The American Heart Association and the American Stroke Association recently published in the journal Stroke a thorough analysis of the evidence for an association between cervical manipulative therapy (CMT) and both vertebral artery dissection (VAD) and internal carotid artery dissection (ICAD). The full article is online: “Cervical Arterial Dissections and Association With Cervical Manipulative Therapy: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.” For background, an arterial dissection is essentially a tear in the inner lining of the artery. This tear disrupts the normal flow of blood, and also causes platelets to gather at the site of injury. This can result in a blood clot at the site of the dissection. This blood clot can block flow through the artery, or it can break off and lodge downstream, blocking flow at that point. Dissections, therefore, can result in a stroke (a lack of blood flow to a portion of the brain causing damage). There are four arteries in the neck that bring blood from the heart to the brain, two carotid arteries in the front, and two vertebral arteries in the back. A dissection in one or more of these arteries is associated with 2% of all strokes, but with 8-25% of strokes in patients <45 years old. This is mostly because strokes associated with processes like atherosclerosis are much less common in the younger population. Arterial dissections are classified as either spontaneous or traumatic. Trauma can be either severe, such as whiplash injury from a car accident, or subtle, such as from yoga or simply turning one’s neck to look past the shoulder. (more…)
Years of analyzing popular but dubious claims leads to the impression that just about all knowledge that filters down to the popular consciousness is essentially wrong, at least as a first approximation. This may sound cynical, but think about any area in which you have specialized knowledge and compare that to what the average person believes about that area. Now extrapolate that to every other area of specialized knowledge.
I may be skeptical, but I am not a nihilist. I do think the situation can be and is being improved by popularizing science and other areas of knowledge. Experts need to be directly involved in teaching the public about their area, and when they are, popular beliefs can be corrected.
One example is the myth that we only use 10% of our brain. This is still fairly popular, and was recently a central plot element to the blockbuster movie, Lucy. However, Google “10% brain” and you will find nothing but links to sites debunking this myth, at least in the first few pages.
In May, prompted by an uncritical article in the Daily Mail, the internet was buzzing about a company that was offering drinkable sunscreen. This is one of those game-changer health products that immediately garners a great deal of attention.
At first the claim seems extraordinary, but it is not impossible. It is theoretically possible to drink a substance that becomes deposited in the skin and absorbs or reflects UV radiation providing protection. However, upon reading the details it becomes immediately apparent that the product in question is pure snake oil.
The product is Harmonized Water by Osmosis Skin Care. In fact, UV protection is just one claim among many for the harmonized water line of products. The website claims:
- Remarkable technology that imprints frequencies (as standing waves) onto water molecules.
- Advances in the ability to “stack” thousands of frequencies onto one molecule.
- Revolutionary formula allows us to reverse engineer the frequencies of substances found in nature and/or the human body.
- Newly identified frequencies that have beneficial effects on the body.
I suppose it was inevitable. In fact, I’m a bit surprised it took this long. SGU Productions, the Society for Science-based medicine, and I are being sued for an article that I wrote in May of 2013 on Science-Based Medicine. My SBM piece, which was inspired by an article in the LA Times, gave this summary:
The story revolves around Dr. Edward Tobinick and his practice of perispinal etanercept (Enbrel) for a long and apparently growing list of conditions. Enbrel is an FDA-approved drug for the treatment of severe rheumatoid arthritis. It works by inhibiting tumor necrosis factor (TNF), which is a group of cytokines that are part of the immune system and cause cell death. Enbrel, therefore, can be a powerful anti-inflammatory drug. Tobinick is using Enbrel for many off-label indications, one of which is Alzheimer’s disease (the focus of the LA Times story).
The claims and practice of Dr. Tobinick have many of the red flags of a dubious medical practice, of the sort that we discuss regularly on SBM. It seems that Dr. Tobinick does not appreciate public criticism of his claims and practice, and he wants me to remove the post from SBM. In my opinion he is using legal thuggery in an attempt to intimidate me and silence my free speech because he finds its content inconvenient.
Of course, we have no intention of removing the post as we feel it is critical to the public’s interest. This is what we do at SBM – provide an objective analysis of questionable or controversial medical claims so that consumers can make more informed decisions, and to advance the state of science in medicine.
We also feel it is critical not to cave to this type of intimidation. If we do, we might as well close up shop (which I suspect the Tobinicks of the world would find agreeable). Defending against even a frivolous lawsuit can be quite expensive, but we feel it is necessary for us to fight as hard as we can to defend our rights and the work that we do here at SBM.
A newly published meta-analysis of studies looking at acupuncture for symptoms resulting from natural menopause (not drug or surgically induced) by Chiu et. al. is entirely negative. That is not what the authors or the press release conclude, however.
This disconnect between the study results and the interpretation of those results is a persistent problem in medicine generally to some degree, but is endemic and profound within the CAM (complementary and alternative medicine) culture. Acupuncture in particular is promoted almost entirely based on this type of misinterpretations – the kind that can magically turn negative studies into positive studies.
In the abstract the authors conclude:
This meta-analysis confirms that acupuncture improves hot flash frequency and severity, menopause-related symptoms, and quality of life (in the vasomotor domain) in women experiencing natural menopause.
