Dr. Richard Rawlins
Dr. Richard Rawlins, an orthopedic surgeon in the UK who is also a magician and member of the Magic Circle, has written an exhaustive review of alternative medicine, Real Secrets of Alternative Medicine: An Exposé.
“A conversation with Mrs. Smith”
A conversation with Mrs. Smith bookends the text. She comes to Dr. Rawlins for hip replacement surgery and asks if there is any alternative medicine she could try first. He tells her some patients say they have benefited, but personal experience is no substitute for critical analysis of evidence. He explains that there is no evidence to support those alternatives but that if she wants to try them, she can go ahead and try. Then she asks which one is most likely to help her. He tells her he can’t recommend one because he has not studied them in any detail. She says perhaps he should study them, and then write a book. So he does.
At the end of the book, he tells Mrs. Smith what he has learned: that complementary and alternative medicine (CAM) “works” but only as a placebo; it does not affect disease outcomes and can sometimes do harm. He quotes cancer researcher David Grimes:
By clinging to delusion, belief in alternative medicine denigrates the very wonder of science and medicine and the massive strides we as a species have made over the last century or so in understanding the world around us, and how our bodies work.
Rawlins ends the book by telling Mrs. Smith “Conventional practitioners care more than you may think. That is the real secret.”
In between those conversations is a 370-page tour de force that covers the entire history of medicine and CAM, stresses the importance of scientific evidence, reviews how good the brain is at deluding itself, explains the placebo effect and the attractions of CAM, and argues that society should not pay for it. (more…)
I didn’t intend to review Jon Palfreman’s book Brain Storms: The Race to Unlock the Mysteries of Parkinson’s Disease, but after reading it I decided it was too good not to share. Palfreman is an award-winning science journalist who has Parkinson’s himself. He has done a bang-up job of describing Parkinson’s disease, its impact on patients, and how science is working to understand and treat it.
Parkinson first described the disease in 1817. It is characterized by shaking, rigidity, slowness of movement, and difficulty with walking. There is a decrease in dopamine in the basal ganglia in the brain. One million Americans have Parkinson’s disease. The incidence increases with age; by age 80 one in fifty people are affected.
Some very strange phenomena have been observed. Parkinson’s disease is less common among smokers and coffee drinkers. When a patient becomes frozen and unable to take the next step, if you draw a line on the floor they will step over the line and walk on. Patients who can’t walk can run, ride a bike, or ice-skate. Some patients appear to have strong responses to placebos, with reversal of symptoms for long periods. Exposure to vibration seems to decrease symptoms; in the late 1800s patients were treated with vibrating chairs until controlled studies showed they didn’t work. (more…)
The publisher recently sent me a review copy of Quackery: The 20 Million Dollar Duck, by Tony Robertson. My first thought was “Do we really need another book on this subject? Don’t I know all this stuff already?” I was very pleasantly surprised. Robertson has ferreted out an impressive array of facts and details that I wasn’t aware of; and yes, we need as many good books on the subject as we can get. Each author has a somewhat different approach that may appeal to a different audience. Robertson’s book is a worthy addition to the canon. He is a retired gynecologist who practiced, taught, and still lives in Zimbabwe. He is a critical thinker who understands and promotes science-based medicine, and he brings a unique perspective, especially on subjects related to his specialty. The book is not just about charlatans, it’s about non-science-based practices wherever they are found, including in mainstream medicine and in Robertson’s own field of obstetrics and gynecology.
I expected to like the book after I read the Dedication “To those who appreciate the truth fairy rather than the toothed one” and the Acknowledgements: “To my teachers and mentors who encouraged me to think, always to question and only to accept where there is good evidence.” That could serve as a motto for all skeptics, scientists, and critical thinkers to live by: Think, question, and only accept where there is good evidence. (more…)
Statistics is hard, often counterintuitive, and burdened with esoteric mathematical equations. Statistics classes can be boring and demanding; students might be tempted to call it “Sadistics.” Good statistics are essential to good research; unfortunately many scientists and even some statisticians are doing statistics wrong. Statistician Alex Reinhart has written a helpful book, Statistics Done Wrong: The Woefully Complete Guide, that every researcher and everyone who reads research would benefit from reading. The book contains a few graphs but is blissfully equation-free. It doesn’t teach how to calculate anything; it explains blunders in recent research and how to avoid them.
