In writing about science-based medicine, we give a lot of attention to medicine that is not based on good science. We use bad examples to show why science is important and how it is frequently misapplied, misinterpreted, misreported, or even wholly rejected. It’s a pleasure, for a change, to write about a straightforward example of the best of science-based medicine in action. The book Heart 411 is such an example.
The medical literature is a jungle of conflicting and complicated studies. It’s difficult for novices and even for sophisticated non-specialists to navigate. It’s useful to have experts as guides who can apply their knowledge, experience, and judgment to analyze the data and put everything into perspective. I can’t imagine anyone more qualified as guides to “matters of the heart” than the authors of this book. Heart surgeon Marc Gillinov and cardiologist Steven Nissen practice at the Cleveland Clinic, which has been ranked as the number one heart hospital by U.S. News & World Report for the last 15 years and is currently ranked 4th best hospital overall. They have treated more than 10,000 heart patients over 30 years of clinical practice and have also done extensive research and published hundreds of articles in peer reviewed journals. Their book contains everything they would like their patients to know about the prevention, diagnosis, and treatment of heart disease. It amounts to an owner’s manual for the heart. (more…)
Many years ago, when I was a naïve and gullible teenager, I read about a home treatment for constipation that involved rolling a bowling ball around on the abdomen. I was intrigued, thought it sounded reasonable, and might even have tried it myself if I had been constipated or had had a bowling ball to experiment with. Many decades later, with the advantages of a medical education and experience in science-based medicine and critical thinking, I encountered a treatment that reminded me of the bowling ball: visceral manipulation (VM), a practice developed by a French osteopath and physical therapist, Jean-Pierre Barral. This time I was far more skeptical. VM may be more sophisticated than a bowling ball, but its effectiveness and safety are equally dubious.
Visceral manipulation (VM) will probably be unfamiliar to most of my readers, but its promoters say it has been adopted by osteopathic physicians, “allopathic” physicians, doctors of chiropractic, doctors of Oriental medicine, naturopathic physicians, physical therapists, occupational therapists, massage therapists and other licensed body workers. Its origin follows the path of many other alternative health systems. Like chiropractic, ear acupuncture, iridology, EMDR, and others, it was developed by one individual based on his personal observations and experiences without any kind of proper testing. Like the others, it started with a single patient: in Ignaz von Peczely’s case an owl with a spot on its iris, in D.D. Palmer’s case a janitor whose hearing allegedly improved after something was done to his back, in Barral’s case a patient who said he had felt relief from his back pain after going to an “old man who pushed something in his abdomen.” From a single case they extrapolated to a general belief about disease causation and a whole diagnostic and/or treatment system.
How is VM Done?
A video shows Barral demonstrating his skills. He “listens with his hands” to detect tension (elsewhere the perception is designated as a thermal phenomenon). His diagnostic process begins by “listening with the hands” on the top of the patient’s head to determine the lateralization or general area of the problem. Then his hands “listen” to the areas of concern to further localize the problem. In this demonstration he detects something in the stomach which he says could be from decreased acidity or emotional tension. Then he listens to the skull repeatedly with both hands, does something simultaneously to the neck and abdomen, and finally he is satisfied that his hands are telling him that he has corrected the problem. (more…)
A Navy neurologist, Capt. Elwood Hopkins, has posted a 3-part article on “The Power of Acupuncture” on Navy Medicine Live, the official blog of Navy and Marine Corps Health Care. It can serve as a useful lesson in how not to think about medicine. It is a prime example of how an intelligent, educated doctor can be fooled and can fool himself into thinking that a placebo is an effective treatment.
To set the scene: acupuncture has been increasingly accepted in military circles. The Air Force is teaching its doctors “battlefield acupuncture” based on the faulty evidence of one Air Force doctor, Richard Niemtzow. The Army is using it to treat PTSD. The Navy offers it too.
