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.
A new study shows that 42 really is the answer to life, the universe, and everything. OK, not really, but it does show that 42% of healthy brain activity is the minimum threshold for consciousness.
Disorders of consciousness, also referred to as coma when severe enough, can be a difficult situation to assess sufficiently to make reliable predictions about outcome. Part of the problem is that once someone is not able to maintain consciousness, we lose much of the neurological exam, and therefore it becomes more difficult to assess brain function other than to say that they are not conscious.
Types of coma
Two types of coma in particular are of interest: the persistent vegetative state, also called unresponsive wakefulness syndrome (UWS), and the minimally conscious state (MCS). Both are severe impairments of consciousness. In UWS, by definition, the patient may have sleep-wake cycles, open their eye, have roving eye movements, and grimace, but they do not have any interaction with their environment. They do not respond to voice, look at faces, or move in response to stimuli.
Daniel David Palmer, creator of the nebulous subluxation and father of chiropractic.
From time to time we respond directly to reader comments or e-mails in an article, when it seems that doing so would be a useful teachable moment. One of the strengths of social media is that it is interactive, which can be didactic.
I feel it is very important to respond to what people actual believe and say, because otherwise we may tend to get lost in our own narrative, as legitimate as it might be. That is the essence of ivory tower syndrome, academics talking to themselves without a reasonable sense of what is happening in society. Part of our mission is to interact with society, not just our colleagues, and to engage in a serious conversation about the nature of science and medicine.
To that end, I recently received an e-mail responding to an interview I had done previously about chiropractic. The e-mail is full of pro-chiropractic propaganda and misconceptions, and so it provides an opportunity to address some of these claims. (more…)
Despite the fact that numerous scientific and health organizations around the world have examined the evidence regarding the safety of genetically modified organisms (GMOs) and found them to be completely safe, there remains a public controversy on this topic. In fact a Pew Poll found that while 88% of AAAS scientists believe that GMOs are safe for human consumption, only 37% of the public do – a 51% gap, the largest in the survey.
This gap is largely due to an aggressive anti-GMO propaganda campaign by certain environmental groups and the organic food industry, a competitor which stands to profit from anti-GMO sentiments. There is also a certain amount of generic discomfort with a new and complex technology involving our food.
Because of all this, the National Academy of Sciences put together an expert committee to systematically review all the evidence regarding this new technology. Their thorough 407 page report is now available.
They pulled together experts with diverse backgrounds, and also took public comment and solicited input from a wide range of interests. They decided specifically not to rely on any previous review, but to conduct their own review of the primary literature. (more…)