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.)
Even though yesterday was Easter, and, as unreligious as I am, I was still thinking of taking it easy, there was one target that popped up that I just couldn’t resist. My wife and I were sitting around yesterday reading the Sunday papers and perusing the Internet (as is frequently our wont on Sunday mornings), when I heard a contemptuous harrumph coming from her direction. She then pointed me to an article in our local newspaper entitled Gluten-free beauty products in demand among some customers. Now, I must admit that I haven’t been keeping up with the gluten-free trend, other than how easily it fits within the niche of “autism biomed” quackery, where, apparently, nearly every “biomed” protocol for autistic children demands that gluten be stripped completely from their diets, lest the evil molecule continue to infect them with the dreaded autism. I’ve kept an eye the literature, but haven’t really written about gluten. That’s why I could immediately tell why my wife had called my attention to the article:
Amy Soergel’s lip gloss was making her sick. The problem, she realized, was gluten — hydrologized wheat protein, to be exact. Then she went to the hairdresser who used a shampoo that made her neck burn. Again, it contained gluten.
“There’s hidden gluten in many places you may not consider,” including stamp and envelope glues, toothpaste and lip balms, said Soergel, who has a store, Naturally Soergel’s, near Pittsburgh that caters to people with allergies. Indeed, for people with celiac disease, a bit of gluten that might get swallowed from a lipstick or a stream of shampoo in the shower can be enough to cause illness.
A slew of gluten-free skin care products have come on the market, including items from well-known companies such as Murad, Dr. Hauschka, EO, MyChelle, Suntegrity, Acure and derma-e. Many are sold in Whole Foods and other health food stores. If they’ve been certified by a third-party agency, an icon usually appears on the packaging.
Whole Foods. Of course, it had to be Whole Foods (among others). Let’s take a look at the whole gluten-free movement and then at the end I’ll revisit the question of gluten-free cosmetics and skin products.
Whole Foods Market is a relentlessly hip American supermarket chain which prides itself on organic fruits and vegetables, gluten-free just-about-everything, and high-end touches like wine bars and exotic take out items (roasted yucca, anyone?). The health products aisle is stocked with Bach Flower and homeopathic remedies. For example, in-house brand Flu Ease: “an established homeopathic formula that should be taken at the first sign of flu for temporary relief of symptoms including fever chills and body aches.”
Selling Flu Ease and like products certainly exhibits a lack of appreciation for scientific evidence, not to mention basic science. But I recently saw a product in the checkout line that was so filled with over-the-top quackery and so shocking in its disregard for the public’s health that I haven’t been back to Whole Foods since. And I won’t be going back.
The product? A glossy, slickly-produced magazine with the conspiracy-minded title What Doctors Don’t Tell You. The April 2014 issue promises, in banner-headline font size, a “New Light on Cancer.” It features the well-known symbol of fighting breast cancer, a loop of pink ribbon, but with a tear in the middle of the loop. We’ll look into this “new light” in a bit.
For those who dismiss advocates of the “natural” as ignorant of science and deluded by the logical fallacy that natural = best, Nathanael Johnson’s new book is an eye-opener: All Natural: A Skeptic’s Quest to Discover if the Natural Approach to Diet, Childbirth, Healing, and the Environment Really Keeps Us Healthier and Happier. If nothing else, it is a testament to the ability of the human mind to overcome childhood indoctrination in a belief system, to think independently, and to embrace science and reason.
Nathanael Johnson was brought up by hippie parents who subscribed to every “natural” belief and fad. His mother nearly died of a postpartum hemorrhage when he was born at home (he weighed 11 pounds!). His parents didn’t report his birth, and he didn’t have a birth certificate. He co-slept with his parents, never wore diapers (imagine the clean-up!), was allowed to play in the dirt and chew on the snails he found there, was fed a Paleolithic diet, was never allowed any form of sugar, didn’t know there was such a thing as an Oreo cookie, was home-schooled, and did not know that public nudity was taboo until he and his brother shocked the folks at a church picnic by stripping naked to go swimming in the lake. Nudity was customary in his home, and he was encouraged to “let his balls breathe.”
As he grew up, he started to question some of the dogmas he had learned from his parents. He had been taught that good health resulted from forming connections with nature, but he found that nature “generally wanted to eat me.” Now an adult and a journalist, he understands science and how to do research. He tried to read the scientific literature with an unbiased mindset, asking questions about the subjects in his book’s title rather than looking for evidence to support any prior beliefs, and he arrived at pretty much the same conclusions we science-based medicine folks did. But he still appreciates that a natural approach has value, and he seeks to reconcile nature with technology. He calls his book a comfortable refuge from people who are driven to extremes. (more…)
Diets fail. Not just often, but almost always—90% of the time. If diets worked we wouldn’t have a worldwide obesity problem. And obesity is a problem that needs to be solved. The prevalence of obesity has doubled since 1980. As a public health issue, there are few determinants of illness that are more destructive, as obesity contributes to the growing rates of diabetes, heart disease, and even cancer. There’s no “one true cause” of all illness, but obesity comes pretty close. When people ask me for the single most important thing they can do for their health, my advice (after quitting smoking) is to (1) ensure you keep your weight under control and (2) exercise in any way possible.
