I have yet another grant deadline to deal with, this time for the Department of Defense Congressionally Directed Medical Research Programs, this time around its Breast Cancer Research Program. Unfortunately, that put a high degree of time pressure on me. Fortunately, there’s still stuff in the archives of my not-so-secret other blog that I deem quite appropriate for this blog and that can be updated with minimal effort. If you don’t know what I’m talking about when I refer to my not-so-secret other blog, then it’ll definitely be new to you. If you haven’t been reading that blog for at least four and a half years, it’ll be new to you as well. And even if you have seen it before, I think it’s worth revisiting.
Why? It came up because of an encounter I had on Twitter with Jane Orient, MD, who, as you might recall, is the executive director of the American Association of Physicians and Surgeons (AAPS). I’ve written about the AAPS before. You can get the details in the link, but if you don’t have time suffice to say that it is an entire organization of libertarian-leaning “brave maverick doctors” who think Medicare is unconstitutional, don’t believe that the government should have much, if anything, to do with regulating the practice of medicine, and reject evidence-based guidelines as an unholy affront to the independence of the physician. Along the way, the AAPS, through its journal, The Journal of American Association of Physicians and Surgeons (often abbreviated JPANDS), promoted antivaccine views, including the discredited concept that vaccines cause sudden infant death syndrome, HIV/AIDS denialism, and the scientifically unsupported idea that abortion causes breast cancer (a topic I might have to revisit, given the activity promoting it recently).
In any case, two or three weeks ago, I was having a bit of an exchange with Dr. Orient over anthropogenic global climate change (often abbreviated as AGW, for anthropogenic global warming, for short), the well-accepted science that concludes that CO2 generated by human activity is having a serious warming effect on the earth’s climate. As you might expect, she’s not big on this particular scientific consensus. I forgot about it, but then the other day saw this Tweet exchange between Dr. Orient and Ed Wiebe:
3D model of dichlorodiphenyltrichloroethane (DDT), an insecticide
I think everyone would agree that it would not be a good idea to put pesticides in a saltshaker and add them to our food at the table. But there is little agreement when it comes to their use in agriculture. How much gets into our food? What are the effects on our health? On the environment? Is there a safer alternative?
Where should we look to find science-based answers to those questions? One place we should not look is books written by biased non-scientists to advance their personal agendas. A friend recently sent me a prime example of such a book: Myths of Safe Pesticides, by André Leu, an organic farmer whose opinions preceded his research and whose bias is revealed in the very title. (more…)
Oh, loneliness and cheeseburgers are a dangerous mix.
– Comic Book Guy
Same can be said of viral syndromes and Thanksgiving. My brain has been in an interferon-induced haze for the last week that is not lifting anytime soon. Tell me about the rabbits, George. But no excuses. I have been reading the works of Chuck Wendig over at Terrible Minds. (Really, really like the Miriam Black books). Writers write and finish what they start and only posers use excuses for not completing their work.
Recently I attended an excellent Grand Rounds on some of the reasons doctors do what they do. Partly it is habit. We learn to a certain way of practice early in our training and it carries on into practice and it is not always best practice. Patients also learn from us and have expectations on what diagnostics or treatments they should receive, and that too it is not always the best practice.
So to educate physicians and patients, the American Board of Internal Medicine (ABIM) started the Choosing Wisely initiative. (more…)
New York may soon join a handful of other states who reject science-based guidelines for the treatment of Lyme disease in favor of ideological guidelines based on the vociferous lobbying of patients and “Lyme literate” health care providers. Ignoring science is an unfortunate but well-known legislative phenomenon. I’ve discussed it a number of times on SBM, in the form of Legislative Alchemy, the process by which credulous state legislators turn practitioners of pseudoscience into state-licensed health care professionals, such as naturopaths, chiropractors, homeopaths and acupuncturists.
Lyme disease is an infectious disease transmitted by a tick bite. Its symptoms are a rash, fever, headache and fatigue, although not all symptoms may appear. According to the Infectious Diseases Society of America (IDSA):
Lyme disease is diagnosed by medical history, physical exam, and sometimes a blood test. It may take four to six weeks for the human immune system to make antibodies against Borrelia burgdorferi and therefore show up in a positive blood test. That is why patients with the Lyme rash usually have a negative blood test and diagnosis is based on the characteristic appearance of the rash. Patients with other clinical manifestations such as Lyme arthritis will usually have a blood test. Anyone who has symptoms for longer than six weeks and who has never been treated with antibiotics is unlikely to have Lyme disease if the blood test is negative.
