Should TRICARE become TRICHIROPRACTIC?
It seems alternative medicine is infiltrating into more and more organizations that should be based on science. We have quackademia in medical schools, integrative medicine clinics in hospitals and medical centers, government funding for alternative medicine research and education, coverage of alternative medicine by government and private health insurance, and acceptance of alternative practitioners in the VA and in military hospitals. Two weeks ago I wrote about an ill-advised effort to get naturopathy into the VA. Now it seems chiropractors have been lobbying to give all veterans and TRICARE beneficiaries access to chiropractic care. On the Society for Science-Based Medicine blog, Jann Bellamy has provided the details.
There are several bills pending: S. 398 and H.R. 1170 for the VA and H.R. 802 for TRICARE. There is also a bill (H.R. 542) that would include chiropractors in the National Health Services Corps. The American Chiropractic Association has issued statements in support of those bills. In their statements, they misrepresent what chiropractic is and what it can do. (more…)
The FDA recently approved flibanserin (brand name Addyi) for the treatment of hypoactive sexual desire disorder (HSDD) in pre-menopausal women. The story of flibanserin illustrates several of the issues we have confronted on this blog:
- It was hyped in the media.
- Misleading headlines called it the female Viagra.
- It was initially rejected by the FDA and was approved only after extensive lobbying efforts.
- The drug is only minimally effective and has a lot of drawbacks.
- Two of the three supporting scientific studies claimed effectiveness based a surrogate measure but failed to show any measurable improvement in sexual desire.
- A campaign to support “women’s sexual health equity” pushed for approval, framing it as a step towards correcting what they perceived as gender bias (they claimed the FDA was biased because it had provided Viagra to help men have sex but hadn’t done anything to help women have sex).
- And the validity of the diagnosis of HSDD itself has been questioned.
Let’s not change the eagle into a duck
AMVETS has joined with The American Association of Naturopathic Physicians in seeking to “promote natural, non-pharmacological approaches to treating patients suffering from chronic pain.” They are petitioning Congress and the VA to authorize bringing licensed NDs into the VA system. As a veteran myself, a retired Air Force Colonel and an MD, I find this appalling. During my twenty years service in the U.S. Air Force as a family physician and flight surgeon, I took pride in the high-quality science-based medical care my colleagues and I were able to provide. This proposal would jeopardize the welfare of our veterans by exposing them to substandard care with irrational, untested, and potentially harmful treatments. Letting naturopaths into the VA would be a grave mistake. (more…)
It’s not clear who first quipped “I’d rather have a bottle in front of me than a frontal lobotomy,” but it’s not just a joke. Almost anything would be preferable to a frontal lobotomy. It was a barbarous procedure with catastrophic consequences, and yet it was once widely accepted and even earned a Portuguese doctor a Nobel Prize. In the annals of medical history, it stands out as one of medicine’s biggest mistakes and an example of how disastrously things can go wrong when a treatment is put into widespread use before it has been adequately tested.
A new book by Janet Sternburg, White Matter: A Memoir of Family and Medicine, puts a human face on the suffering of mentally ill patients and their families, and helps us understand why they agreed to lobotomies. It is the affecting story of how her relatives made the difficult but misinformed decision to lobotomize two of her mother’s five siblings, one for schizophrenia and the other for depression, and the consequences of that decision.
My mother had a favorite saying that rhymed: “All you need from dawn to dawn is someone else to blame it on.” WiFi involves mysterious emissions that you can’t see and that sneakily permeate our environment, and they have become a popular target for blame.
A lawsuit has been filed against the Fay School in Massachusetts on behalf of a 12-year-old boy designated as “G,” alleging that the school violated his rights under the Americans with Disabilities Act and failed to use ordinary care for his safety. They allege the school was negligent in failing to make accommodations to protect the boy from extremely high levels of radiofrequency/microwave radiations. He allegedly suffers from Electromagnetic Hypersensitivity Syndrome (EHS). The family is seeking $250,000 in damages.
After the school upgraded its Wi-Fi system in 2013, G began to have headaches, itchy skin, rashes, nosebleeds, dizziness, chest pains, and nausea. He frequently went to the school nurse and had to leave school early. His symptoms would usually resolve after he had been home for several hours, and he did not experience “the intense symptoms” on weekends and holidays.
From the author’s website: “Shameless use of cute baby to promote book”
When a baby is born, parents are often awed and alarmed to find themselves responsible for this tiny new person, and they desperately want to do their very best to keep their infant safe and healthy. New mothers worry about everything from SIDS to vaccines, from feeding practices to sleep hygiene, and they are bombarded with conflicting advice about caring for their babies. Myths and misinformation abound. Finally someone has written a truly science-based guide to the first year of life: The Science of Mom. The author, Alice Callahan, is a research scientist with a PhD in nutritional biology. When her first child was born, she had a lot of questions, and thanks to her background she knew how to look for reliable answers in the scientific literature. She started writing the Science of Mom blog and eventually turned her findings into a book.
Her first chapter covers the important concepts for understanding how to think about scientific studies:
- Good science is a process that takes lots of experiments, time, and people.
- Good science is peer-reviewed.
- One study on its own isn’t worth much, but scientific consensus is trustworthy.
