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Brief Announcement

My book Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon  is now available as a Kindle file for $3.99. If you don’t have a Kindle device, there is a free download so you can play Kindle files on your computer or iPad.

Some readers may remember my mentioning it on SBM 4 years ago in the context of an article on women in medicine. A lot of people prefer to read books electronically these days, so I thought I’d let you know.

Posted in: Announcements

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Therapy or Injury? Your Tax Dollars at Work.




The U.S. Army Medical Command recently announced a job opening  in the Interdisciplinary Pain Management Center at the San Antonio Military Medical Center at Fort Sam Houston, Texas. Two GS-12 positions were advertised for acupuncturists at a salary of $68,809 to $89,450. As a licensed acupuncturist, a candidate would be expected to

offer a full array of the most current and emerging evidenced based approaches in integrative medicine for patients with acute and chronic pain who have not responded well to conventional treatment modalities.

This is wrong on more levels than one. After giving lip service to the politically correct term “evidence based” they proceed to include clearly non-evidence-based modalities in the job description. Rigorous scientists do not classify acupuncture itself as evidence-based, since the evidence is compatible with the hypothesis that it is no more than an elaborate system to provide placebo and other nonspecific effects. And the described duties of the position make it even worse.   (more…)

Posted in: Acupuncture

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Red Yeast Rice and Cholesterol

While much of CAM is ridiculous or implausible, herbal remedies are an exception. Plants produce pharmacologically active substances; in fact, the science of pharmacology grew out of herbalism. Some herbal remedies have not been scientifically tested, but others have been tested and are clearly effective. Nevertheless, these are seldom if ever the best choice for treatment.

One natural remedy stands out. Red yeast rice has been tested and has been shown to lower cholesterol as well as a statin drug. That’s hardly surprising when you realize that it contains the exact same ingredient as the pharmaceutical drug lovastatin.

Only it doesn’t any more.
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Posted in: Herbs & Supplements

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Oxygen Is Good, Even When It’s Not There

Note: This article originally appeared in Skeptical Inquirer, 28(1), 48-50 & 55, January/February 2004. I’m recycling it now because I have been at The Amazing Meeting in Las Vegas instead of home at my computer writing new posts. It’s still timely: despite multiple debunkings and FTC actions, vitamin O is still for sale. Amazon has it for $4.80 an ounce. I’m no Mark Crislip; but I like to think this article borders on the Crislipian. Enjoy!

 

Oxygen is not just in the air; it’s on the shelves. It has been discovered by alternative medicine and is being sold in various forms in the health supplement marketplace. Back when I was an intern, we used to joke that there were four basic rules of medicine: (1) Air goes in and out. (2) Blood goes round and round. (3) Oxygen is good. (4) Bleeding always stops.

Alternative medicine has latched on to rule number three and won’t let go. The rationale, apparently, is that oxygen is required to support life; therefore more oxygen should make you more healthy. It’s not clear how this relates to alternative medicine’s advice on anti-oxidants, but that’s irrelevant. OXYGEN IS GOOD, so we should put it in our soft drinks and breathe it at oxygen bars. Take an oxygen tank home with you — you might feel better. The oxygen vendor might feel better, too. Dr Andrew Weil, the renowned health guru, tells patients with chronic fatigue to ask their doctors to prescribe oxygen for a home trial. Sure, why not? The money it costs will literally vanish “into thin air,” but who cares? OXYGEN IS GOOD.

Ignore the fact that you could find out whether you need oxygen by testing your blood oxygen saturation with that little-clip-thingy-they-stick-on-your-finger-in-the-emergency-room (aka pulse oximeter). Who cares if your blood is fully saturated with oxygen already? OXYGEN IS GOOD. If your oxygen saturation is a little less than 100 percent, there is no evidence that raising it will help with anything. If it is a lot less, and you do need oxygen, any competent doctor should be able to figure that out. But try an oxygen tank anyway: OXYGEN IS GOOD. Is this starting to sound like a mantra? It should. This is religious belief I am talking about, not science. (more…)

Posted in: Herbs & Supplements, Humor

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Why Do They Do Studies Like This?

A recently published study claims to have shown that a proprietary mixture of velvet bean and Chlorophytum borivilianum improves sleep quality. The journal, Integrative Medicine Insights, is online, peer-reviewed, PubMed indexed, open-access, and it charges authors $1848.00 to publish their article. It advertises editorial decisions in 3 weeks and publication in 2 weeks after acceptance. I can see two reasons why authors might be willing to pay that much for publication: to speed the process of getting important research results out to the public, or because their research is poor quality and they know it would be rejected by other journals.

The quality of this study is unfortunately typical of much of the research on alternative medicine.

Description of Study

The full text is available for download here.  The title is “A Dietary Supplement Containing Chlorophytum Borivilianum and Velvet Bean Improves Sleep Quality in Men and Women.” They gave a proprietary supplement mixture to 18 young healthy subjects with self-reported impairment of sleep quality (defined as routine difficulty falling asleep, waking more than twice during the night, and awaking in the morning feeling tired) and had them fill out a questionnaire about sleep quality before and after the trial. They also measured heart rate, blood pressure, CBC, metabolic panel, and lipid panels.
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Posted in: Clinical Trials, Herbs & Supplements

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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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