On SBM we have documented the many and various ways that science is abused in the pursuit of health (or making money from those who are pursuing health). One such method is to take a new, but reasonable, scientific hypothesis and run with it, long past the current state of the evidence. We see this with the many bogus stem cell therapy clinics that are popping up in parts of the world with lax regulation.
This type of medical pseudoscience is particularly challenging to deal with, because there is a scientific paper trail that seems to support many of the claims of proponents. The claims themselves may have significant plausibility, and parts of the claims may in fact be true. Efforts to educate the public about such treatments are frustrated by the mainstream media’s lazy tendency to discuss every study as if it were the definitive last word on a topic, and to site individual experts as if they represent the consensus of scientific opinion.
Recent claims made for low dose naltrexone (LDN) fit nicely into this model – a medical intervention with interesting research, but in a preliminary phase that does not justify clinical use. And yet proponents talk about it as if it is a medical revolution.
Those with an anti-vaccine ideology come from various starting points. There are those who just hate vaccines – because they don’t trust the system, they don’t like the idea of injecting something into their children, or they blame vaccines for their child’s illness or disorder. There is also the “mercury militia” – those who blame environmental mercury for all ills, and whose attention was drawn to vaccines through the mercury-based thimerosal connection. I wrote recently about another group – radical environmentalists who see vaccines and just another environmental exposure the government is trying to cover up.
There is another group that has been around for a while but about which I have not written before – some elements of the right-to-life group. What is their connection to vaccines? – the false belief that vaccines contain cells from aborted fetuses. Recently Lifenews published an article with the following headline: Study Suggests Link Between Autism and Use of Cells From Abortions in Vaccines. The study, of course, does nothing of the sort.
The EPA Study
LifeNews editor, Steven Ertelt, was referring to a recent EPA study published in Environmental Science Technology called Timing of Increased Autistic Disorder Cumulative Incidence. If you read the paper you will find no mention of vaccines, let alone fetal cells in vaccines. The study simply looked at databases of autism diagnosis to see if there was a point at which the increasing cumulative diagnoses was most sharp – any turning points in the data. The point of this exercise is to suggest where to look for a potential environment factor contributing to autism – because that’s what the EPA does, look for environmental exposures that are causing human disease.
To be blunt up front – SBM is not apologetic about the pharmaceutical industry. We get zero funding from any company, and have no ties of any kind to “big pharma.” In today’s world I have to spend time making that clear, because despite the reality critics are free to assume and falsely claim that our message is coming straight from the bowels of hell (a.k.a. the pharmaceutical industry).
We promote science-based medicine and criticize pharmaceutical companies along with everyone else when they place other concerns ahead of scientific validity, or promote bad science, for whatever reason.
It has become fashionable, however, to not only criticize the pharmaceutical industry but to demonize them – and the term “big pharma” has come to represent this demonization. Cynicism is a cheap imitation of skepticism – it is the assumption of the worst, without careful thought or any hint of fairness.
The health marketplace has a life of its own, mostly separated from science and evidence. Generally the marketplace gets a hold of an idea and runs with it, before the science is carefully worked out. Since most new ideas in science turn out to be wrong, that means most products will eventually be found to be worthless.
One such idea is that “brain training” can improve overall cognitive function – so of course now there is an industry of products which claim to train your brain. Lumosity (just to pick a random example served up by Google) claims on their website:
* Improve memory and attention
* Shown to improve cognitive function
* Neuroscience based brain training
* Train your brain today
I always enjoy the phrase “scientifically designed” or “scientifically formulated” – they are wonderful marketing phrases that invoke “science” without making any specific claims.
There is no question that the incidence and prevalence of autism are on the rise. Starting in the early 1990s and continuing to today, there has been a steady rise in the number of children diagnosed with autism. Prior to 1990 the estimates of autism prevalence were about 3 per 10,000. The most recent estimates from the CDC and elsewhere now have the number at about 100 per 10,000, or 1%.
The burning question is – why are the rates increasing steadily? There are those, particularly in the anti-vaccine community, who conclude that the increase in prevalence is a real biological effect – an epidemic – and is evidence for an environmental cause (which they believe is vaccines, even though the scientific evidence does not support this position). However, the evidence strongly suggests that the rising prevalence of autism is largely an artifact of broadening the diagnosis and increased surveillance.
It should be noted that the data cannot rule out a small true increase in autism prevalence. Some hypothesize that increasing maternal and paternal age are contributing to the incidence of autism, but I will leave that question for another post.
A new study now adds significant support to the surveillance hypothesis – Ka‐Yuet Liu, Marissa King, and Peter S. Bearman from Columbia University, publishing in the American Journal of Sociology, report that the risk of being diagnosed with an autism spectrum disorder (ASD) correlates with social proximity to another family with a child with an ASD diagnosis. For those interested in this topic, the full paper is worth a read. While it gets technical at times, the authors do an excellent job of reviewing this topic in detail.
