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Another Misguided Cancer Testimonial

An economic analyst, Mike “Mish” Shedlock, wrote a blog post to describe how he beat prostate cancer. When laymen and patients write about cancer, they are likely to get some things wrong. Mish’s story is full of typical misunderstandings and misinterpretations.

He interpreted his experience in his own way and did his own research into the medical literature, something he was not qualified to do. Prostate cancer is a very complex subject, and understanding the implications of published studies for treating patients can be difficult even for experts. In typical Dunning-Kruger fashion, he rejected the advice of his doctors, thinking he could do better.
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Posted in: Cancer, Herbs & Supplements

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Shedding Light on Unreasonable Decisions

BloodPressure2

One of the biggest frustrations for a doctor is when a patient refuses to take science-based medical advice. We would like to believe that giving a patient accurate information will lead him to make good decisions that will improve his health or save his life. But that’s not how it works. Patients reject life-saving surgery and chemotherapy, patients on essential medications are non-compliant, parents reject vaccines for their children…what are these people thinking? Why would anyone in their right mind knowingly reject a treatment that has been proven to increase their chances for survival and health? What could their reasons possibly be?

This ties into a subject we have debated over and over: why do people choose alternative medicine? Many reasons have been suggested: cost and accessibility, the need for control, dissatisfaction with mainstream medicine, the peer pressure of a popular fad, “belonging” to a group of like-minded people, a need for answers, autonomy, health freedom, ideology, rebellion against authority, a need for hope even if it is false hope, giving more importance to stories than to studies, the post hoc ergo propter hoc fallacy, scientific illiteracy, misinformation, superstition, magical thinking…the list goes on. Studies have been done, but we can’t be sure the reasons people give to researchers are the real reasons. There is a problem with the search for reasons: these decisions are not made on the basis of reason. Physician Lisa Rosenbaum has written a beautiful essay in The New England Journal of Medicine entitled “Beyond Belief — How People Feel about Taking Medications for Heart Disease“, that sheds a penetrating light on what is really going on. It made me think of the subject in a whole new way. (more…)

Posted in: Critical Thinking

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Smoking Cessation and the Affordable Care Act

A young child and a chicken — neither of whom should smoke.

A young child and a chicken — neither of whom should smoke.

Smoking is the leading preventable cause of death. Each year it kills more than 5 million people around the world, 480,000 in the US alone. And for every person who dies, about 30 more have serious illnesses caused by smoking. On average, smokers die 10 years earlier than nonsmokers. Anyone who is concerned about preventive medicine must consider smoking cessation a priority. Fortunately, the Affordable Care Act (ACA) has taken a step in the right direction.

The ACA’s provisions

The Affordable Care Act requires health plans and health insurance to cover tobacco-use counseling and interventions without cost sharing or prior authorization. It requires screening of all patients for tobacco use and covering at least two attempts to quit each year. For each quit attempt, it authorizes four tobacco-cessation counseling sessions, each at least ten minutes long (including telephone, group, and individual counseling) and any FDA-approved tobacco-cessation medications (whether prescription or over-the-counter) for a 90-day treatment regimen when prescribed by a health care provider. In a separate provision, it requires that states not exclude FDA-approved cessation medications from existing Medicaid programs. These provisions should encourage providers and patients to increase their smoking cessation efforts. (more…)

Posted in: Politics and Regulation, Public Health

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Is the Ebola Crisis a Reason to Skip RCTs?

Ebola virus

 

In a recent “Perspective” article in The New England Journal of Medicine, three physicians (Drs. Cox, Borio, and Temple) make a strong case for not letting the rush to save Ebola patients tempt us to deviate from good science and skip the randomized controlled trial (RCT). Their arguments cut to the essence of the scientific approach to medicine, and they deserve careful consideration.

Ebola is uniquely scary

Ebola is the kind of threat that really gets our attention. The virus was first identified in 1976, and prior to 2013 there were several small outbreaks in Africa with death rates as high as 90%. This time the death rates are lower, but the numbers are much greater. It has spread to several African countries, and a few cases have even reached the US and Europe due to infected travelers and health care workers. We face a risk that Ebola may become endemic, smoldering along as a constant presence in Africa.