Inadequate education and self-deception
Most of us have little or no formal education in statistics and have picked up some knowledge in a haphazard fashion as we went along. Reinhart offers some discouraging facts. He says a doctor who takes one introductory statistics course would only be able to understand about a fifth of the articles in The New England Journal of Medicine. On a test of statistical methods commonly used in medicine, medical residents averaged less than 50% correct, medical school faculty averaged less than 75% correct, and even the experts who designed the study goofed: one question offered only a choice of four incorrect definitions.
There are plenty of examples of people deliberately lying with statistics, but that’s not what this book is about. It is about researchers who have fooled themselves by making errors they didn’t realize they were making. He cites Hanlon’s razor: “never attribute to malice that which is adequately explained by incompetence.” He says even conclusions based on properly done statistics can’t always be trusted, because it is trivially easy to “torture the data until it confesses.” (more…)
A superb writer, Siddhartha Mukherjee’s books are easier to read than his name is to spell
Six years ago I reviewed Siddhartha Mukherjee’s book The Emperor of All Maladies: A Biography of Cancer. It was hands-down one of the best books I have ever read on a medical topic. Now he’s done it again. His new book is titled The Gene: An Intimate History.
Mukherjee is a superb writer. Much of what I said about his first book applies equally to his second, so I will quote myself:
It is a unique combination of insightful history, cutting edge science reporting, and vivid stories about the individuals involved: the scientists, the activists, the doctors, and the patients. It is also the story of science itself: how the scientific method works…
Beautifully written and informative
Reads like a detective story with an exciting plot.
He links this second book to his first by pointing out that cancer is an ultimate perversion of genetics, and that studying cancer means also studying its obverse: normalcy. He gives the subject a human face by interspersing anecdotes from his own family’s struggles with mental illness and its connection to inherited genes. He sets out to tell the story of the birth, growth, and future of one of the most powerful and dangerous ideas in the history of science: the gene. He says it is one of three destabilizing ideas that have transformed science: the concept that irreducible units underlie matter (the atom), digitized information (the byte or bit), and biological information (the gene). He explains how the consequences of these ideas have transformed our thinking, our language, our culture, politics, and society. (more…)
I’ve finally seen it. I’ve finally seen Andrew Wakefield and Del Bigtree’s “documentary” VAXXED: From Cover-up to Catastrophe, and I didn’t even have to pay to see it! Now, having watched Wakefield and Bigtree’s “masterpiece,” I can quite confidently say that it’s every bit as accurate and balanced a picture of vaccine benefits and risks as Eric Merola’s two movies about the quack Stanislaw Burzynski and his Second Opinion: Laetrile at Sloan-Kettering are about cancer and cancer research, The Beautiful Truth is about the Gerson protocol for cancer, Simply Raw: Reversing Diabetes in 30 Days is about diet and diabetes, Expelled! No Intelligence Allowed is about evolution, and The Greater Good is about…vaccines! Of course, based on what I knew of the story, saw of the VAXXED trailer (which deceptively edited together statements by William Thompson), and have discussed about the efforts of Andrew Wakefield, Del Bigtree, and Polly Tommey to use VAXXED as a tool in a publicity campaign to try to spread fear, uncertainty, and doubt (FUD) about vaccines using the “CDC whistleblower” conspiracy theory (about which a primer can be found here), I shouldn’t have been surprised, but I was actually surprised (slightly) at the manipulative depths to which this film sinks.
On the plus side, its production values are better than those Eric Merola’s films (although I, with no experience, could probably make a film with better production values than Merola), but that just makes it somewhat more effective propaganda. In my review and discussion of the movie and its claims, I will discuss the claims made by Bigtree and Wakefield as well as the movie as a movie. Unfortunately, there is so much misinformation in this 91 minute documentary that I will only be able to hit the “high” points without going far, far beyond even a Gorski level of logorrhea in this post. Worse, there is a considerable amount of dishonest framing, in which actual facts and events are presented in a deceptive manner to tell a distorted narrative. Before that, though, let’s meet the key players.
If vegans really followed these guidelines, they could get adequate nutrition; but all too often they don’t.
NOTE: The original version of this book review was criticized for not making it clear when I was simply reporting the book’s content and when I was expressing support for one of its arguments. I have revised it to make it more clear. The additions are marked by brackets.