Treatment with antibiotics usually eliminates the symptoms, but delayed treatment can result in more serious problems. (more…)
Does anyone remember the H1N1 influenza pandemic? As hard as it is to believe, that was five years ago. One thing I remember about the whole thing is just how crazy both the antivaccine movement and conspiracy theorists (but I repeat myself) went attacking reasonable public health campaigns to vaccinate people against H1N1. It was truly an eye-opener, surpassing even what I expected based on my then-five-year experience dealing with the antivaccine movement and quacks. Besides the usual antivaccine paranoia that misrepresented and demonized the vaccine as, alternately, ineffective, full of “toxins,” a mass depopulation plot, and many other equally ridiculous fever dream nonsense, there was the quackery. One I remember quite well was the one where it was claimed that baking soda would cure H1N1. Then there was one of the usual suspects, colloidal silver, being sold as a treatment for H1N1. Then who could forget the story of Desiree Jennings, the young woman who claimed to have developed dystonia from the H1N1 vaccine but was a fraud? Truly, pandemics bring out the crazy, particularly the conspiracy theories, such as the one claiming that the H1N1 pandemic was a socialist plot by President Obama to poison Wall Street executives, which was truly weapons-grade conspiracy mongering stupidity. Oh, wait. That last one was a joke. It’s so hard to tell sometimes with these things.
Yes, pandemics and epidemics do bring out the worst in people in many ways, but particularly in terms of losing critical-thinking abilities. This time around, five years later, it’s Ebola virus disease. To the average person, Ebola is way more scary than H1N1, even though H1N1, given its mode of transmission, had the potential to potentially kill far more people. Now that cases of Ebola virus disease have been reported in the US, the panic has been cranked up to 10 in certain quarters, even though the risk of an outbreak in the US comparable to what is happening in West Africa is minimal. We’ve seen quackery, too, such as homeopaths seriously claiming that they can treat it and quacks advocating high-dose vitamin C to “cure” Ebola. The über-quack Mike Adams is selling a “natural biopreparedness” kit to combat Ebola and pandemics, while the FDA is hard-pressed to track down all the quacks, such as hawkers of “essential oils,” who—of course!—also think that their wares can cure Ebola. (more…)
Yahoo News appears to have confused NaturalNews with actual news. It’s not. NaturalNews is the in-house propaganda organ for Mike Adams, whom I’ll introduce in a minute (although he needs no introduction for most readers here). A couple of recent examples:
A recycled story, over a year old, from NaturalNews, appearing on Yahoo News last week. It starts out as a fairly straightforward report of the Japanese’s governments suspending its recommendation if favor of the HPV vaccine pending further research, although government health officials were still standing by the vaccine’s safety. Actually, Medscape reported that the actual rate was 12.8 serious adverse side effects reported per 1 million doses, a fact not revealed in the NaturalNews story. These effects were correlated with the vaccine; there is no evidence of causation.
After this rather tame start, NaturalNews cranks it up to 11 and beyond, as David Gorski would say. Governments which still recommend HPV vaccinations “remain under the thumb of Merck’s vaccinations spell” even though Merck is “an organization of murderers and thieves.” A scary list of adverse events are described as “side effects of Guardasil” even though causation has not been shown.
Two days ago there was an “ongoing debate”? There is no ongoing debate about “whether or not vaccines cause autism” because there never was any credible evidence that vaccines cause autism and there still isn’t.
This cover picture is scientifically inaccurate. See explanation below.
José Jarimba believes that our bodies are physically molded into an asymmetric form by our mothers’ sleeping positions during pregnancy, that this has lifelong adverse impacts on health, and that shoe inserts can eliminate pain and other health problems by realigning the body. This is a silly untested hypothesis by a single individual. As such, it would be too minor to merit mention on SBM; but it is worth analyzing as a teaching opportunity. Jarimba attempts to bypass the scientific process; he provides a prime example of self-deception, confirmation bias, scientific ignorance, and the “Unpersuadables” I recently wrote about.
