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Do We Need “Evolutionary Medicine”?

3 years ago I wrote an article critical of “evolutionary medicine” as it was presented in a new book.   Recently a correspondent asked me if I thought another book, Why We Get Sick: The New Science of Darwinian Medicine, by Randolph M. Nesse, MD and George C. Williams, PhD, was a more reasonable approach to the subject. It was published in 1994 and got good reviews from respected scientists like Richard Dawkins (“Buy two copies and give one to your doctor.”) and E.O. Wilson (“bringing the evolutionary vision systematically into one of the last unconquered provinces…”).  I was able to obtain a copy through interlibrary loan.

The book was interesting and gave me some things to think about, but it didn’t convince me that “Darwinian medicine” is a new science, that its existence as a separate discipline is justified, or that its unique approach offers any real practical benefits for improving medical care.

Why do we get sick? A simplistic view of evolution holds that it systematically eliminates any factors that decrease fitness for survival. So why does disease persist? Why didn’t we evolve to be “fit” enough to never get sick? Because evolution is not a straightforward process.

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Posted in: Book & movie reviews, Evolution

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5-hour Energy

5-Hour_Energy

What should you do if you feel tired? Taking a nap isn’t always possible. The ever-inventive capitalist marketplace has come up with another option.

5-hour Energy is a flavored energy drink sold as 2 oz “shots.” It was invented by Innovation Ventures in 2004. It is intended to counteract the afternoon slump, to increase alertness and energy, to help you stay sharp, improve attention, leave grogginess behind and sail through your day.

Ingredients

According to the label, its ingredients are:

  • Niacin 30 mg — 150% of the RDA
  • Vitamin B6 40 mg — 2000% of the RDA
  • Folic acid 400 mg — 100% of the RDA
  • Vitamin B12 500 mcg — 8333% of the RDA
  • Energy blend: taurine, glucuronic acid, malic acid, N-acetyl L tyrosine, L-phenylalanine, caffeine, and citicoline. Total amount of blend: 1870 mg. The caffeine content is not specified on the label, but it is supposedly comparable to a cup of the leading premium coffee.

It contains only 4 calories, with no sugar. (more…)

Posted in: Herbs & Supplements

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Followup: Benedetti on Placebo Ethics

A few months ago I wrote about Fabrizio Benedetti’s research on the neurobiology of the placebo response, and a discussion about placebos and ethics ensued in the comments. Now Dr. Benedetti has written about that issue in a “Perspective” article in the journal World Psychiatry, “The placebo response: science versus ethics and the vulnerability of the patient.” 

We have learned that verbal suggestions can activate neurotransmitters and modulate pain perceptions, and positive expectations can activate endogenous opioid and cannabinoid systems. A complex mental activity has objective effects on body physiology. Words and drugs can activate the same mechanisms. Drugs are less effective without therapeutic rituals. We are delving deep into human foibles and vulnerable traits at the center of human interactions. What implications do these insights into mind-body interactions have for patient care?

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Posted in: Medical Ethics

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What Would It Take?

I recently wrote a SkepDoc column on fantasy physics in Skeptic magazine in which I mentioned a study that had allegedly measured 2 milligauss emanations from a healer’s hands. A reader inquired about it and went on to ask “what criteria is [sic] necessary for gaining acceptance in the scientific community in regards to purported healing processes using energy fields generated in the human hand, specifically the palm area.”

What would it take to prove this implausible claim to the satisfaction of the scientific community? That is an excellent question with a complicated answer. It’s worth looking at because there is only one science and the same standards apply to how science evaluates any claim. I’ll take a stab at it, and perhaps our commenters can add words of wisdom.

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Posted in: Energy Medicine

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The Forerunners of EBM

The term “evidence-based medicine” first appeared in the medical literature in 1992. It quickly became popular and developed into a systematic enterprise. A book by Ulrich Tröhler To Improve the Evidence of Medicine: The 18th century British origins of a critical approach argues that its roots go back to the 1700s in Scotland and England. An e-mail correspondent recommended it to me. Can’t remember who, but I would like to thank him.

Francis Bacon (1561-1626) differentiated between “ordinary experience” (chance observations) and more objective “ordered experience” (methodological observations). Both of these involved empirical knowledge.  It’s hard to get back into the mindset of his time, when most physicians rejected empiricism as the sphere of quacks and surgeons.  Tröhler helps us understand why they did:

…since antiquity, the mark of distinction of a learned man had been the certainty of his knowledge. A doctor knew — he did not need to test his kind of knowledge empirically because this would imply acknowledgement of uncertainty.

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Posted in: Book & movie reviews, History

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“How do you feel about Evidence-Based Medicine?”

