fungi, and disabling viruses, without harming the white blood cells. It is supposed to clean germs out of the blood just as taking a shower cleans germs off of the skin. It comes with two probes, one for cleaning the bloodstream and another for making nano-silver in a glass of water to kill pathogens in the upper GI tract. Nano-silver (a form of colloidal silver) may kill germs in vitro, but it is useless and potentially harmful when ingested by humans. Colloidal silver has been known to turn people as blue as a Smurf. (more…)

Posted in: Lyme, Medical devices

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The Primo Vascular System: The N-rays of Acupuncture?

Is this a PVS structure or something else?

Is this a PVS structure or something else?

Acupuncture meridians and acupoints are imaginary until proven otherwise. Anatomists have never been able to detect them by microscopy or autopsy, and they are not mentioned in anatomy textbooks. For decades, acupuncturists have been trying to prove that their pre-scientific belief system is grounded in scientific reality. Now they are telling us that acupuncture meridians and acupoints have been discovered in the form of the Primo vascular system (PVS). A typical website trumpets “Science Finally Proves Meridians Exist.”

The available information is confusing.

Primo vessels were supposedly missed by anatomists because they are so small. They are reported to only be visible by electron microscopy, yet researchers have used dye to show them under a regular microscope. There has been speculation about their involvement in cancer metastasis: one paper provides images of a putative PVS cancer metastasis thread afloat in a lymph duct.  PVS vessels are said to be too tiny to study by the usual methods of science, but some researchers say they have somehow learned that they are characterized by high resistance and low capacitance. They are allegedly studded with electrically charged nodes that attract nutrients, oxygen, and regulatory hormones. They allegedly transmit energy to organs and integrate the features of the cardiovascular, nervous, immune, and hormonal systems and serve as the physical substrate for acupuncture points and meridians. (more…)

Posted in: Acupuncture, Basic Science

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Therapeutic Touch Pseudoscience: The Tooth Fairy Strikes Again

When tested, therapeutic touch (TT) practitioners failed to detect the human energy field they thought they could feel. Experimental setup from Rosa et al., from JAMA, 1998, 279 (13)

When tested, therapeutic touch (TT) practitioners failed to detect the human energy field they thought they could feel. Experimental setup from Rosa et al., from JAMA, 1998, 279 (13)

A study out of Iran titled “Therapeutic touch for nausea in breast cancer patients receiving chemotherapy: Composing a treatment” was recently published in the journal Complementary Therapies in Clinical Practice. It is a great example of the Tooth Fairy science that permeates much of the research in complementary and alternative medicine. In Tooth Fairy science, researchers attempt to study a phenomenon without first determining whether it exists.

What is therapeutic touch?

Therapeutic touch (TT) is a type of energy medicine; practitioners claim to be able to:

  1. sense a patient’s “human energy field” with their hands,
  2. manipulate the energy field by moving their hands near (but not touching) a patient’s skin surface, and
  3. thereby improve the patient’s health.

TT was the delusional invention of a nurse and a theosophist, and it has no scientific basis. Scientists can detect and measure minute energies down to the subatomic level, but they have never detected a “human energy field.” And when TT practitioners were tested on their ability to detect such a field, they failed miserably.

Therapeutic touch is pure vitalism, the belief in a soul or animating force,” writes Paul Ingraham, “exactly like the Force in Star Wars, and just as fanciful. Auras and life energy do not exist and cannot be felt, let alone manipulated therapeutically.”

Despite the combination of extreme implausibility and a total lack of evidence, TT is taught to nurses in many otherwise reputable institutions, and there are more than 90,000 practitioners worldwide. There is even a Therapeutic Touch International Association that claims TT is evidence-based. It is not.

TT practitioners believe they are helping patients. That belief is reinforced by seeing patients improve due to the natural course of illness, suggestion, and the “placebo” or nonspecific contextual effects of the provider/patient encounter. They allow confirmation bias to overcome scientific reality, and they do poorly-conceived research seeking further confirmation. Since the studies are designed to show that TT works rather than to ask if it works, they find evidence that is convincing to believers but not to the scientific community as a whole. (more…)

Posted in: Energy Medicine

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Uncertainty in Medicine

snowball
Medicine is an uncertain business. It is an applied science, applying the results of basic science knowledge and clinical studies to patients who are individuals with differing heredity, environment, and history. It is commonly assumed that modern science-based doctors know what they are doing, but quite often they don’t know for certain. Different doctors interpret the same evidence differently; there is uncertainty about how valid the studies’ conclusions are and there is still considerable uncertainty and disagreement about things like guidelines for screening mammography and statin prescriptions.

Snowball in a Blizzard by Steven Hatch, MD, is a book about uncertainty in medicine. The title refers to the difficulty of interpreting a mammogram, trying to pick out the shadows that signify cancer from a veritable blizzard of similar shadows. (more…)

Posted in: Book & movie reviews, Science and Medicine

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