Vegetarians come in several flavors. Ovo-vegetarians eat eggs, lacto-vegetarians eat dairy products but not eggs, ovo-lacto-vegetarians eat both eggs and dairy products. Pescatarians eat fish but no other animals. Vegans eat nothing derived from animals. Vegans have claimed that a plants-only diet offers a multitude of health benefits, is better for the environment, and is the only ethical choice. While some of them respect the dietary choices of others, some of them proselytize with religious-like fervor and are working to get their diet adopted by all of humanity. In her new book, Vegan Betrayal: Love, Lies, And Hunger In A Plants-Only World, Mara Kahn questions those beliefs, pointing out that no human population has ever endured on a plants-only diet; that while some studies have shown short-term health benefits, long-term follow-up is missing; that long-term vegans frequently experience “failure to thrive,” go off their diet, and feel better when they return to eating meat; and that veganism might actually harm the environment and might not even save animal lives overall.
The book is really three books interleaved into one:
- The story of her own experiences as a vegan.
- An evidence-supported analysis of veganism and vegetarianism
- Some rather woo-woo ideas about finding a unique diet for each individual
I can highly recommend the first two, but I deplore the third. (more…)
Lagniappe, a word often heard in New Orleans, refers to a bonus or extra gift, like the thirteenth donut in a baker’s dozen. You may have noticed that I write a lot of book reviews. I read far more books than I review, and I have always loved to read about the experiences of doctors and the interesting patients and intriguing illnesses they have encountered. I thought I would write an extra post this week to share some titles that SBM readers might also enjoy.
I value these books for several reasons. They are entertaining. They prove that doctors are not all evil Big Pharma shills just in it for the money. They let readers vicariously experience what it is like to be a doctor in a particular specialty or setting. They highlight the joys of helping patients, as well as the many frustrations doctors struggle with. They put a human face on the practice of medicine. (more…)
Medicine is an uncertain business. It is an applied science, applying the results of basic science knowledge and clinical studies to patients who are individuals with differing heredity, environment, and history. It is commonly assumed that modern science-based doctors know what they are doing, but quite often they don’t know for certain. Different doctors interpret the same evidence differently; there is uncertainty about how valid the studies’ conclusions are and there is still considerable uncertainty and disagreement about things like guidelines for screening mammography and statin prescriptions.
Snowball in a Blizzard by Steven Hatch, MD, is a book about uncertainty in medicine. The title refers to the difficulty of interpreting a mammogram, trying to pick out the shadows that signify cancer from a veritable blizzard of similar shadows. (more…)
Robert De Niro made a massive mistake last week. Fortunately, he started to make up for it.
One of the disadvantages of only doing one blog post a week here at Science-Based Medicine is that sometimes stuff happens at too fast a pace for me. If something happens on Tuesday, by the time Sunday rolls around and it’s time for me to do my weekly post, it’s often old news, too old to bother with. That’s why it’s a good thing that I have my not-so-super-secret other blog, where I can keep up with such events. On the other hand, the advantage of a once-a-week posting schedule is that there are times I can look back at a story that evolved over the last week and, instead of blogging about it in daily chunks, I can put together a post that tells the whole story and puts it in context. Something like that happened last week. The beauty of it is that I played a major role in bringing the story to public consciousness, followed the story as it evolved, and now can provide a fairly complete recounting. Or so I hope.
First, however, let’s take advantage of another good thing about waiting to blog about a story, namely getting to see the reactions of quacks to what happened. No one can do it better than everybody’s favorite all around quack, crank, and all-purpose conspiracy theorist Mike Adams, who greeted me yesterday morning with this headline: VAXXED film pulled from Robert De Niro’s Tribeca Film Festival following totalitarian censorship demands from pharma-linked vaccine pushers and media science trolls. What on earth is Adams talking about, you might wonder? In case you haven’t been following the news, here’s a link to the New York Times story on the same incident: “Robert De Niro Pulls Anti-Vaccine Documentary From Tribeca Film Festival.” Basically, the 2016 Tribeca Film Festival selected an antivaccine documentary directed by Andrew Wakefield for screening and then thought better of it after a major uproar and a whole boatload of bad press.
I’ll deal with Adams’ post a bit later because it’s so hilariously nutty but also because it is basically the propaganda line that antivaccinationists are putting on this PR debacle brought about by Andrew Wakefield and Robert De Niro. (I never thought I’d use those two names in the same sentence.) Let’s go back a week and see what I mean. (more…)