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…)
Evil Mr. Vaccine and the consequences of vaccination.
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…)
PETA (People for the Ethical Treatment of Animals) has a history of (as the old saying goes) using science as a drunk uses a lamppost – for support rather than illumination. In that way they are typical of ideological groups. They have an agenda, they are very open about their beliefs, and they marshal whatever arguments they can in order to promote their point of view.
Favoring information that supports our current beliefs is a cognitive bias common to Homo sapiens, but ideology tends to take this simple bias to a new level. It can lead to the systematic distortion or denial of science, and render belief systems immune to logic and evidence.
PETA provides us with a nice example of how having an ideological agenda can motivate an individual or a group to embrace dubious science. In an article currently on their website, and making the rounds in social media (this is repeating a claim from at least 2008, but the current article is undated), the group warns: Got Autism? Learn About the Link Between Dairy Products and the Disease. They claim:
The reason why dairy foods may worsen or even cause autism is being debated. Some suspect that casein harms the brain, while others suggest that the gastrointestinal problems so often caused by dairy products cause distress and thus worsen behavior in autistic children.
Saying that “how” dairy harms the brain is being debated implies “that” dairy harms the brain is accepted and not being debated. This is misleading. It is not accepted that dairy harms the brain or is in any way linked to autism, and the evidence is largely against it. (more…)
Myths tend to be persistent and require periodic maintenance debunking. The anti-vaccine movement arguably can credit its recent increase in effect to successfully spreading fears that vaccines in general, and particularly either the MMR vaccine (mumps, measles, and rubella) or the vaccine preservative thimerosal, are linked to autism. This claim was never based on legitimate science, and over the last 15 years has been overwhelmingly repudiated by multiple independent lines of scientific evidence.
It is easier to spread fears than it is to reassure anxious parents with abstract scientific data, but still we must try. It also seems that giving people information is not an effective way to change their opinions or their behavior. But at the very least I hope to better inform those who are already on board with the science-based approach, and perhaps we can reach the occasional person on the fence who is simply misinformed and open to changing their mind.
A new meta-analysis seems like a good opportunity to remind the public that vaccines are safe and effective, and that they are not linked to neurodevelopmental disorders. The study is: “Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies,” by Taylor, Swerdfeger and Eslick, is published in the journal Vaccine. They found: (more…)
A recent opinion piece in The New York Times is an invitation to a dialogue on so-called alternative therapies, written by James Gordon. Gordon directs the Center for Mind-Body Medicine and was chairman of the White House Commission on Complementary and Alternative Medicine Policy appointed by President Bill Clinton. The piece, unfortunately, represents many of the common misconceptions about mainstream medicine and CAM (complementary and alternative medicine).
Even more distressing, the Affordable Care Act will likely reinforce current practice, which dictates surgical and pharmacological interventions that can be expensive, inappropriate, burdened by side effects and, often, ineffective.
His piece is doomed right from the start. Current practice does not “dictate” drugs and surgery, no matter how often CAM proponents claim that it does. This is simply a straw man designed by CAM advocates to create a niche for their brand. Mainstream medicine uses treatments that are backed by sufficient plausibility and evidence, regardless of modality. At least, this is what mainstream medicine strives for. We acknowledge the implementation is imperfect, and improving the standard is part of what we strive for at SBM. (more…)
A new website came to my attention that promises to “Discover what truly works.” The idea is to essentially crowdsource anecdotal reports about what treatments work for specific conditions.
This is an interesting idea, that can harness the power of information flow over the internet to do what is essentially an observational, uncontrolled, and unscientific study about treatment effects. At its best, this type of information would consist of what we call a pragmatic study – an open-label study of the real-world application of specific treatments.
Pragmatic studies have their place – they add information about the practical applicability of various treatments. Pragmatic studies, however, are not efficacy trials – they cannot and should not be used to make efficacy claims. It has recently come into vogue for proponents of various CAM treatments to rely on pragmatic studies to make efficacy claims, when actual efficacy trials have failed to show effectiveness. (more…)
Science-based medicine is a concept that is larger than the analysis of any specific topic. It is, essentially, an approach to answering health and medical questions, one that involves careful and thorough analysis of scientific evidence within a framework of understanding of critical thinking, mechanisms of self-deception, and the process of science itself. We feel this creates the best opportunity to arrive at tentative conclusions that are most likely to be reliable.
We often address claims that are the result of a very different process. In fact there seems to be a thriving subculture on the internet that emphasizes the naturalistic fallacy, fear of anything technological (including irrational chemophobia), paranoia about the government, corporations, and mainstream medicine, and embracing anything perceived as being contrarian, exotic, or radical. To this subculture science is either the enemy, or it is used (as Andrew Lang famously quipped) like a drunk uses a lamppost, for support rather than illumination. This approach is simultaneously gullible and cynical.
It is no surprise that those who follow this fatally flawed approach consistently arrive at the wrong conclusion, especially on any controversial scientific topic. The two most prominent netizens following this approach, in my opinion, are Joseph Mercola and Mike Adams. I do believe, however, that there is another hoping to join their ranks – Vani Hari, who blogs under the name Food Babe. (Mark Crislip also blogged about her here.)
The infiltration of pseudoscience and simply bad medicine into mainstream medicine continues. Hospitals are an easy breech point because they are run by administrators who may have more talent and interest in marketing than in science. Many hospitals in my area, for example, proudly display their “integrative” centers, offering nutrition advice and massage alongside more dubious offerings, such as reflexology and reiki.
So-called “alternative” treatments are tempting because they are often not covered by insurance, and so patients will have to pay cash for them, and they are often inexpensive to run – so they are a nice cash cow for hospitals.
The Wall Street Journal reports another, more serious, chapter in this infiltration – the opening of Chinese herbal clinics, specifically in the Cleveland Clinic. The article itself is reasonably balanced, and lacks the gushing anecdotes that most such pieces have, but could certainly have been more hard-hitting in terms of the serious problems with herbal medicine.
The BBC reports that 11 doctors and a GlaxoSmithKline regional manager in Poland have been charged with alleged corruption. The apparent scheme was simple — GSK sales reps are given targets for new prescriptions for whatever drugs they are promoting. In order to meet those targets, it is alleged that one sales rep agreed to pay doctors £100 to give educational lectures to patients. The lectures never took place, and it was understood that in exchange for the payment the doctors would prescribe more of the rep’s drug.
The case is still under investigation but one doctor has already admitted guilt, stating that the £100 was simply too tempting.
Assuming the charges are upheld, such cases are very damaging to public confidence in the system. This is similar to cases of researchers faking their published research — I cringe every time I read about such cases.
What will it take? That is the lingering question, one that has significant implications for the legitimacy and effectiveness of our professional and regulatory institutions.
Homeopathy is 100% pure nonsense. It is one of the so-called “alternative” medical systems that has absolutely no basis in reality. It is magic-based medicine. It is based on two-centuries-old pre-scientific ideas, bad guesses that turned out to be wrong.
The notion behind homeopathy is that illness is caused by a problem with the essence or life energy. Based on the idea of “like cures like” the homeopath must find a substance that is the match for the totality of symptoms, including personality traits and superficial details like eye color, and then give a magic potion which is created by diluting the matched substance out of existence – but the essence remains. (more…)