There is no known effective treatment. Fear of Ebola has sparked bizarre conspiracy theories and claims of “natural” cures and prevention kits from homeopaths, alternative medicine advocates like Mercola, and purveyors of remedies like colloidal silver and essential oils. These have been covered on SBM here, here, and here. (more…)

Posted in: Clinical Trials, Science and Medicine

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The Health Benefits of Moderate Drinking

A Book of Verses underneath the Bough,
A Jug of Wine, a Loaf of Bread–and Thou
Beside me singing in the Wilderness–
Oh, Wilderness were Paradise enow!”

- The Rubaiyat of Omar Khayyam

 1024px-A_glass_of_red_wine

Alcoholic beverages have always inspired strong opinions pro and con. Omar Khayyam included wine in his vision of Paradise; Carrie Nation took a hatchet to saloons. Humans have been drinking alcoholic beverages for at least 12,000 years. In earlier eras beer and wine were dietary staples that provided essential calories and were safer to drink than water. Early cultures worshipped wine deities; today, some religions ban all forms of alcohol while others embrace red wine as an essential part of a holy sacrament. Alcoholic beverages are widely used as an accompaniment to meals and as a social lubricant (as Ogden Nash put it, “Candy is dandy, but liquor is quicker”). Prohibition didn’t work.

It’s always good when opinions can be backed up by scientific evidence. Those who drink, especially wine lovers, can bolster their personal preference with the evidence from recent studies showing that moderate alcohol consumption prolongs life and improves health in various ways. Those who prefer not to drink are being told they can get the same benefits from resveratrol, a component of red wine. Just how good is the evidence, and what does it really tell us? (more…)

Posted in: Nutrition

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The Marvelous Dr. Mütter

The Mütter Museum in Philadelphia has a marvelous collection of human bones, surgical specimens, monsters in jars, and medical memorabilia. It holds attractions for everyone, from the jaded medical professionals who thought they’d seen it all to the coveys of youngsters who compete to point out the grossest items to their friends, from the student of history to the connoisseur of the macabre. There is an enormous megacolon said to look like a sandworm from Dune, a plaster cast of the famous Siamese twins Chang and Eng along with their actual preserved conjoined livers, a collection of bizarre swallowed objects, an iron lung, a tumor removed from president Grover Cleveland’s jaw while he was in office, a shocking assortment of deformed fetuses…the list goes on.

I knew about the museum and greatly enjoyed visiting it, but I didn’t know anything about Dr. Mütter himself until I read a delightful new book by Cristin O’Keefe Aptowicz , Dr. Mutter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine. I learned that the good doctor was every bit as marvelous as his museum, and the book took me on a fascinating trip back to the medicine of the early 1800s that made me better appreciate all that modern medicine has accomplished.

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Posted in: Book & movie reviews, History, Surgical Procedures

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Study of “Acupressure” for Constipation

constipationA recent study in the Journal of General Internal Medicine evaluated a treatment for constipation. It tested whether training patients to massage the perineum (the area between the vagina or scrotum and the anus) would improve their reported bowel function and quality of life at 4 weeks after training. They found that it did. It’s a simple, innocuous treatment that may be worth trying, but why, oh why, did they have to call it “acupressure”? That irritated me. Should it have? Why should it matter? Isn’t a rose by any other name still a rose? Is this a meaningless semantic quibble and hypersensitivity on my part, or am I right to see it as yet another example of quackademia’s attempts to infiltrate science-based medicine? I’ll explain my thinking and let you decide for yourself. (more…)

Posted in: Acupuncture, Clinical Trials, Traditional Chinese Medicine

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Pesticides: Just How Bad Are They?

3D model of DDT, an insecticide

3D model of dichlorodiphenyltrichloroethane (DDT), an insecticide

I think everyone would agree that it would not be a good idea to put pesticides in a saltshaker and add them to our food at the table. But there is little agreement when it comes to their use in agriculture. How much gets into our food? What are the effects on our health? On the environment? Is there a safer alternative?

Where should we look to find science-based answers to those questions? One place we should not look is books written by biased non-scientists to advance their personal agendas. A friend recently sent me a prime example of such a book: Myths of Safe Pesticides, by André Leu, an organic farmer whose opinions preceded his research and whose bias is revealed in the very title. (more…)

Posted in: Book & movie reviews, Critical Thinking, Public Health

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Vitamin D: To Screen or Not to Screen?

