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Chronic Lyme Disease – Another Negative Study

Borrelia burgdorferi, the spirochete bacteria that causes Lyme disease.

Borrelia burgdorferi, the spirochete bacteria that causes Lyme disease.

While Lyme disease itself is a real and often serious infectious illness, the existence and proper treatment of so-called chronic Lyme disease is dubious, and some would say controversial. However, like many controversies we cover, the science itself is not very controversial, but the topic is made so by a persistent minority of outliers who refuse to accept the scientific consensus.

The issue has been raised yet again by a study published recently in The New England Journal of Medicine: “Randomized Trial of Longer-Term Therapy for Symptoms Attributed to Lyme Disease.” The study was negative, but I will get into the details below.

Lyme disease

Lyme in an infection caused by the bacteria Borrelia burgdorferi, and related species. In Europe the infecting species are B. afzelii and B. garinii. These bacteria are spirochetes, which refers to their spiral shape. They are related to the bacterium which causes syphilis, Treponema pallidum, which is also a spirochete.

Syphilis and Lyme both have three stages of illness – a primary infection, secondary symptoms, and then a persistent tertiary syndrome. With Lyme disease, stage 1 involves local infection, including headache, fever, chills, and local arthritis. Stage 2 is disseminated Lyme, including the classic target- or bullseye-shaped rash at the site of the bite, pain, weakness, fatigue, and diffuse arthritis. Stage 3 is persistent late stage infection, and includes ongoing stage 2 symptoms, heart involvement, and neurological involvement. (more…)

Posted in: Lyme

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What Not To Say When Someone Is Sick

If your friend is getting chemotherapy, they need sympathy and support - not advice.

If your friend is getting chemotherapy, they need sympathy and support – not advice.

I understand the impulse, but you are well-advised to resist it. When someone you know has a serious illness, maybe even dying, you want to say something to them that is helpful, positive, and hopeful. The hopeful tone takes away some of the sting and the awkwardness of not knowing what to say to someone who just told you they are dying.

The problem with this approach is that you risk making the other person feel worse just so you can make yourself feel temporarily better, to ease the discomfort of that one encounter. It is really easy to rationalize this behavior to yourself; you are just trying to be helpful.

Sick shaming

There are multiple problems with this approach, however. The first is that it makes the person with an illness feel terrible. As Steven Thrasher said in a recent excellent editorial (which you should read in full): (more…)

Posted in: Commentary

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Zap Your Way to Learning?

halo-sport-tdcs-headphones-640x390
The company Halo Neuroscience is now offering a device, the Halo-Sport, which they claim enhances sports performance through “neuropriming.” Their website claims:

Neuropriming uses pulses of energy to increase the excitability of motor neurons, benefiting athletes in two ways: accelerated strength and skill acquisition.

Regular readers of SBM can probably see where this is going.

A proper threshold of evidence

Before I get into the details of this product, I want to back up and discuss some basic principles. There is a clear pattern that has played itself out countless times on SBM or with regular authors on SBM in their other outlets. A person, company, or industry makes a clinical medical claim. We examine the evidence and find it wanting, and state so. Believers in the claim then attack us for being shills, closed minded, and/or failing to do our research.

(more…)

Posted in: Neuroscience/Mental Health

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Another Anti-GMO Paper Retracted

electrophoresis1

The heart of Federico Infascelli’s questionable claims.

Retraction Watch is a great website. As the name implies, it focuses on a key aspect of quality control in science, the retraction of scientific papers that have already passed peer-review and were published when serious concerns about those papers come to light.

Retracting published papers is similar to phase IV clinical trials – tracking side effects of drugs that have already been approved and are on the market so regulatory agencies can monitor for post-marketing concerns and recall the drug if necessary.

Infascelli’s woes

Recently the journal animal retracted a paper by Italian researcher, Federico Infascelli. Here is there announcement:

From late September 2015, we received several expressions of concern from third parties that the electrophoresis gels presented might have been subject to unwarranted digital manipulations (added and hidden bands or zones, including in the control samples and the DNA ladder). A detailed independent investigation was carried out by animal in accordance with the Committee on Publication Ethics (COPE) guidelines. This investigation included an analysis of the claims using the figures as submitted, and reassessment of the article by one of the original peer-reviewers in light of the results of the analysis. The authors were notified of our concerns and asked to account for the observed irregularities. In the absence of a satisfactory explanation, the institution was asked to investigate further. The University of Naples concluded that multiple heterogeneities were likely attributable to digital manipulation, raising serious doubts on the reliability of the findings.

Based on the results of all investigations, we have decided to retract the article.

(more…)

Posted in: Quality Improvement

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P Value Under Fire

coinflipThe greatest strength of science is that it is self-critical. Scientists are not only critical of specific claims and the evidence for those claims, but they are critical of the process of science itself. That criticism is constructive – it is designed to make the process better, more efficient, and more reliable.

