Four years ago, while watching the 2012 Olympic Games, I noticed a lot of athletes wearing colored strips in various patterns on their body. I discovered that these strips were called kinesiotape, and they were used to enhance performance, reduce injury, and help muscles recover more quickly. I also discovered that these claims for kinesiotape were complete nonsense.
This year at the 2016 Rio Olympics, I (and many other people, judging by my e-mails) noticed that many athletes, especially the swimmers, had what appeared to be circular bruises on their backs, shoulders, and sometimes elsewhere on their body. I immediately recognized the telltale signs of cupping, a pseudoscientific treatment that is part of traditional Chinese medicine (TCM).
Pseudoscience in sports
What both kinesiotape and cupping have in common, other than a lack of evidence that they work, is that they are immediately visible to the casual observer (another example would be the hologram bracelets that were once common). This led me to suspect that they represent only the tip of the nonsense iceberg at the Olympics. What other worthless treatments are athletes using that don’t leave visible marks on their skin?
The pattern has repeated so many times that it is truly predictable. Scientists turn their eyes to one type of treatment that has theoretical potential. However, proper research from theory to proven treatment can take 10-20 years, if all goes well. Most such treatments will not work out – they will fail somewhere along the way from the petri dish to the clinic.
However, the media likes a good story, and one of their favorite narratives is the “new miracle cure.” They will often take preliminary basic science research and present it with headlines promising a cure for some horrible disease (sometimes they will add a question mark).
When we see these headlines, we know what will happen next – hucksters will ride the hype with a wave of snake oil products promising the same cure, and claiming to be based in science. Dr. Oz will probably promote it on his show, and Mike Adams will rant about the government conspiracy to keep this cure from the public (but he will sell it to you).
We have seen this pattern with antioxidants, stem cells, resveratrol, and countless others. Sometimes the hucksters manufacture their own hype, as with green coffee beans. They don’t wait for actual scientists, they corner the market on some worthless bean or berry, then invent health claims for it and try to hype demand through the usual channels. This sadly works. (more…)
There are many complex factors driving up the cost of healthcare, but one major factor is increasing medical technology. Often new expensive technologies provide incremental, or even questionable, additional benefits but can dramatically increase the cost of health care. This is especially true of in-hospital treatments.
There are also, of course, medical technologies that provide significant benefits, and others that improve our ability to make diagnoses. The public clearly wants and expects the latest and greatest medical technology when it comes to their health care or that of their loved-ones.
From this perspective the culture is definitely very pro-medical technology. Nothing is too invasive or heroic if it might save a loved-one. In fact, access to the latest medical miracles is considered a right, and even the suggestion that such technology might be futile is often met with hostility and anger.
Edzard Ernst published an excellent editorial today addressing the question of why pharmacists sell bogus products. Our own resident pharmacist, Scott Gavura, expressed similar points here on SBM a year ago. Their points are worth emphasizing and expanding upon.
The explicit premise of both editorials is that pharmacists, like physicians, are health care professionals. Being a professional means adhering to certain professional standard of quality control and ethical behavior. A profession is essentially a contract with society – the profession gets exclusive rights to certain commercial behaviors, and in return promises to maintain adequate quality control and to act in the best interests of society and their individual clients.
When a profession puts their own commercial interests ahead of society or their individual customers, they have violated that contract.
There are multiple layers of regulation to maintain quality and ethical standards in the health care professions. Once a profession is licensed, they basically self-regulate, with members of the profession establishing the standard of care. Standardized testing designed by the profession is used to establish competence or specialized expertise.
“Miracle” is an almost literal health halo.
The mental pathway of least resistance, what psychologists often refer to as the “default mode” of human thought, is to go with our “gut feelings.” We evolved emotions, heuristics, and cognitive biases partly so that we could make quick judgments that are good enough and err on the side of survival.
This can be adaptive – if we smell something rotten we have an emotional disgust response and avoid it. We don’t have to make a calculation about the odds of getting sick from the rotten food vs the calories and nutrients we can derive from it, we just feel disgust and avoid it.
This apparatus, however, does not deal well with a complex technological civilization that contains things like marketing and social media. The low-energy cognitive process of doing what feels right is easily manipulated and often leads us astray. (more…)
One way to describe our overall editorial stance at SBM is that we are criticizing medical science in a constructive way because we would like to see higher standards more generally applied. Science is complex, medical science especially so because it deals with people who are complex and unique. Getting it right is hard and so we need to take a very careful and thoughtful approach. There are countless ways to get it wrong.
One way to get it wrong is to put too much faith in a new technology or scientific approach when there has not been enough time to adequately validate that approach. It’s tempting to think that the new idea or technology is going to revolutionize science or medicine, but history has taught us to be cautious. For instance, antioxidants, it turns out, are not going to cure a long list of diseases.