Vitamin D, the so-called sunshine vitamin, has generated a lot of attention in recent years. It has been claimed to benefit a wide variety of diseases, everything from cancer to multiple sclerosis. It is widely used along with calcium for bone health. It is added to milk and prenatal vitamins and is prescribed for breastfed babies. Some doctors are recommending everyone take it for prevention. Some CAM advocates are recommending it as a more natural way to prevent the flu than getting a flu shot.

sesame-street-letter-d-s

It has been touted as a panacea; Michael Holick even wrote a book titled The Vitamin D Solution: A 3-Step Strategy to Cure Our Most Common Health Problems. Christiane Northrup praised it, saying “This information can save your life. Really.” (Really? I’m skeptical, and her recommendation is not enough to make me want to read the book.) Then there’s Jeff Bowles’ book The Miraculous Results of Extremely High Doses of the Sunshine Hormone Vitamin D3 My Experiment With Huge Doses of D3 From 25,000 To 50,000 Iu A Day Over A 1 Year Period. That one’s not on my reading list either; the tolerable upper intake level is 4,000 IU a day.

It’s hard to avoid the hype and just examine the actual scientific evidence without any bias. The United States Preventive Services Task Force has tried to do just that. It recently evaluated screening for vitamin D deficiency and concluded that the current evidence is insufficient to recommend either for or against screening. Predictably, their announcement has already led to misunderstandings and protests.

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Posted in: Herbs & Supplements

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Product B: Here We Go Again

Telomere

“Telomeres shorten each time a cell divides. In most cells, the telomeres eventually reach a critical length when the cells stop proliferating and become senescent. But, in certain cells, like sperm and egg cells, the enzyme telomerase restores telomeres to the ends of chromosomes. This telomere lengthening insures that the cells can continue to safely divide and multiply. Investigators have shown that telomerase is activated in most immortal cancer cells, since telomeres do not shorten when cancer cells divide.” — National Institute of Aging

New health products are constantly appearing on the market in such numbers that I can’t hope to keep up. Product B was new to me. I was introduced to it by a doctor who said a family member was “quite enthusiastic” about its potential to “lengthen telomeres and thereby address a myriad of health issues.” Of course, I immediately asked “What exactly are they claiming Product B does?” and “Do they have evidence that it actually does what they claim?” Their website didn’t provide satisfactory answers.

Product B is described as “a powerful blend of complex botanicals and vitamins uniquely designed to offer superior telomere support for youthful aging.” It is sold as part of a multilevel marketing (MLM) scheme. Because it is classified as a dietary supplement, FDA regulations only allow them to make “structure and function” claims, so the claims are deliberately nebulous. Basically, they seem to be saying that short telomeres are bad (they cause aging and disease), telomerase is good because it makes telomeres longer, and Product B is an effective way to increase telomerase; therefore Product B prevents disease and retards aging. But these assertions are questionable, and the website doesn’t offer any credible evidence of clinical efficacy for any single health issue, much less a myriad of them. Or any evidence of safety, for that matter.

Oh, good grief! It’s sold by the Isagenix company. Talk about déjà vu! Isagenix keeps coming back to haunt me; it even generated my favorite insult ever: “Dr. Harriet Hall is a refrigerator with a head.” You can read the three articles I wrote about Isagenix here, here, and here.

If I am a refrigerator, at least I try to be a fair one. I wasn’t going to reject the claims out of hand just because Isagenix made them. I spent quite a bit of time searching the Internet for information, and I even wrote the company to ask directly for their evidence. They didn’t bother to reply.

One thing puzzled me right off the bat. Was there a Product A that I had somehow missed? Why did they name this “Product B”? That doesn’t impress me as a savvy marketing choice. Couldn’t they have thought up something catchier like “Telomiracle”? I couldn’t help wondering what the B might stand for and my mind quickly associated the words bogus, blarney, business, baloney, bunk, bullshit, blunder, basura (Spanish for garbage), barbaridad (Spanish for stupid thing), and blague (French for joke). It made me think of second choice, as in “plan B.” What does it make you think of?

Pardon the digression. It makes no difference what they call it. “A rose by any other name…” All that matters is what it is and whether it works. (more…)

Posted in: Herbs & Supplements

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