Hopkins says that after 40 years of practicing neurology, “It was only natural to begin thinking about something else.” (Why? Boredom? And why pick acupuncture?) When he got an e-mail from his Specialty Leader announcing the opportunity for Navy doctors to learn how to do acupuncture, he submitted his application that same day. He was undoubtedly impressed that this training was being offered by the Navy, lending it the imprimatur of authority. His prior impression of acupuncture was that it was a “mysterious tool” that seemed to work; and instead of asking critical questions, he says he was looking for “a fundamental scientific understanding of acupuncture” and asking to see the supporting research and data. (more…)
Critics of mainstream medicine often point to the dangers of drugs. I previously wrote about “Death by Medicine,” where I explained the fallacy of fixating on harmful effects of drugs without putting them into perspective with all the good drugs do. Yes, patients have died from severe allergic reactions to penicillin, but penicillin has also saved countless lives.
A recent article in The New England Journal of Medicine looks at emergency hospitalizations for adverse drug events in elderly Americans. It confirms that adverse reactions are a serious problem, but some of its findings are surprising.
A number of buzz-words appear repeatedly in health claims, such as natural, antioxidants, organic, and inflammation. Inflammation has been implicated in a number of chronic diseases, including diabetes, Parkinson’s, rheumatoid arthritis, allergies, atherosclerosis, and even cancer. Inflammation has been demonized, and is usually thought of as a bad thing. But it is not all bad.
In a study in Nature Medicine in September 2011, a research group led by Dr. Umut Ozcan at Children’s Hospital Boston (a teaching hospital affiliated with Harvard Medical School) reported that two proteins activated by inflammation are crucial to maintaining normal blood sugar levels in obese and diabetic mice. This could be the beginning of a new paradigm. Ozcan says:
This finding is completely contrary to the general dogma in the diabetes field that low-grade inflammation in obesity causes insulin resistance and type 2 diabetes. For 20 years, this inflammation has been seen as detrimental, whereas it is actually beneficial.
Increasing levels of these inflammatory signals might actually be therapeutic in diabetes and obesity. On the other hand, they might worsen inflammatory diseases like asthma and rheumatoid arthritis. Ozcan’s findings are intriguing and might eventually lead to new treatments, but there are no clinical applications as yet.
The holiday season is upon us. As a bit of a holiday from science-based writing, I thought I would offer some thoughts inspired by the season and not supported by any scientific evidence.
One of my friends refers to Christmas as “The Feast of St. Dyspepsia.” Holidays are indeed an occasion for over-indulging. People change their routine: they have time off work, they travel, spend too much money, go to parties, skip exercising, eat and drink things they ordinarily avoid, gain weight, and then suffer from post-holiday guilt.
Science and Mom both tell us we will be healthier if we eat our fruits and vegetables, exercise, avoid large quantities of alcohol, get enough rest, avoid stress, and control our weight. I would argue that if we follow that guidance most of the time, an occasional lapse is not likely to matter very much. And the pleasure we experience might even be good for our health.
Now for some heretical words.
Science isn’t everything. Health isn’t everything. Even truth isn’t everything. Humans find value in other things like music and mythology, things that bring great pleasure and help make life worth living.
Is your soup poisoning you? In a recent study subjects who ate canned vegetable soup had markedly increased levels of BPA in their urine compared to those who ate freshly prepared soup. We are constantly bombarded with alarmist warnings about the dangerous chemicals in the products we use. Especially BPA (Bisphenol A) and phthalates. Beware plastic bottles! Beware rubber ducks! And now, beware canned soup! BPA and phthalates are classified as endocrine disruptors. They have been discussed before on SBM here and here. BPA has been accused of causing everything from obesity to prostate cancer. Phthalates have been accused of causing everything from breast cancer to reduced anogenital distance in baby boys (the significance of this is unknown: there is not even any standard for what the normal distance is).
In the book Slow Death by Rubber Duck
Using a variety of test methods, the authors determined individual “body burdens,” or the toxic chemical load we carry. The innocuous rubber duck, for example, offers a poison soup of phthalates that “permeate the environment and humans.” From other products and food we also have a collection of chemicals shorthanded as PFCs, PFOAs, PSOSs, and PCBs. None of them are good, and they are everywhere…
Is this science or irresponsible fear-mongering? What does the best evidence tell us? Should we be afraid of our canned soup and rubber ducks? (more…)
I recently received an e-mail from a high school science department head who is teaching a unit on nutritional science. He asked for my opinion of a YouTube video of a lecture advocating a high saturated fat diet. The speaker is Donald W. Miller, Jr., M.D., a cardiothoracic surgeon at my alma mater, the University of Washington. My correspondent commented, “I have a feeling that there is room for some skepticism.” I agree: there’s a whole lot of room for skepticism.