One recent technology that is very exciting, but insiders recognize is very problematic, is perhaps even more problematic than we thought –functional MRI scans (fMRI). A new study suggests that the statistical software used to analyse the raw data from fMRIs might be significantly flawed, producing a flood of false positive results.
An fMRI primer
MRI scanning uses powerful magnets to image soft tissue in the body. The magnets (1.5-3 Tesla, typically) align the spin of hydrogen atoms in water molecules with the magnetic field. The time it takes for the atoms to align and then relax depends on the characteristics of the tissue. The MRI scan therefore sees subtle differences in tissue (density, water content) and uses this information to construct detailed images. (more…)
In a perfect world, high quality science would inform politics and policy. Science cannot determine policy by itself because there are also value judgments and trade-offs that need to be negotiated. At the least, however, policy should be consistent with the best available science.
We, of course, don’t live in a perfect world. Too often politics and ideology seem to inform, or corrupt, science. It is so much easier to just cherry pick the science that seems to confirm what you already believe, than to go through the process of changing your beliefs to accommodate the evidence. The stronger the ideology, the greater the motivated reasoning used to defend it, without apparent practical limit. For core ideologies that are part of someone’s identity, there does not appear to be any amount of evidence that will change their beliefs.
Anti-scientific motivated reasoning is often codified in specific organizations, institutions, or professions. Political parties are essentially organized ideologies, and when that ideology is predominantly pseudoscientific, you have organized pseudoscience. (more…)
Post-mortem cross sections of a healthy brain (left) and a brain with advanced Alzheimer disease (right), showing characteristic shrinkage.
The medical profession is currently engaged in a simmering debate about what is the best overall approach to take toward the relationship between science and health care. I would say that the current dominant model is Evidence-Based Medicine (EBM). We, of course, advocate for a number of tweaks to EBM we call Science-Based Medicine (SBM).
SBM essentially advocates for an ironic-sounding holistic approach to scientific evidence. All evidence should be considered in its proper context with an eye toward the strengths and weaknesses of each kind of evidence, and in the context of the institutions of science and medicine. SBM represents a higher standard of overall evidence, which we feel is justified given the degree to which medical interventions are adopted prematurely (as evidenced by later reversals).
At the same time there are those, in the minority but with an established presence, who are essentially arguing for lowering the standard of science in health care. They exist on a spectrum, at one end including those who would abandon science entirely in favor of spirituality and philosophy-based medicine. At the other end are those who claim to endorse science but want to change the rules of scientific medicine to include a much lower standard of evidence. This is more pseudoscience than antiscience. Chief among them, in my opinion, are proponents of what they call “functional medicine.” Functional medicine essentially uses science incorrectly, but still cloaks itself with the imprimatur of science. (more…)
AMA members voting on the issue of gun violence research.
On June 14th the American Medical Association’s (AMA) House of Delegates in Chicago, IL voted almost unanimously to adopt a resolution supporting the idea that gun violence is a public health issue. The resolution also called for lobbying Congress to eliminate the ban on research into the causes of gun violence. The AMA reports:
“With approximately 30,000 men, women and children dying each year at the barrel of a gun in elementary schools, movie theaters, workplaces, houses of worship and on live television, the United States faces a public health crisis of gun violence,” said AMA President Steven J. Stack, M.D. “Even as America faces a crisis unrivaled in any other developed country, the Congress prohibits the CDC from conducting the very research that would help us understand the problems associated with gun violence and determine how to reduce the high rate of firearm-related deaths and injuries. An epidemiological analysis of gun violence is vital so physicians and other health providers, law enforcement, and society at large may be able to prevent injury, death and other harms to society resulting from firearms.”
The resolution is aimed primarily at a congressional ban on research into gun violence by the Centers for Disease Control (CDC). I will discuss this ban further, but first let’s address the underlying issue. (more…)
Noel Edmonds is a game show host, famous for Britain’s version of Deal or No Deal. As far as I can tell, he has no medical or scientific qualifications at all. This unfortunately has not stopped him from using his celebrity status to offer dubious medical advice via his Twitter feed. Such is the world in which we live.
Edmonds tweeted, referring to the EMP Pad:
A simple box that slows ageing, reduces pain, lifts depression and stress and tackles cancer. Yep tackles cancer!
This Twitter-brief statement packs in many red flags for quackery and snake oil: such as a simple device that can tack a wide range of medical conditions that do not appear to share a common cause or mechanism. The word “tackle” is vague, but implies either a cure or at least a significant treatment. Anyone claiming to treat or cure cancer deserves close scrutiny.
In response, cancer patient Vaun Earl tweeted:
I think Noel Edmonds should stick to what he’s good at. Presenting quiz shows and beard trimming, rather than curing cancer.
To which Edmonds responded:
Scientific fact-disease is caused by negative energy. Is it possible your ill health is caused by your negative attitude? #explore.