Peer review, a flawed but vital part of the scientific process.
When I lecture about the need for science-based medicine (SBM), I have to pause about half-way through my list of all the things wrong with the current practice of medical science, and I balance my discussion by emphasizing what I am not saying: I am not saying that medical science is completely broken. It is just really challenging, we need to raise the threshold for what we consider reliable higher than most people think, and there are some practical fixes we can do, some of which are already in the works.
It is easy, however, to “demonize” any person, institution, or philosophy by taking all the negative aspects that are inevitably present and wrapping them up in a frightening package, perhaps throwing in some conspiracy thinking or sensational alarmism.
Take, for example, a recent article by F. William Engdahl, “Shocking Report from Medical Insiders“. The headline alone warns you that you may be in for some sensationalism.
One of the major themes of science-based medicine (unsurprisingly) is that medicine should be based on science. We consider ourselves specialists in a larger movement defending science in general from mysticism, superstition, and spiritualism. We are not against anyone’s personal belief, and are officially agnostic toward any faith (as is science itself), but will vigorously defend science from any intrusion into its proper realm.
The so-called alternative medicine movement (CAM) is largely an attempt to insert religious beliefs into the practice and profession of medicine. CAM is also an attempt to create a double standard or even eliminate the standard of care so that any nonsense can flourish and con-artists and charlatans can practice their craft freely without being hounded by pesky regulations designed to protect the public. These are both insidious aspects of CAM that need to be exposed and vigorously opposed.
A recent article by Dr. Michel Accad demonstrates how brazenly some are trying to insert faith healing and spiritualism back into medicine. He does so by couching his arguments in philosophy and marketing terms, but in the end he is essentially saying that doctors should practice his faith. He doesn’t really make any arguments for this position, but rather simply gives a history of progress in Western thought as if that is sufficient. (more…)
Today the UK Parliament will have a vote for the chair of the Health Select Committee. The two choices could not be more starkly different, so much so that this vote might be seen as a referendum on two world views, one that respects science and another that confuses pseudoscience and spirituality for medicine.
On one side we have Sarah Wollaston, the previous chair, who is a former general practitioner and has taken a solid stand against pseudoscience in medicine. She has previously tweeted, for example, “Homeopathy can also have serious harms when masquerading as a ‘vaccine’.”
Tredinnick, on the other hand, has previously argued that the NHS should incorporate astrology into the healthcare system. I have previously argued that homeopathy is the most absurd and easily debunked major form of alternative medicine. Astrology, however, is arguably more absurd, I had just never heard it offered as a basis for healthcare. Tredinnick has at least accomplished setting a new low bar for alternative medicine nonsense.
Tredinnick appears to be a true-believer, fully steeped in the propaganda that is CAM (so-called complementary and alternative medicine). He has said:
Ninety per cent of pregnant French women use homeopathy. Astrology is a useful diagnostic tool enabling us to see strengths and weaknesses via the birth chart.
And, yes, I have helped fellow MPs. I do foresee that one day astrology will have a role to play in healthcare.
The First Amendment of the United States of America, guaranteeing freedom of speech
For those of you following the defamation lawsuit against me by Dr. Edward Tobinick, there has been a significant and positive update. For quick background, Dr. Tobinick filed a suit against me personally, the Society for Science-Based Medicine, Yale University and SGU Productions for an article I wrote here critical of his claims that perispinal etanercept can treat a variety of neurological conditions. All the defendants but me have since been removed from the case.
There are three plaintiffs in the case; Dr. Tobinick himself, his California corporation, and his Florida LLC. Last year I filed a motion to strike some of the claims as they apply to the California corporation under that state’s anti-SLAPP statute. The update is that last week the judge in the case ruled in my favor on this motion. These are public documents, so you can read the entire decision here. It concludes:
For the foregoing reasons, it is hereby ORDERED AND ADJUDGED that Steven Novella’s Special Motion to Strike (Anti-SLAPP Motion) [DE 93] is GRANTED. Tobinick M.D.’s claims for unfair competition under 28 U.S.C. § 1338(b) (Count II), trade libel (Count III), and libel per se (Count IV) are STRICKEN from the Amended Complaint.
Wally Sampson, MD
March 29, 1930 – May 25, 2015
I’m sad to report that Dr. Wallace (Wally) Sampson, one of the original authors at Science-Based Medicine, passed away on May 25th at the age of 85. Wally was a valued member of the SBM community, a mentor to many of us, and a tireless crusader against health fraud and pseudoscience in medicine. He carried the banner of defending science and reason within medicine for a generation, and his is one of the giant shoulders on which SBM currently rests. His contributions to this website can be found here.
Wally was fighting against health fraud back when it was still called health fraud, rather than “alternative medicine” or whatever the latest marketing term they have adopted is. I would often go to him for perspective on the long range trends in our struggle to promote science in medicine. He had put in the decades of service necessary to have such perspective.
I personally owe Wally a great deal for my own career battling medical pseudoscience. Wally was keen to identify and nurture new people interested in promoting science in medicine. As a much younger skeptic, prior to social media, when I was only running a new and obscure local skeptic group, Wally invited me to speak at conferences, and eventually to be one of the assistant editors for The Scientific Review of Alternative Medicine, a print journal of which he was the first editor (available online here). Such nurturing was not common in my experience. He gave me the experience and platform upon which I eventually built Science-Based Medicine.
CAM: More branding than medicine.
One of the persistent themes of SBM is that CAM (complementary and alternative medicine, or integrative medicine) is nothing more than a marketing brand. Its recent popularity is not based upon new evidence or a changing paradigm of medicine as its proponents claim. Its popularity is increasing despite the lack of evidence for specific CAM treatments and despite a dedication to evidence-based medicine within the medical profession.
