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…)
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.
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.
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.
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…)
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…)
Is this the G-Spot?
The press release proclaims “Study Confirms Anatomic Existence of G-Spot.” The study itself is titled “G-Spot Anatomy: A New Discovery.” It was just published in The Journal of Sexual Medicine. The author, Adam Ostrzenski, is an “internationally renowned gynecologic surgeon” with multiple degrees (MD, PhD, Dr Hab) and many peer-reviewed articles listed in PubMed.
The G-spot, or Gräfenberg Spot, is an area on the anterior wall of the vagina that can be stimulated to produce sexual excitement, stronger orgasms, and maybe even female ejaculation. Its existence is questionable. Wikpedia has an extensive article explaining the controversy and the published evidence, pro and con, with links to the original sources. You can read more than you ever wanted to know about it there, so I won’t bother trying to repeat it here. A 2012 review of the G-spot literature concluded:
Objective measures have failed to provide strong and consistent evidence for the existence of an anatomical site that could be related to the famed G-spot. However, reliable reports and anecdotal testimonials of the existence of a highly sensitive area in the distal anterior vaginal wall raise the question of whether enough investigative modalities have been implemented in the search of the G-spot.
Dr. Ostrzenski claims to have found the G-spot and taken its picture (above). Believers in Bigfoot and the Loch Ness monster have pictures too. They even had “Bigfoot hair” that later turned out to be synthetic wig fibers. Ostrzenski’s “proof” is no more credible than theirs.
A recent three-part article published in ACA News advocates turning chiropractors into “conservative primary care providers” who would be the initial point of contact for patients, would serve as gatekeepers for referrals to medical doctors and specialists, and would co-manage patients with those specialists on a continuing basis: essentially, family doctors. I think that’s a terrible idea. It might benefit chiropractors by increasing their market share, but it wouldn’t benefit patients. There is no evidence to indicate that chiropractors are capable of filling that role effectively or safely.
NUHS. The article was co-authored by several chiropractors on the faculty of the National University of Health Sciences, a school noted for integrating quackery with medicine. The “sciences” this school teaches are listed at the top of its website: chiropractic medicine, naturopathic medicine, oriental medicine, acupuncture, biomedical science, and massage therapy. The only one of those that even sounds like science, “biomedical science,” offers a bachelor of science degree with an integrative medicine focus and with no required core courses whatsoever!
Their doctor of chiropractic degree program says:
National University prepares students to become first-contact, primary care physicians fully qualified to diagnose, treat and manage a wide range of conditions.
Eric Topol, MD, has written a book about the convergence of the digital revolution and medicine. It is full of fascinating information and prognostication, but I wish he had given it a better title. He called it The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. Medicine will not and cannot be “destroyed.” It will be improved and transformed, perhaps, but not destroyed. And any new developments will have to be evaluated for safety and effectiveness by the good old time-tested methods of science.
The future world of medicine is really exciting: science fiction is becoming real. As I read Topol’s book I serendipitously found it paraphrased by a character in another book I was reading, Chop Shop, by Tim Downs.
I see a world where no one ever dies from an adverse drug reaction; where physicians have an entire range of medicines to choose from to treat a deadly disease; where medications target tumors like smart bombs and leave surrounding tissues unharmed; where genetic susceptibility to disease can be determined in childhood, and possibly even prevented.
(If you haven’t yet discovered Downs’ hilarious “Bug Man” detective series about a crazy forensic entomologist, you have a treat in store.)
But back to non-fiction. Our world is changing almost too rapidly to comprehend: the Internet reaches everywhere, and there are far more mobile phones in the world today than toilets. We have hardly begun to tap the current potential of new technologies, and unimagined further developments await us. Topol is a qualified guide to this new world: he is a respected cardiologist and geneticist who ha s been on the forefront of wireless medicine and who was a major whistleblower in the Vioxx fiasco. He knows whereof he speaks, and he writes lucidly and accessibly.
Last week I wrote about a regrettable piece on homeopathy that was published in Scientific American Brasil. There have been gratifying developments. Within hours, the editor in chief of Scientific American, Mariette DiChristina, appeared in the Comments. She said that Scientific American does not condone the pseudoscience of homeopathy, that the piece clearly should not have been published, that it would never have been published if Scientific American had been consulted beforehand, and that she had complained to the responsible parties. I was very grateful for her response to my article, for her intervention, and for her willingness to speak out in support of good science.
Lo and behold, two days later Ms. DiChristina reported that the editor of Scientific American Brasil had written a letter of apology and had published it on the website. Here is a full translation:
I recently received an e-mail from one of SBM’s readers in Brazil, Felipe Nogueira Barbara de Oliveira, a PhD candidate in Medical Science who holds an MS in Computer Science and is who is trying to promote critical thinking and scientific medicine in his country. He sent me a jpeg copy of a short piece that was published (in Portuguese) in the April, 2012 issue of Scientific American Brasil. He was appalled that this appeared under the aegis of Scientific American, and so was I. He provided the translation which follows.
Warning: this is painful.
The Questioned Effectiveness of Homeopathy
Application of this technique in agriculture shows recuperation of plants and environment.
Homeopathy is known as an alternative treatment for human beings, but few people know about its utilization on animals, plants, soils, and water. This technique is the target of critiques regarding results and efficacy. One of them is about the “placebo effect” of its remedies, which do not contain any trace of the raw material used in its preparation. To answer this criticism, a clarification is necessary: homeopathy is not related to chemistry, but to quantum physics, because it works with energy, not with chemical compounds that can be qualified and quantified. (more…)