- Some studies are more valuable than others (here she covers the various types of study from animal studies through observational studies in humans to RCTs and meta-analyses).
- Numbers matter (sample sizes).
- Don’t believe everything you read on the Internet (here she gives some practical tips for evaluating whether a website is reliable).
- Correlation is not causation (she uses my favorite example of the correlation between autism diagnoses and the sales of organic food).
- We can’t eliminate risks (but science can quantify the risks and benefits and families can use the information to decide what risks they are personally willing to take).
- Find smart allies (experts and providers you can trust).
- Forget about perfection and pay attention to your baby.
The “Hubbard protocol” is Scientology’s religion-based, pseudoscientific “detoxification” treatment used in its Narconon program to treat drug addiction. It was dreamed up by a science fiction writer with no medical training. Now it is being studied as a treatment for veterans suffering from Gulf War illness. Our limited public money for research is being wasted on a study with no scientific merit. Whether or not you consider this a church/state conflict, the study is clearly ill-advised.
The study: $600K worth of sweat
A description of the study is available online in the government’s clinical trials registry. The DOD funded this study to the tune of $633,677. The subjects are veterans with Gulf War illness characterized by persistent memory and concentration problems, headaches, fatigue, and muscle and joint pain. The illness has not been well defined, and its cause has not been determined; but the researchers are working on the assumption that toxins are the cause and that the treatment will relieve symptoms by removing toxins from the body.
The control group will get only “usual care.” The experimental group will get:
A four to six week regimen consisting of daily, supervised, mild-moderate exercise as tolerated for 20 minutes, supervised, intermittent Finnish saunas (at about 140’F) sauna time with breaks and showers, gradually increased as tolerated to approximately 4 hours, dietary supplements including immediate release niacin in gradually increasing doses from 100 mg to a maximum of 5000 mg per day, salt and water, other vitamins, minerals and oils per Hubbard protocol.
An appendix, mid-appendectomy.
My title doesn’t refer to alternative medicine, it refers to an alternative within medicine: treating appendicitis with antibiotics instead of surgery. You may be surprised to learn that patients with appendicitis don’t always automatically need an appendectomy. A recent randomized controlled trial in Finland compared surgery to medical treatment.
History of appendicitis treatment
There is an excellent, detailed history of appendicitis available online, complete with anecdotes illustrating its importance. The appendix was not mentioned in early anatomical studies, probably because they were done on animals that didn’t have an appendix. The organ was first described in 1521. The existence of appendicitis (called “typhlitis” until 1886) was gradually recognized during the 19th century, and by the end of that century surgical removal of the appendix had become the standard treatment. Walter Reed, the yellow fever researcher for whom the Army hospital was named, died of a ruptured appendix. King Edward VII’s coronation was delayed while he underwent a life-saving appendectomy.
Appendectomy predated antibiotics, and it was believed that appendicitis would invariably progress to perforation. Once antibiotics were available, doctors experimented with treating appendicitis with them instead of with surgery, starting as early as 1956. The published trials had limitations, so the new study was done to try to get a more definitive answer to the question of whether the antibiotic approach was as effective as the surgical approach.
“Dr. Joe” (from the title of his radio show) has done it again. He keeps putting out books faster than I can take them in; this one is titled Monkeys, Myths, and Molecules. It is packed with pithy analyses of health-related subjects that should be of particular interest to SBM readers.
Dr. Joe is Joseph Schwarcz, a chemistry professor and science popularizer based at McGill University. I’ve reviewed two of his many previous books before, Is that a Fact? here on SBM and The Right Chemistry over at Skeptic.com, as well as his free online chemistry lectures, “Food for Thought“, over at edX.org. As usual, this new book is a compendium of short (four-page) articles on a variety of subjects, written in a humorous, accessible style, and larded with intriguing trivia like where to see the largest illuminated advertising sign in the world.
If you read this book, you will:
- Learn that Mozart only had seven teeth when he died.
- Learn what was the first synthetic drug ever given to a human, and who administered it.
- Learn that Popeye really ate spinach for the vitamin A, not for the iron, and how myths about myths about spinach (no, that’s not a typo) led to ever-increasing misinformation.
- Hear the story of American military experts in WWII who had the bright idea of turning bats into weapons by attaching small incendiary devices to them. In an experiment hilariously gone wrong, the flaming bats set fire to a general’s car. (Remember that saying about military intelligence?)
- Learn the role of coprolites (fossilized animal poop) in the development of modern agriculture.
- Learn why Greek yogurt is not friendly to the environment.
Dr. Joe is a packrat for tidbits like these. I wonder where he finds them all. He seems to have a bottomless supply. (more…)
Homeopathy is full of crap! Click to embiggen.
Borrowed with loving attribution from Hell’s News Stand. Go to He…go there!
“A gentle ethical defence of homeopathy” by Levy et al. was recently published in an ethics journal. A full-text preprint is available online. They say:
Utilitarian critiques of homeopathy that are founded on unsophisticated notions of evidence, that adopt narrow perspectives on healthcare assessment, and that overstate the personal, social and ontological harms of homeopathy, add little to our understanding of the epistemology of medicine. But when they are used to denounce the ethics of homeopathy – they are not only ill-considered and counterproductive, but philosophically and socially perverse.
I found their arguments unconvincing. (more…)