CAM is also modern mythology, which I guess all really effective advertising and branding is. It floats atop a number of demonstrably false marketing claims. One is that the popularity and use of CAM is surging. This is partly a self-fulfilling prophesy, and no doubt it is increasing, but the degree to which CAM is popular has been consistently exaggerated by proponents (largely as a way to justify its existence).
This myth is largely perpetuated by redefining CAM as needed, including things like prayer, massage, and taking vitamins. I suspect that praying for a sick loved-one has always been popular and doesn’t represent a trend toward CAM. When unequivocal alternative modalities are considered, their use is still tiny and not increasing. The most recent NIH survey found:
Use of acupuncture (1.1%), homeopathic treatment (1.7%) naturopathy (0.2%), and energy healing (0.5%) was miniscule.
Nootropics are an emerging class of drugs that are designed to enhance cognitive function. They are part of a broader category of drugs known as performance and image enhancing drugs (PIED) which are used for enhancement of memory and cognition, sexual performance, athletic performance or musculature (also called “lifestyle” drugs).
It will probably come as no surprise to regular readers of SBM that nootropics and PIED are being abused and hyped without adequate evidence. One of the primary problems is that they are sold as supplements or as drugs, often over the internet without adequate regulation. One simple fix is to properly classify these drugs as drugs, and to properly regulate them as drugs.
Many of the cognition-enhancing “supplements” on the market make all the usual claims about “natural” enhancement – meanwhile they predictably contain just vitamins, herbs which have not been shown effective, perhaps nootropics (see below), and often a stimulant, like caffeine. The only drug in the mix which is likely to have a noticeable effect by the user is the stimulant.
There are few home-runs in medicine. Most of our choices have some sort of trade-off – drugs have side effects, interventions have risks, and many treatments have marginal benefits. Sometimes, however, medical science hits one out of the park and develops a treatment that is safe, effective, cost effective, and convenient. Any dispassionate view of the evidence can only lead to one conclusion, leading to the absence of any legitimate scientific or medical debate.
I think the human papilloma virus (HPV) vaccine falls into this category. We have learned that many oral and genital cancers are caused by a sexually transmitted virus, HPV. Getting vaccinated against several strains of this virus prior to becoming sexually active effectively protects against infection by the virus, and dramatically reduces the risk of these cancers. Think about it – we can prevent cancer with a vaccine. This is a no-brainer.
A recent study shows:
HPV DNA was detected in 90.6% of cervical, 91.1% of anal, 75.0% of vaginal, 70.1% of oropharyngeal, 68.8% of vulvar, 63.3% of penile, 32.0% of oral cavity, and 20.9% of laryngeal cancers, as well as in 98.8% of cervical cancer in situ (CCIS). A vaccine targeting HPV 16/18 potentially prevents the majority of invasive cervical (66.2%), anal (79.4%), oropharyngeal (60.2%), and vaginal (55.1%) cancers, as well as many penile (47.9%), vulvar (48.6%) cancers: 24 858 cases annually. The 9-valent vaccine also targeting HPV 31/33/45/52/58 may prevent an additional 4.2% to 18.3% of cancers: 3944 cases annually.
The new 9-valent vaccine covers more strains. The study suggests that there are over 28,000 cases of cancer each year in the US that could be prevented by this vaccine.
One of the greatest triumphs of marketing over evidence was the incredible rise of vitamin supplement use in the 20th century. Supplement makers successfully created a “health halo” around vitamins, and taking your vitamins became a virtue, something mothers told their children to do. The evidence, however, does not tell such a simple story.
In recent years it has become increasingly apparent that there are unintended consequences to taking vitamin supplements, and in fact there may be a net negative health effect. This is especially true for those who are healthy and don’t need vitamins, and for those who exceed the recommend dosages.
A recent review of the last 20 years of literature on the subject, presented at the American Association for Cancer Research 2015 meeting, found an overall increased risk of cancer among vitamin users. Dr. Tim Byers presented the study, which echoes the result of a 2012 review that he and others published. He specifically refers to two famous studies showing an increased risk of cancer from vitamins.
The 2011 SELECT trial found an overall increased risk of prostate cancer among men taking vitamin E. (more…)
Pepsi has announced that it will remove aspartame from its formulation of diet Pepsi products in the US this year. Apparently this is a reaction to a 5% drop in the sales of Pepsi. Seth Kaufman, vice-president of Pepsi, said “Aspartame is the number one reason consumers are dropping diet soda.”
This move comes in the same week that Chipotle announced it is removing GMO food from its food chain. Unlike Pepsi, who cited only public opinion, Chipotle went one step further and directly cited pseudoscientific fears of GMOs as their justification. (But that’s another story.)
Like GMOs, aspartame has been widely studied and found to be safe, but remains the target of fear-mongering and conspiracy theories. It is not clear why this one food additive has continued to be the target of a fake controversy, other than that fears and conspiracies can take on a life of their own. The best example of anti-aspartame conspiracy theories comes from Janet Starr Hull, who wrote:
I will never accept the news of aspartame safety. I think it is a “business” decision to discredit/discount the research results that aspartame DOES cause cancer, major nerve disorders, birth defects, and brain imbalances. Think about it – can you imagine the chaos that will occur when the truth of aspartame dangers is accredited. The FDA has known about the dangers, the corporations have known about the dangers, and the medical community (if it is really worth anything) has known about the dangers.
That is a common claim of conspiracy theorists – the truth is being suppressed out of fears that it will bring chaos if revealed. I think our society will survive Pepsi moving over to a different sweetener. (more…)