That was the question asked on a Medscape Connect discussion

I did a double-take. How do you feel? Could anybody object to the idea of basing treatments on evidence? The doctor who started the discussion asked:

Besides using EBM, a lot of my prescribing comes from anecdotal experience and intuition. How about you? Where do you get your information from that you use to treat your patients? Do you always ascribe to EBM, or do you deviate from it with certain medical conditions/patients?

I had naively thought that my profession uniformly embraced EBM. How could they not? The commenters broke my bubble big-time. Some of them summarily reject EBM… although it appears that what they are rejecting is not what I understand EBM to mean. (more…)

Posted in: Science and Medicine

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Bach Flower Remedies

May is the month associated with flowers, so I thought it would be timely to look at flower remedies. You may have heard of “rescue remedy” or other Bach flower remedies. (The preferred pronunciation is “Batch,” but it’s also acceptable to pronounce it like the composer.) They contain a very small amount of flower material in a 50:50 solution of brandy and water, and are said to work by transmitting a vibrational energy through the memory of water (not the same as homeopathy, but equally implausible).

Bach was trained as a homeopath and even created some bacterial homeopathic nosodes, but then he branched out. He used his intuition to access a psychic connection to plants. He would hold his hand over different plants to see which one affected his emotional state, and he would collect the dew from that plant to use as a remedy.

The Remedies

A facsimile edition of Bach’s 1936 book The Twelve Healers is available free on the Internet. It makes interesting reading. It starts off:

From time immemorial it has been known that Providential Means has placed in Nature the prevention and cure of disease, by means of divinely enriched herbs and plants and trees. The remedies of Nature given in this book have proved that they are blest above others in their work of mercy; and that they have been given the power to heal all types of illness and suffering.

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Posted in: Energy Medicine, Herbs & Supplements

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RISUG: Birth Control for Men

According to an enthusiastic article on the Internet, “The Best Birth Control In the World Is For Men.”

It’s called RISUG: Reversible Inhibition of Sperm Under Guidance. It involves a minor surgical procedure in which the vas deferens is exposed and pulled outside the scrotum by the same techniques used for a vasectomy. A copolymer, powdered styrene maleic anhydride (SMA, for which the method was previously named) combined with dimethyl sulfoxide (DMSO) is then injected into the vas deferens. The polymer coats the walls of the vas and kills the sperm as they swim by. The mechanism is not understood, but the developer thinks the polymer’s mosaic of positive and negative charges causes the membranes of the sperm to burst, rendering them immotile.

RISUG is rapidly effective: in a phase II clinical trial in India, viable sperm were absent as soon as 5 days after the procedure. They say there have been no pregnancies in the first months “other than a handful of cases in which the RISUG was not injected properly.” (One wonders how they determined that it was not injected properly: by the fact that pregnancy occurred? Could this be just a rationale to explain away failures? Or to spare patients the embarrassment of discovering the wife had another sperm donor?) The contraceptive effect is said to last for a decade or more; it might require repeat injections every 10 years.
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Posted in: Surgical Procedures

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Announcement: New Edition of Consumer Health

For decades Consumer Health: A Guide to Intelligent Decisions was the only textbook available for college classes on the subject, and it is still the best: the most comprehensive and the most reliable. It was first published in 1976, and it has clearly had staying power. An updated 9th edition has just been released. The authors have changed over the years: this edition’s authors are Stephen Barrett, William London, Manfred Kroger, Harriet Hall, and Robert Baratz. It’s an invaluable compendium of information that would be useful to any consumer, and it’s unfortunate that McGraw-Hill is marketing it as an expensive textbook ($163).

What exactly is “consumer health”? The book’s preface and the table of contents are available here. They will provide the long answer to that question. The short answer is:

The book’s fundamental purpose is to provide trustworthy information and guidelines to enable people to select health products and services intelligently. (more…)

Posted in: Announcements, Book & movie reviews

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Homeopathy and Nanoparticles

I had never heard of Dr. Shantaram Kane, a chemical engineer in Mumbai, India. I don’t know how he heard of me, but he apparently knows I am critical of homeopathy. He e-mailed me out of the blue to tell me about a study he had published in 2010 in the journal Homeopathy: “Extreme homeopathic dilutions retain starting materials: A nanoparticulate perspective.” The full text is available online here.  It was lauded in an accompanying editorial.  Incredibly, it is an uncontrolled study.

Kane recognizes that a major objection to homeopathy is that, at high potencies, not a single molecule of the starting material is present. He says his study found nanoparticles of the parent metal in 200C dilutions of metal-based remedies. He says his findings represent a paradigm shift. In other words, there really is something there when we assumed there wasn’t. (more…)

Posted in: Homeopathy

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