There is an ongoing debate that has come to the fore recently about the ultimate limits of human longevity. The ultimate goal of medicine is to optimize health, with the result of maximizing the duration and quality of life. This is accomplished through health promotion, disease prevention, and disease treatment.
There is no question that this approach has increased life expectancy, which is the number of years one can statistically expect to live. The longevity debate is about life span – how long could a human theoretically live if they enjoyed optimal health? What is the ultimate limit of the human biological system?
A recent study by Dong, Milholland, and Vijg concludes that we are already reaching the maximal human lifespan, which they calculate at about 115 years. They looked at two statistical trends. First they looked at the age of the oldest person to die in each country, and found that this age increased from 1970 to 2000, reaching an average of about 115 years. From 2000 to present, however, this figure has peaked, and in fact trended down slightly.
They also looked at the age that had the greatest annual increase in survival. If both life expectancy and lifespan were increasing then this number should be increasing. They found that this number was also increasing from 1920 to about 1980, but then plateaued at around 100 years, and has only slightly crept up since then (101 for men, 102 for women).
A Canadian academic, Dr. Mark Loeb, who is a respected infectious disease researcher who knows how to conduct high quality research, wants to study homeopathic nosodes. Nosodes are essentially homeopathic vaccines.
Tim Caulfield, a Canadian professor of health law and policy, thinks the study is misguided and unethical. The two are having a respectful public debate about the risks and merits of doing such a study.
David Gorski and I have actually published in the peer-reviewed literature on the broader question of studying alternative medicine: “Clinical trials of integrative medicine: testing whether magic works?” So we have both weighed in already on this debate, but since this is a major theme of science-based medicine I thought it was important to bring the discussion here as well. It is an interesting dilemma worth discussing, and we are seeing that exact dilemma play out on the question of this specific proposed study.
Homeopathy is pseudoscience
For quick background, both sides in this debate agree that homeopathy is 100% pseudoscientific nonsense. Homeopathy was invented by one person, Samuel Hahnemann, about 200 years ago. It was not based on any scientific research or knowledge base, it did not develop out of emerging knowledge of biology or physiology. It was simply invented out of whole cloth based loosely on the superstitious belief in sympathetic magic – the notion that substances contain a mysterious “essence” that can be transferred to the body and stimulate the life force. (more…)
The FDA recently put out a consumer warning about homeopathic teething gels and pills. The warning states:
The FDA recommends that consumers stop using these products and dispose of any in their possession.
The warning is not because all homeopathic products are inherently useless. As we have discussed here often, the basic principles of homeopathy are pure pseudoscience. The practice of diluting substances so that almost no or no active ingredient remains means that most homeopathic products are just sugar pills. Further, clinical studies show that homeopathic products don’t work. There isn’t a single homeopathic product that has been shown to be effective for a single condition with rigorous clinical trials.
The FDA acknowledges this, writing in their warning:
Homeopathic teething tablets and gels have not been evaluated or approved by the FDA for safety or efficacy. The agency is also not aware of any proven health benefit of the products, which are labeled to relieve teething symptoms in children.
A man undergoing blood irradiation therapy.
If there is one thing this election cycle has demonstrated it’s that, when ideology or emotions are involved, people can be entirely immune to facts. The narrative takes control, reinforced by motivated reasoning and confirmation bias.
Even worse, people tend to think they are actually informed, and are confident in their opinions, even when they are grossly misinformed. Regular contributors here frequently receive e-mails from people who truly believe they have it all figured out – modern medicine is a con and we are all shills, while alternative gurus speak the Truth. The confident reality distortion is amazing to behold.
A total lack of ethics and regulation
Let’s take one stunning example from the world of alternative medicine – ultraviolet blood treatment. Britt Hermes, who has contributed to SBM before, is an ex-naturopath who wrote recently about a medical device called the UVLrx. This is a device that is inserted into a vein like a catheter, and then emits UV light directly to the blood.
Pictured: Peer review; something that doesn’t happen in predatory journals
Because I have a university e-mail address I frequently get spam from journals I have never heard of soliciting submissions, and even offering editorial positions. I have generally ignored them, and it’s probably a good thing.
Over the last decade we have seen the rise of open-access science journals. The idea is a good one – journals charge a moderate fee to publish an article to cover costs, and then make all articles freely available online. It is a great way to leverage the power of the internet and make published science freely available. This contrasts to the subscription model where published research often sits behind a very expensive paywall.