One aspect of the process of science that has received intense criticism in the last few years is an over-reliance on P-values, a specific statistical method for analyzing data. This may seem like a wonky technical point, but it actually cuts to the heart of science-based medicine. In a way the P-value is the focal point of much of what we advocate for at SBM.

Recently the American Statistical Association (ASA) put out a position paper in which they specifically warn against misuse of the P-value. This is the first time in their 177 years of existence they have felt the need to put out such a position paper. The reason for this unprecedented act was their feeling that abuse of the P-value is taking the practice of science off course, and a much needed course correction is overdue. (more…)

Posted in: Science and Medicine

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Bad Reporting about Uploading Memories

hemisity
The Mirror declares, ‘Scientists develop Matrix-style technique of ‘feeding’ information directly into your brain.’ Discovery News went with, “Novices ‘Download’ Pilots’ Brainwaves, Learn To Fly.” Most other outlets spoke of ‘uploading’ information to the brain, and learning in seconds.

The one thing I was certain of from reading these headlines is that this was not what was happening. Brain-machine interface technology is progressing rapidly, but we are a long way away from downloading information from or uploading information to the human brain.

The news outlets reported that electrical activity was recorded from pilots and then used to stimulate the subject. They also reported that this enhanced learning by 33%.

What actually happened

Here is the actual study: “Transcranial Direct Current Stimulation Modulates Neuronal Activity and Learning in Pilot Training.”

(more…)

Posted in: Neuroscience/Mental Health

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Air Pollution and Public Health

airpollution

Public health measures are those not aimed at individuals but at society as a whole, or subgroups within society. Physicians are charged not only with promoting the health of their own patients, but as a profession we (and health care professions in general) are charged with promoting the public health.

Public health measures, however, are highly likely to cross into politically charged areas. This should not deter the promotion of public health.

Issues that we deal with regularly involving public health include vaccination programs and laws surrounding vaccine requirements, fluoridation of public water supplies, helmet laws, and even gun laws. We have never, however, written about air pollution as a public health concern (except for dubious claims that air pollution is linked to autism).

The health risk of air pollution

Air pollution as a health risk is nothing new, but several recent studies are focusing attention on this issue. Recently the Royal College of Physicians produced a report in which they claim that 40,000 deaths per year in the UK can be attributed to poor air quality, both indoors and outdoors. (more…)

Posted in: Epidemiology, Public Health

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Organic vs Conventional Meat and Milk

cow-eating-grassTwo recently published meta-analyses, one on meat and another on milk, conclude that levels of polyunsaturated fatty acids (PUFA) and omega-3 fatty acids are higher in the organic versions of both. This is being widely reported as evidence that organic meat and milk is healthier, but a closer look at these two studies shows a different picture.

The organic false dichotomy

I am going to start with what I consider to be the biggest problem with how both studies are being presented and reported. This relates to a deeper issue – the false dichotomy of organic vs conventional. In my opinion, we should use whatever farming techniques prove to be best (for the quality of the food, sustainability, cost-effectiveness, and environmental impact) regardless of whether or not they are considered organic.

While proponents of organic farming claim that for them food quality and sustainability are the real issue, they aren’t. Organic techniques are based on the appeal to nature, not an evidence-based approach to best practices. (more…)

Posted in: Nutrition

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Update on the Zika Virus

zika-virus-mosquitoA new word has been added to the public’s vocabulary – the Zika virus. It seems we have one more infectious agent to worry about. Here are the facts as we currently understand them regarding the recent Zika epidemic, and also some rumors and conspiracy theories that need debunking.

Zika virus

The Zika virus (of the viral family Flaviviridae, an Arthropod-Borne or arbovirus) is spread through Aedes mosquito bites, the same mosquitoes that also spread dengue fever, West Nile, and yellow fever. The infections themselves are usually mild, causing fever, rash, joint pain, and conjunctivitis. Many of those infected (about 80%) may even have a subclinical infection, meaning they do not notice any symptoms.

According to the World Health Organization:

Zika virus is diagnosed through PCR (polymerase chain reaction) and virus isolation from blood samples. Diagnosis by serology can be difficult as the virus can cross-react with other flaviviruses such as dengue, West Nile and yellow fever.

(more…)

Posted in: Public Health, Vaccines

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Laws Limiting Vaccine Exemptions Work

VaccineIt’s nice when a question can be resolved with objective numbers of unequivocal outcomes. Subjective outcomes give scientists a headache.

In this case we are talking about the effect of vaccine exemption laws on vaccine compliance rates. The question here is not the ethical one, the rights of parents to determine the fate of their children vs the right of the state to protect the health of children and the public health. I think the latter trumps the former, but some disagree.

Regardless of what you feel about the ethical question, we need to know if the laws we pass to achieve our goals actually work, or if they don’t work, or even have unintended consequences. Having an admirable goal is not enough; when you make actual decisions (practice decisions, policy decisions, healthcare decisions for you and for family) you want to know that those decisions are having the desired effect.

(more…)

Posted in: Legal, Public Health, Vaccines

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