Let’s take a close look at the results, however. Indeed, when comparing acupuncture to no treatment controls there was a significant decrease in subjective symptoms in the pooled data. Outcomes were hot flash frequency, hot flash severity, other menopausal symptoms, and quality of life. Some of the included studies were large controlled trials, which the authors used to argue that their results are valid. They also point out that their results showed heterogeneity and lack of publication bias.
Part of the mission of SBM is to continually prod discussion and examination of the relationship between science and medicine, with special attention on those beliefs and movements within medicine that we feel run counter to science and good medical practice. Chief among them is so-called complementary and alternative medicine (CAM) – although proponents are constantly tweaking the branding, for convenience I will simply refer to it as CAM.
Within academia I have found that CAM is promoted largely below the radar, with the deliberate absence of public debate and discussion. I have been told this directly, and that the reason is to avoid controversy. This stance assumes that CAM is a good thing and that any controversy would be unjustified, perhaps the result of bigotry rather than reason. It’s sad to see how successful this campaign has been, even among my fellow academics and scientists who should know better.
The reality is that CAM is fatally flawed in both philosophy and practice, and the claims of CAM proponents wither under direct light. I take some small solace in the observation that CAM is starting to be the victim of its own success – growing awareness of CAM is shedding some inevitable light on what it actually is. Further, because CAM proponents are constantly trying to bend and even break the rules of science, this forces a close examination of what those rules should actually be, how they work, and their strengths and weaknesses.
A new Cornell University study examines the origins of food fears, and possible remedies. It’s a survey of 1,008 mothers asking about foods they avoid and why.
Food fears are a common topic on SBM, likely for several reasons. Humans have an inherent emotion of disgust, which is likely an adaptation to help avoid contaminated or spoiled food. In our modern society this reflex can be tricky, because we do not always have control over the chain of events that leads to food on our plates. Other people grow the food, transport it, process it, and perhaps even cook it.
Modern food technology can also involve many scary sounding substances and unusual processes. As the saying goes, you may not want to know how the sausage is made, as long as the end result is wholesome.
This leads to a second reason for modern food fears – we are living in an age of increasing transparency, partly brought about by the dramatic increase in access to information on the internet. I think ultimately this is a good thing – people are seeing how the sausage is made, which makes it more difficult to hide shady practices. This introduces a new problem, however. If you’re going to inspect the process of making sausage, then you need to know something about sausage-making. (more…)
The BBC recently reported that a Guinean singer, Alama Kante, sang through her surgery in order to protect her voice. The reporting is unfortunately typical in that it emphasizes the seemingly amazing aspects of the story without really trying to put them into proper context. Specifically, the story emphasizes that hypnosis was used during the surgery, since Kante could not be placed under general anesthesia and still be able to sing, reporting:
“The pain of such an operation is intolerable if you are fully awake. Only hypnosis enables you to stand it,” he was reported as saying by to French publication Le Figaro.
“She went into a trance listening to the words of the hypnotist. She went a long way away, to Africa. And she began to sing – it was amazing,” he said.
Reports of major surgery being performed using self-hypnosis or hypnosis instead of anesthesia crop up regularly, because of the obvious sensationalism of such stories. I reported a similar case from 2008, for example. At least in this case the news report gave the critical piece of information, often missing entirely from such reports:
The Guinean singer, who is based in France, was given just a local anaesthetic and hypnotised to help with the pain during the operation in Paris.
Prolotherapy is a treatment technique used for chronic myofascial pain, back pain, osteoarthritis, or sports injury. It involves repeated injections of dextrose solution or other irritating substances into the joint, tendon, or painful tissue in order to provoke a regenerative tissue response. Similar techniques have been used for about a century, but the first formal publication describing prolotherapy dates back to 1956, by Dr. George Hackett. He wrote:
Within the attachment of weakened ligaments and tendons to bone, the sensory nerves become overstimulated by abnormal tension to become not only the origin of specific local pain, but also definite areas of referred pain throughout the body to as far as the head, fingers and toes from specific relaxed ligaments and tendons.
Prolotherapy. A treatment to permanently strengthen the “weld” of disabled ligaments and tendons to bone by stimulating the production of new bone and fibrous tissue cells has been developed.
Initially the concept, referred to a sclerotherapy, was that the injections formed scar tissue to stabilize the joint, tendon, or ligament. The newer concept, called prolotherapy, is that the injections provoke the proliferation of tissue, allowing for limited regeneration. (more…)
There’s nothing like cold hard data to counteract opinion and propaganda. The anti-vaccine movement hit upon a clever marketing phrase with their “Too Many, Too Soon” campaign. Unfortunately, it is often difficult to capture the complexity and nuance of scientific data with a witty slogan, so such slogans tend to work better for those who don’t really care about such things as scientific data.
I’ll give it a try in any case: how about “too few, too late.” Or maybe, “A day late and an antigen short.”
OK, now you know why I’m not in the marketing business. So let’s talk about the actual scientific data.
The recommended vaccine schedule is not, it turns out, arbitrary or designed to maximize the profits of the vaccine industry. The Center for Disease Control (CDC) recommended vaccine schedule is designed to give children vaccines as soon as they need them and are old enough to handle them – maximizing benefit while minimizing risk. Booster shots are optimized to produce a sufficient antibody response for maximal protection. I don’t think anyone would argue that the schedule is perfect, but it is rational and evidence-based. (more…)