An article based on that video lecture is available on Dr. Miller’s website. It’s entitled “Enjoy Saturated Fats, They’re Good for You!” If you want to judge for yourselves, I recommend the article over the video, as he is a poor public speaker.
Dr. Miller’s website contains a lot of disturbing material. He appears to be a contrarian who disagrees with the consensus of scientific experts on a wide variety of topics, for instance:
- Health Benefits of a Low-Carbohydrate, High-Saturated Fat Diet
- Fighting Fluoride [fluoride is poison!]
- Cardiac Surgeon Dr. Donald Miller Tells Dr. Dean Ornish to Take a Hike
- Avoid Flu Shot, Take Vitamin D [flu is a Vitamin D deficiency disease?]
- Questioning HIV/AIDS, Human-Caused Global Warming, and other Orthodoxies in the Biomedical Sciences
- A User-Friendly Vaccination Schedule [no vaccinations before age 2, no live vaccines, etc.]
He refers to questionable sources of information like the Weston Price Foundation and the notorious AIDS denialist Peter Duesberg. (more…)
Steven Novella recently wrote about so-called “chiropractic neurology” and its most outspoken proponent, Ted Carrick. In 2005 I published an article in The Scientific Review of Alternative Medicine (Vol 9, No 1, p. 11-15) entitled “Blind-Spot Mapping, Cortical Function, and Chiropractic Manipulation.” It was an analysis of a study Carrick had published.
Carrick read a shorter, popularized version of my critique in Skeptical Inquirer and responded with a diatribe that was inaccurate, distorted what I had said, and accused me of fraud, deception, and mis-representation. He failed to offer a credible rebuttal of my specific criticisms; and, in my opinion, showed that he failed to understand some of my points. He referred to me as “Ms. Hall” and suggested that I was psychotic. He characterized my e-mail correspondence with him as “bizarre, rude, and offensive.” It was none of those, and I have copies of the e-mails to prove it. Carrick says he “forwarded it to the legal council for the American Chiropractic Association for review.” Now that strikes me as bizarre.
I am re-publishing the entire text of my article here as an instructive example of what passes for science in the chiropractic neurology community. Readers can judge for themselves whether my critique amounts to fraud and whether I am showing signs of psychosis, whether Carrick is a good scientist and whether his reply to my critique was appropriate. (more…)
A recent announcement is likely to generate a lot of controversy. The Advisory Committee on Immunization Practices of the CDC has recommended that boys and young men be vaccinated against human papillomavirus (HPV). Previously the guidelines said boys “could” be given the HPV vaccine. Now they have recommended that boys age 11 to 12 “should” be vaccinated, as well as boys age 13 to 21 who have not already had the full series of 3 shots. The vaccine can also be given to boys as young as 9 and to young men age 22 to 26.
The vaccine was originally promoted as a way to prevent cervical cancer. Boys don’t have a cervix, so why should they be subjected to a “girl’s” vaccine? There are some good science-based reasons:
- Boys can transmit the virus to female sex partners later in life, leading to cervical cancer in women.
- More importantly, boys themselves can also be directly harmed by the virus. It can cause genital warts, cancer of the head and neck (tongue, tonsils and throat), anal and penile cancer, respiratory papillomatosis, and giant condyloma of Buschke and Lowenstein. In rare cases, immunocompromised patients can develop epidermodysplasia verruciformis.
- There are other unconfirmed concerns: HPV has been associated with cardiovascular disease in one study.
Some of these conditions are not common, and the most common one, genital warts, may sound trivial. But “a picture is worth a thousand words,” so here is a link to a picture of a giant condyloma of Buschke and Lowenstein as an example of what HPV can do to the unvaccinated. The picture is not pleasant. If you are squeamish, you may not want to look at it. If you can’t even stand to look at it, imagine how devastating it would be to have it appear on your own body, and how nice it would be to be vaccinated against it.