Over the past two plus years of the existence of Science-Based Medicine (SBM) we have been highly critical of the National Center for Complementary and Alternative Medicine (NCCAM) – going so far as to call for it to be abolished. We are collectively concerned that the NCCAM primarily serves as a means for promoting unscientific medicine, and any useful research it funds can be handled by other centers at the NIH.
So we were a bit surprised when the current director of the NCCAM, Josephine Briggs, contacted us directly and asked for a face-to-face meeting to discuss our concerns.
That meeting took place this past Friday, April 2nd. David Gorski, Kimball Atwood and I met with Dr. Briggs, Deputy Director Dr. John Killen, Karin Lohman PhD (Director, Office of Policy, Planning, and Evaluation) and Christy Thomsen (Director, Office of Communications and Public Liaison).
Dr. Briggs very graciously began the meeting by telling us that she and her staff have been reading SBM and they find our arguments to be cogent and serious. She shares many of our concerns, and feels that we are an important voice and are having an impact. She then essentially turned it over to us to discuss our primary concerns regarding the NCCAM.
We were prepared for this.
A new study published in PLOS Biology looks at the potential magnitude and effect of publication bias in animal trials. Essentially, the authors conclude that there is a significant file-drawer effect – failure to publish negative studies – with animal studies and this impacts the translation of animal research to human clinical trials.
SBM is greatly concerned with the technology of medical science. On one level, the methods of individual studies need to be closely analyzed for rigor and bias. But we also go to great pains to dispel the myth that individual studies can tell us much about the practice of medicine.
Reliable conclusions come from interpreting the literature as a whole, and not just individual studies. Further, the whole of the literature is greater than the sum of individual studies – there are patterns and effects in the literature itself that need to be considered.
A panels of bloggers from SBM will be taking part in the Northeast Conference on Science and Skepticism – NECSS 2010, April 17th beginning 10:00AM in New York.
There will be a 70 minute panel discussion moderated by John Snyder and featuring David Gorski, Kimball Atwood, Val Jones, and myself – Steven Novella. The topic of discussion will be the infiltration of pseudoscience into academic medicine.
This will be part of a full day of science featuring other excellent speakers, including James Randi, D. J. Grothe, Steve Mirsky, George Hrab, and Julia Galef. There will also be a live recording of the wildly popular science podcast, The Skeptics’ Guide to the Universe.
Go to www.NECSScon.org to register.
In the Wall Street Journal last week was a particularly bad article by Melinda Beck about acupuncture. While there was token skepticism (by Edzard Ernst, of course, who is the media’s go-to expert for CAM), the article credulously reported the marketing hype of acupuncture proponents.
Toward the end of the article Beck admits that “some critics” claim that acupuncture provides nothing more than a placebo effect, but this was followed by the usual canard:
“I don’t see any disconnect between how acupuncture works and how a placebo works,” says radiologist Vitaly Napadow at the Martinos center. “The body knows how to heal itself. That’s what a placebo does, too.”
That is a bold claim, and very common among CAM proponents, especially acupuncturists. As the data increasingly shows that acupuncture (and other implausible treatments) provides no benefit beyond placebo, we hear the special pleading that placebos work also.
But is that true? It turns out there is a literature on the placebo effect itself, and the evidence suggests that placebos generally do not work.
A question that arises often when discussing the optimal role of science in medicine is the precise role of plausibility, or prior probability. This is, in fact, the central concept that separates (for practical if not philosophical reasons) science-based medicine (SBM) from evidence-based medicine (EBM).
The concept featured prominently in the debate between myself and Dr. Katz at the recent Yale symposium that Kimball Atwood recently discussed. Dr. Katz’s treatment of the topic was fairly typical of CAM proponents, and consisted of a number of straw man derived from a false dichotomy, which I will describe in detail below.
I also recently received (I think by coincidence) the following question from an interested SBM reader:
What would Science Based Medicine do if H. pylori was not known, but a study showed that antibiotics given to patients with stomach ulcers eliminated symptoms? I assume that SBM wouldn’t dismiss it outright saying that it couldn’t possibly be helping because antibiotics don’t reduce stomach acid. I assume a SBM approach would do further studies trying to discover why antibiotics work. But, in the meantime, would a SBM practitioner refuse to give antibiotics to patients because he doesn’t have a scientific explanation as to why it works?
This is the exact type of scenario raised by David Katz during our discussion. He claimed that strict adherence to the principles of SBM would deprive patients of effective treatments, simply because we did not understand how they work. This is a pernicious straw man that significantly misconstrues the nature of plausibility and its relationship to the practice of medicine.