Much of alternative medicine originated with a “lone genius” who had an epiphany, thought he had discovered something no one had ever noticed before, extrapolated from a single observation to construct an elaborate theory that promised to explain all or most human ills, and began treating patients without any attempt to test his hypotheses using the scientific method. Some of them were uneducated laymen, others were scientifically trained medical doctors who should have known better. I wrote about one of them here, Dr. Batmanghelid, inventor of the Water Cure, who attributed a great variety of illnesses to dehydration after he thought he had cured a prisoner’s peptic ulcer disease by giving him a glass of water. Similar paths were followed by many others. Hahnemann invented homeopathy after he thought a malaria remedy gave him symptoms of malaria. Palmer invented chiropractic after he thought he had restored a man’s hearing by repositioning an out-of-place bone in his back. Nogier invented ear acupuncture after he imagined that the external ear looked sort of like a fetus. Shapiro invented EMDR after she noticed during a walk in a park that moving her eyes seemed to reduce the stress of disturbing memories. Bach invented Bach flower remedies after a walk in the country revealed his intuitive psychic connection to various plants. Jose Jarimba follows in their footsteps. (more…)
We would like to believe people are rational. We would like to believe that if they have formed a false belief based on inaccurate information and poor reasoning, they will change that belief when they are provided with accurate information and better reasoning. We are frequently disappointed.
An example of what should happen
I recently talked with a college professor who believed chiropractic treatment could lower blood pressure. His belief was based on a media report of a chiropractic study. He thought it was plausible that neck manipulation could somehow relieve obstructions to blood flow to the base of the brain, thereby somehow correcting the cause of high blood pressure. I told him that rationale was anatomically and physiologically implausible. I pointed out that the researchers used NUCCA, a form of manipulation that is rejected by most chiropractors. He did not know what NUCCA was. I provided him with information, including links to the study itself and to chiropractor Sam Homola’s excellent critique of the study. My friend changed his mind and thanked me for educating him.
An example of what all too often happens
I was invited to give the “con” side of a pro/con presentation on dowsing to a local discussion group. I lent my opponent my copy of Vogt and Hyman’s classic book Water Witching USA so he would know ahead of time what I was going to say. He read it. The book explains how the ideomotor effect creates the illusion that the dowsing rod moves of its own accord and explains that dowsers have never been able to pass controlled scientific tests. I said as much in my “con” presentation. His “pro” presentation consisted of two arguments: he had personally seen dowsing work, and lots of people believed in it. He didn’t even try to rebut my facts and arguments; he simply refused to engage with them in any way. It was as if he had not read the book and had not heard anything I said. Afterwards, one of the audience was heard to say she would have liked to hear more about how dowsing worked and less about how it didn’t work!
Will Storr investigates
Sadly, some people are unpersuadable. They might as well be saying “My mind’s made up; don’t confuse me with the facts.” We have seen plenty of glaring examples in the comments section of this blog. Will Storr wrote a book The Unpersuadables: Adventures with the Enemies of Science about his struggle to understand the phenomenon. He did a great job of investigative reporting, interviewing people with strange beliefs, spending time with them and also with their critics, and reading pertinent research. (more…)
A lot of medical specialties have throwaway newspapers/magazines that are supported by advertising and somehow mysteriously managed to show up for free in the mailboxes of practitioners. In my case, I’ve found myself on the subscription list for such papers about oncology, but also general surgery (I’m Board-certified as a general surgeon). When I have to recertify in about three years, it will be as a general surgeon, which was really fun to try to do last time after having specialized as a breast cancer surgeon, and will likely be even more fun next time, when I will be 10 years further out from my general surgery and surgical oncology training. In any case, that must be why, no matter where I end up working, sooner or later I end up receiving General Surgery News (GSN).
As throwaway professional newspapers go, GSN is not bad. However, occasionally it publishes op-ed articles that make me scratch my head or even tick me off with their obtuseness. Lately, apparently, it’s started some blogs. The one in particular that is the center of attention for this post is by Victoria Stern, is called “The Scope” and is billed as “exploring the lesser known sides of surgery.” Of course, it’s a bit odd that some of the first posts on this blog are about work hour restrictions and whether they leave new surgeons unprepared to practice surgery, the debate over breast screening, and what it takes to train expert surgeons, none of which are exactly “lesser known sides of surgery.” Work hour restrictions, in particular, have been discussed in surgery journals, at conferences, and among surgeons ad nauseam, particularly whether we are training a generation of surgeons unable to deal with the rigors of practicing surgery in the real world.
This post might look familiar to some of you who know me from what I like to call my not-so-secret other blog (NSSSOB). However, what happened last week was important enough that I wanted to make sure that it was covered on SBM, just as Steve Novella covered it on his own blog on Friday. (Fear not, there will be fresh material tomorrow, as always.) Another reason that I wanted to recycle and update this for SBM is because I believe the incident involving über-quack Mike Adams provides to me a “teachable moment” related to my talk at TAM two weeks ago, which was entitled “How ‘They’ View ‘Us’” and based on a post of mine here on SBM entitled, appropriately enough, How “they” view “us”.