Three years ago I wrote about an experimental treatment for chronic fatigue syndrome (CFS): rituximab (brand name Rituxan). I was concerned that doctors who offered it, like Andreas Kogelnik, were jumping the gun by offering it before the evidence was in, and that they might be putting patients at risk.
A correspondent who has been following the CFS forums asked me to revisit this issue. She sent me links to forum posts indicating that Dr. Kogelnik is treating CFS patients with the drug, that they are not being enrolled in clinical trials, that information about results is not available, and that at least one patient may have developed a life-threatening side effect. I want to stress that I don’t have any evidence that those statements are true. These are only posts on a forum, and I have no way to verify the information. I tried to get more information from Dr. Kogelnik’s clinic, but was unsuccessful. Nevertheless, even if everything in those forum posts is false, I think the issue is serious enough to bring it to the attention of the public again. My purpose is to provide accurate information about rituximab and to get people to think about the principles involved, not to make claims or accusations or cast any blame. (more…)
What’s the best route to this happy outcome?
Doctors used to insist “once a C-section, always a C-section.” Today it is standard practice to allow vaginal births after C-section (VBAC) for appropriately selected patients. The American Congress of Obstetricians and Gynecologists (ACOG) has issued a Practice Bulletin to guide obstetricians in determining which patients are appropriate candidates for VBAC.
We frequently hear criticisms of practice guidelines like these. The doctors who write the guidelines are accused of conflict of interest, turf protection, and biased evaluation of the evidence. For those who believe doctors put profits before patients, this should be an eye-opener. It would presumably be in the best financial interests of obstetricians to do as many C-sections as possible, since they can charge more for them than for vaginal births. It would have been easy for the ACOG to put a spin on the data to make repeat C-sections look like a better choice. The fact that they offer VBACs despite their conflict of interest makes me think that their evaluation of the evidence was probably fair and unbiased.
So just how safe is VBAC? What are the pros and cons? What does the evidence say? (more…)
Joseph Mercola, D.O., runs the website mercola.com which is full of misinformation, advocates all kinds of questionable alternative treatments including homeopathy, and discourages vaccination and other aspects of conventional medicine.
Like Dr. Oz and Andrew Weil, he is more dangerous than easily recognizable quacks in that he combines some good medical information with egregious misinformation, and readers who know he is right about the good information are likely to wrongly assume everything else he says must be equally true. He’s right about some things, but the safest course is to assume that anything on his website is false unless you can verify it as true by consulting other sources that are reliable. I tried to verify the information in his recent article on colonoscopy. I found outright errors along with fear-mongering and bias. (more…)
Image courtesy of www.kevinmd.com
The evidence is clear: statin drugs are effective in reducing the rate of heart attacks and death in people who have already had a heart attack as well as in people who are at high risk of having one. Some people refuse to believe that evidence; they are statin deniers, similar to the climate change deniers and AIDS deniers (and there are even germ theory deniers!) who manage to disregard the strong evidence that proves their opinions wrong. The deniers demonize statins, cherry-picking studies to minimize the benefits and exaggerate the side effects.
A new study found that negative media reports about statins were correlated with patients discontinuing statin therapy. It also found that discontinuing statin therapy was correlated with an increase in heart attacks and death.
What is autism? What causes it? Is it genetic? Is it a consequence of something in our environment or lifestyle? What’s an “idiot savant” or an “autistic savant”? What happens when autistic children become adults? Why are so many of their parents scientists, academics, and engineers? If your grandfather’s Uncle Fred was a socially inept inventor with a lot of strange quirks, do you think he might have been autistic? Is autism really becoming more prevalent, or are we just getting better at diagnosing it? What’s happening with these people and what can be done to give them a better life?
Sorry to burden the list of recommended reading with yet another book, but if you are on the autism spectrum, if you know anyone who is autistic, if you think there is an epidemic of autism, if you think vaccines or environmental toxins cause autism, or if you are just interested in autism and want to understand it better, you will benefit from reading this new book by Steve Silberman: NeuroTribes: The Legacy of Autism and the Future of Neurodiversity. You will walk away from the book with new insights and a new appreciation of the “neurodiverse.” (more…)
Fasting can mean anything from total abstinence from food and beverages to restricting specific foods or the hours of food intake. Many religions have traditions of fasting, with various restrictions. There is a good summary of those traditions on Wikipedia. The reason for religious fasting is not to improve health, but for other reasons like improving discipline and demonstrating devotion.
