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…)
The doubling time for E.coli bacteria is 20 minutes. With uncontrolled growth, it would take a mere two days for the weight of bacteria to equal the weight of the Earth. What rules determine the actual numbers of bacteria? Why is the world green; why don’t insects eat all the leaves? How does the body maintain homeostasis? What determines the uncontrolled growth of cancers? What happens when you remove natural predators from an ecosystem?
You can find the answers in Sean Carroll’s new book The Serengeti Rules: The Quest to Discover How Life Works and Why It Matters.
Everything is regulated: every kind of molecule, cell, and process in the body is maintained in a specific range and governed by a specific substance or set of substances. Diseases are mostly abnormalities of regulation. Too little insulin = diabetes. Uncontrolled cell multiplication = cancer. To intervene in disease, we need to understand the rules of regulation.
Carroll calls them the Serengeti Rules because of the ecological rules that regulate the predator/prey ratios in Africa. But the same rules apply everywhere, at every level of biology. (more…)
It dates back at least to Galileo. A scientist finds evidence that contradicts a cherished popular belief. Instead of a rational examination of his evidence, he is subjected to vicious personal attacks. Alice Dreger examines the phenomenon in her book Galileo’s Middle Finger: Heretics, Activists, and the Search for Justice in Science. She is eminently qualified to do so. She is a professor of clinical medical humanities and bioethics, a historian, a gifted writer, an activist for patient rights, and an indefatigable investigative journalist who has herself been a victim of the kind of persecution she describes.
The histories she recounts are horrifying. She gives example after example of activists using lies and personal attacks to suppress evidence they don’t like. She reveals dirty linen in the most unexpected places. (more…)
In a recent post, Dr. Gorski criticized two articles by Jo Marchant on placebos and alternative medicine. He mentioned that she had a book coming out and suggested I might want to review it. The title is Cure: A Journey into the Science of Mind Over Body.
I don’t know of any evidence that the mind has ever cured a disease, so I would have been prejudiced against this book just from its title, and Dr. Gorski’s post prejudiced me even more. But I was willing to give it a fair trial. The publisher sent me a review copy of the book and I read it. I was expecting to hate it, but I was pleasantly surprised. I enjoyed reading it. I found it fascinating. I found myself agreeing with much of what Marchant says, and I was intrigued by some of the recent research she reports that I was not yet aware of. Preliminary studies, to be sure, but thought-provoking. The book challenged me to think more deeply about placebos, alternative medicine, and patient comfort. (more…)
What is autism? What causes it? Is it genetic? Is it a consequence of something in our environment or lifestyle? What’s an “idiot savant” or an “autistic savant”? What happens when autistic children become adults? Why are so many of their parents scientists, academics, and engineers? If your grandfather’s Uncle Fred was a socially inept inventor with a lot of strange quirks, do you think he might have been autistic? Is autism really becoming more prevalent, or are we just getting better at diagnosing it? What’s happening with these people and what can be done to give them a better life?
Sorry to burden the list of recommended reading with yet another book, but if you are on the autism spectrum, if you know anyone who is autistic, if you think there is an epidemic of autism, if you think vaccines or environmental toxins cause autism, or if you are just interested in autism and want to understand it better, you will benefit from reading this new book by Steve Silberman: NeuroTribes: The Legacy of Autism and the Future of Neurodiversity. You will walk away from the book with new insights and a new appreciation of the “neurodiverse.” (more…)
Yes, it’s a disease
No, it’s a habit
Addiction is a puzzling phenomenon. Why do addicts persist in self-destructive behavior even after it has lost them their jobs, their family, their health, and their self-respect? Do they have any control over their behavior? If so, why don’t they control it? If not, why not? Two recent books shed light on these questions: The Biology of Desire: Why Addiction Is Not a Disease, by Marc Lewis, and The Thirteenth Step: Addiction in the Age of Brain Science, by Markus Heilig.