The problem with the open-access model is that it created the means to easily generate income through predatory behavior. All you need is a website and minimal infrastructure and you can look like a real journal. Since authors are paying you to publish each article, just publish anything that gets submitted.
A recent New York Times article about how the sugar industry manipulated research starting in 1965 is getting some attention. The article is largely based on a recent JAMA Internal Medicine article that reviews historical documents revealing how the Sugar Research Foundation (SRF) (based largely on revealed internal documents) put their thumb on the scale of diet research starting in 1965 in an attempt to shift the blame for heart disease from sugar onto fat.
The diet wars
I think this latest round of information can only be understood in the context of the longstanding diet wars. Heart disease has become the number one cause of death, as life expectancy has increased and we have reduced many other causes of mortality.
Overweight and obesity are also diseases of modern civilization which is characterized by abundance and an increasingly sedentary lifestyle. Further, the food industry is driven by market forces which favor tasty foods, which often means being high in fat and/or sugar.
Using stem cells to treat disease or improve recovery is an exciting area of research. The potential is undeniably great – these are cells that have the potential to differentiate into mature cells of a specific type. They can be used to replace damaged cells or improve the environment for cell function and recovery. Ideally stem cells can be developed from cells harvested from the patient themselves, so there is no issue of rejection.
Stem cell technology, however, is tricky and currently in its infancy. One challenging hurdle is to prevent transplanted stem cells from turning into tumors. We also need the cells to do what we want and to survive long enough to be useful. Research is progressing, but the potential for stem cells has not yet been realized.
Quackery in the gap
Into this gap between the hype and potential of stem cells and the current reality of the research there is a space where dubious stem cell clinics can thrive. I first wrote about dubious stem cell clinics debuting in China nine years ago. Despite various regulatory efforts these clinics continue to thrive.
A few years ago some colleagues and I at the Institute for Science in Medicine were debating what our official position should be regarding non-medical vaccine exemptions. We all agreed that the ideal situation would be no non-medical exemptions. There is no legitimate reason for such exemptions and the evidence clearly shows that states who allow non-medical vaccine exemptions have lower vaccination rates.
The debate was about whether or not that should be our only position, to take a strong and uncompromising stance, or should we also advocate that states who do allow non-medical exemptions to make them as difficult as possible (which also is effective in reducing vaccine refusal). The concern was that the perfect solution was politically too difficult and the lesser solution was at least something (like a prosecutor including lesser charges in case they lose on the big charge).
I advocated for the latter position, which is what we ultimately decided. After the Disneyworld measles outbreak, however, I think the political calculus has changed. It is much more politically viable to simply advocate for the elimination of all non-medical exemptions. (more…)
Patients should get health information from doctors, not quacks.
The biggest challenge we face promoting high standards of science in medicine is not making our case to the community. Our case is rock solid, in my opinion, and backed by evidence and logic. There is no question, for example, that homeopathy is 100% bogus and should not be part of modern medicine.
Our challenge is that there are literally billions of dollars to be made selling fake medicine and dubious treatments. This means that unscientific practitioners have an immediate financial incentive to promote themselves and their treatments, and they will tirelessly do so, on any front they can find. Further, the stars of unscientific medicine have the resources to do so – to intimidate critics, cozy up to politicians, open centers in respected hospitals, and market their brand.
We simply don’t have the manpower to confront them on every front, and the mainstream scientific and medical communities are frankly just not paying enough attention. They are largely unaware that pseudoscience is infiltrating their profession right under their noses, or they have been lulled into thinking this is a small and benign phenomenon.
These many fronts in which science confronts pseudoscience include the media, hospitals, continuing education, journals, the marketplace, politics and regulation, and research funding.
The definition of “propaganda,” like so many things, is a bit fuzzy. The dictionary definition is: “information, especially of a biased or misleading nature, used to promote or publicize a particular political cause or point of view.” There is no sharp demarcation line, however.
Speech occurs on a spectrum from obsessively objective, fair, balanced, and scholarly at one end, to deliberately deceptive and manipulative propaganda at the other. Most speech is somewhere in the middle. We are all coming from a certain narrative, one which we believe is valid and important, and often speech is meant to be persuasive.
Persuasive speech promoting a point of view or certain conclusion is fine – it does not necessarily deserve the label of propaganda. The fuzzy line gets crossed, however, the more logic and evidence are compromised for the sake of the narrative. (more…)