There are many health claims for different fasting regimens. Daily calorie restriction has been demonstrated to prolong lifespans in several organisms, from yeast and worms to mice and monkeys, although the evidence for monkeys is equivocal and there is no evidence for humans. There is some evidence that intermittent fasting can forestall and even reverse cancer, cardiovascular disease, diabetes, and neurodegenerative disorders in mice. In humans, there is some evidence that it might help reduce obesity, hypertension, asthma, and rheumatoid arthritis. How good is the evidence? (more…)
Chelation with intravenous EDTA (disodium ethylene diamine tetra-acetic acid) has long been used for heavy metal poisoning. It binds the metal ions and facilitates their excretion from the body. In recent years it has been used for many other indications that are not evidence-based, such as autism and coronary heart disease.
The Trial to Assess Chelation Therapy (TACT) was done to assess the effectiveness and safety of EDTA plus high-dose oral vitamins for preventing second heart attacks in patients who had already had one. An article on The People’s Pharmacy website portrays the study as strongly positive. The Graedons, authors of the website, claim that science supports the use of chelation. They report that for every 12 patients undergoing chelation, one heart attack will be prevented over a five-year period. They cite a 5-year NNT (number needed to treat) of 16 for statin therapy and they conclude that:
EDTA chelation outperformed statins because fewer people needed to receive treatment to achieve a desirable outcome.
Yes, it’s a disease
No, it’s a habit
Addiction is a puzzling phenomenon. Why do addicts persist in self-destructive behavior even after it has lost them their jobs, their family, their health, and their self-respect? Do they have any control over their behavior? If so, why don’t they control it? If not, why not? Two recent books shed light on these questions: The Biology of Desire: Why Addiction Is Not a Disease, by Marc Lewis, and The Thirteenth Step: Addiction in the Age of Brain Science, by Markus Heilig.
Lewis is a neuroscientist and former addict; Heilig is a physician and addiction researcher. Lewis is convinced that addiction is not a disease, but a habit created by the neural circuitry of desire in the course of its normal functioning. Heilig is convinced that addiction is a chronic disease like diabetes that can’t be cured but that must be managed by lifelong treatment.
While they disagree about whether addiction is a disease, they actually agree about almost everything else. They agree that we should reject the stigma of addiction as a kind of moral failing. They reject the hypotheses that addiction is a matter of choice or self-medication. They think current diagnostic labels are inadequate. They both try to integrate two levels of information: the case histories of addicts and the scientific knowledge from research. They are both skeptical of AA and of conventional rehab programs. They both support evidence-based treatments. They both think addicts are not all alike and that individual addicts will respond better to individualized approaches. (more…)
A couple of years ago, the James Randi Educational Foundation commissioned me to develop a series of 10 video lectures on Science-Based Medicine. After a lot of work and many vicissitudes, it has finally gone live on YouTube. http://web.randi.org/educational-modules.html The lecture titles are:
- Science-Based Medicine vs. Evidence-Based Medicine
- What Is CAM?
- Naturopathy and Herbal Medicine
- Energy Medicine
- Miscellaneous “Alternatives”
- Pitfalls in Research
- Science-Based Medicine in the Media and Politics
The series is accompanied by a Course Guide that can be downloaded as a pdf.
Strong medicine…along with a little nonsense
Since passing my board exams in family practice in 1979 I have relied heavily on the American Academy of Family Physicians for continuing medical education via the American Family Physician and the AAFP home study programs. The AAFP prides itself on its evidence-based approach to medicine. In general, it delivers. But the recent FP Essentials Number 432 on “Chronic Pain Management” fell short. It recommended treating chronic pain with acupuncture, chiropractic, touch therapy, and S-adenosyl methionine (SAM-e), presenting them in a way that misled readers into thinking that the recommendations were based on good scientific evidence. They were not.
With 6,500 peer reviewed journals and over two million papers published every year, it is easy to find a study to support pretty much any point of view. John Ioannidis taught us that most published research findings are false, with preliminary studies frequently being overturned by larger, better follow-up studies. When evaluating the evidence for a treatment, it is not enough to find one or two positive studies. It is essential to also look for negative studies and for systematic analyses that weigh all the published evidence, and to put all the available evidence into perspective. The authors failed to do that. (more…)