Lewis is a neuroscientist and former addict; Heilig is a physician and addiction researcher. Lewis is convinced that addiction is not a disease, but a habit created by the neural circuitry of desire in the course of its normal functioning. Heilig is convinced that addiction is a chronic disease like diabetes that can’t be cured but that must be managed by lifelong treatment.
While they disagree about whether addiction is a disease, they actually agree about almost everything else. They agree that we should reject the stigma of addiction as a kind of moral failing. They reject the hypotheses that addiction is a matter of choice or self-medication. They think current diagnostic labels are inadequate. They both try to integrate two levels of information: the case histories of addicts and the scientific knowledge from research. They are both skeptical of AA and of conventional rehab programs. They both support evidence-based treatments. They both think addicts are not all alike and that individual addicts will respond better to individualized approaches. (more…)
The Truth About Cancer: A Global Quest is billed as “the documentary series the mainstream media refused to air.” It consists of eleven episodes and is produced by Ty Bollinger, an outspoken supporter of natural treatments for cancer. Episodes 1 and 2 are currently available online.
Ty Bollinger started his quest because several of his family members had died of cancer despite conventional cancer treatment. He believed they had died not of the cancer but of the cancer’s “so-called treatments” and “false treatments.” He doesn’t explain which cancers they had, what the treatments were, or why he calls them “false.” He was angry, and he wanted his relatives’ lives to matter; he thought he could give their deaths meaning by seeking out alternative treatments that would have saved them and could save others. He was an accountant and bodybuilder, untrained in science or medicine. He started out with the conviction that conventional cancer treatment was a fraud, and confirmation bias had a field day. Instead of learning about cancer from reliable sources, he avoided mainstream cancer experts and researchers and only interviewed alternative practitioners from all over the world who agreed with his premise. He eagerly swallowed everything they told him.
He says, “You are about to learn the best treatments and preventions to cancer, protocols that won’t harm your body, from the world leading doctors across the globe.” He promises to show viewers science and documented evidence. He promises to expose the lies of conventional cancer treatment. He thinks he has information that will eradicate cancer once and for all. He couldn’t be more wrong. (more…)
Gideon Burrows has an inoperable brain cancer that is slow growing but is inevitably going to kill him. He has written a remarkable book about his experience, This Book Won’t Cure Your Cancer. A professional wordsmith, he is able to describe his experience of illness so vividly that the reader enters into his life, feels what he feels, and shares his suspense about what the next scan or doctor’s visit will reveal. Along with him, we suffer through the panic and fear, the chaos, the agonies of delays and uncertainty, the unpleasant hospital environment, and specialists with poor bedside manners. We follow him through difficult decisions about how to share the bad news with friends, relatives, and his young children; and we understand why this engenders guilt feelings. The story is as engaging as a detective story; we can hardly wait to see what the next scan will show and how the story of his illness will play out. It puts a human face on the cancer experience, and it would be valuable for that alone, but it is much more. The gradually unfolding episodes of his personal story are interwoven with what amounts to a primer on how to think critically about science-based medicine vs. alternative treatments. I can’t recommend this book highly enough.
Since I graduated from medical school, new scientific developments in immunology have been occurring at a prodigious rate. I knew I could use a refresher course, and serendipity dropped one in my mailbox in the form of a review copy of the new book Immunity, by William E. Paul, MD, chief of the Laboratory of Immunology at the National Institute of Allergy and Infectious Diseases of the National Institutes of Health and a major player in many of the scientific discoveries he describes. It was just what I needed. It brought me up to date, and it left me in awe of the amazing things our bodies do to keep us alive.
We are bombarded with claims that something will “boost the immune system” but the people who say that have no understanding of how the immune system really works. We have anti-vaxxers who still deny the effectiveness of vaccines and the existence of herd immunity, and who imagine all kinds of hypothetical harms from vaccines, but who have little understanding of how vaccines actually work. This book itself could serve as a sort of vaccine to immunize readers against scientifically ignorant arguments. (more…)