Despite its tremendous impact on health, I’ve only blogged about obesity in an indirect way—by pointing out what doesn’t work. Dr. Oz is my perpetual source of bad health information with his regular promotion of bogus “weight loss” supplements like the green coffee bean “miracle”. I’ve also criticized eating programs like the fads of “Eating Clean”, gluten “intolerance”, or harmful diet delusions like “detox”. It’s the typical skeptical science blogger approach—spot pseudoscience, debunk it, and hope you did something good. But none of my posts have focused on what one should do—just what you shouldn’t. Weekly SBM contributor Dr. Mark Crislip recently commented that what we (SBM) support manifests in what we oppose. He’s right, because that’s the easy approach. Using the principles of science-based medicine, there’s an awful lot to oppose in the current writing and popular opinion on how to treat obesity. And my professional advice in the role of a pharmacist has been limited to steering people away from supplements, and then giving some basic advice about dietary planning. Anecdotes and platitudes. I admit that I’ve told patients to “eat less and exercise more”.
I am excited to tell you about a wonderful new endeavor that is helping to promote critical thinking about science and medicine. It’s a free online course on “Food for Thought” that offers a scientific framework for understanding food and its impact on health and society from past to present.
The “Food for Thought” course is a product of EdX, which offers online college courses from Harvard, MIT, and other prestigious universities. They provide videos with interactive features and access to online student communities. Students can audit a course and get full access to all the materials including tests, assignments, and discussion forums with no commitment, and can choose what and how much they want to do. (more…)
We (the authors and editors) at SBM get accused of many nefarious things. Because we deliberately engage with the public over controversial medical questions, we expect nothing less. It goes with the territory. In fact, if there were a lack of critical pushback we would worry that we were not doing our job.
Still, it is disconcerting to see the frequently-repeated ideological accusations in response to simply evaluating and reporting the evidence. That is what we do here – follow the science and evidence. When that trail leads to a conclusion that some people do not like (usually for ideological reasons) a common response is to accuse us of ideology, malfeasance, being part of a conspiracy, or having conflicts of interest or ulterior motives. That is easier, I suppose, than engaging with us on the science.
One common accusation is that we are shills for the pharmaceutical industry, and downplay or ignore the benefits of diet and “natural” treatments. A search through the SBM archives demonstrates that this accusation is false – we criticize bad science and poor-quality control, regardless of who is committing it. Sometimes pseudoscience is used to promote a drug, sometimes a nutritional supplement, and sometimes pure magic. (more…)
This will be a departure from my usual posts. Several announcements in the news and medical journals have caught my attention recently, and as I delved into the details, I thought I would share them with our SBM readers. Topics include AIDS cures, the continuing danger of polio, eating nuts for longevity, racial differences in vitamin D, and the use of pharmacogenetic testing to guide the dosage of anticoagulant drugs. They are all examples of science-based medicine in action.
Have patients been cured of AIDS?
I read that the HIV virus had returned in patients thought to have been cured by bone marrow transplants, and I mistakenly thought they were referring to the original claim of cure I had read about. Nope, that one still stands. (more…)
Elsevier has announced that they are retracting the infamous Seralini study which claimed to show that GMO corn causes cancer in laboratory rats. The retraction comes one year after the paper was published, and seems to be a response to the avalanche of criticism the study has faced. This retraction is to the anti-GMO world what the retraction of the infamous Wakefield Lancet paper was to the anti-vaccine world.
The Seralini paper was published in November 2012 in Food and Chemical Toxicology. It was immediately embraced by anti-GMO activists, and continues to be often cited as evidence that GMO foods are unhealthy. It was also immediately skewered by skeptics and more objective scientists as a fatally flawed study.
The study looked at male and female rats of the Sprague-Dawley strain of rat – a strain with a known high baseline incidence of tumors. These rats were fed regular corn mixed with various percentages of GMO corn: zero (the control groups), 11, 22, and 33%. Another group was fed GMO corn plus glyphosate (Round-Up) in their water, and a third was given just glyphosate. The authors concluded: (more…)
It is a triumph of marketing over evidence that millions take supplements every day. There is no question we need vitamins in our diet to live. But do we need vitamin supplements? It’s not so clear. There is evidence that our diets, even in developed countries, can be deficient in some micronutrients. But there’s also a lack of evidence to demonstrate that routine supplementation is beneficial. And there’s no convincing evidence that supplementing vitamins in the absence of deficiency is beneficial. Studies of supplements suggest that most vitamins are useless at best and harmful at worst. Yet the sales of vitamins seem completely immune to negative publicity. One negative clinical trial can kill a drug, but vitamins retain an aura of wellness, even as the evidence accumulates that they may not offer any meaningful health benefits. So why do so many buy supplements? As I’ve said before, vitamins are magic. Or more accurately, we believe this to be the case.
There can be many reasons for taking vitamins but one of the most popular I hear is “insurance” which is effectively primary prevention – taking a supplement in the absence of a confirmed deficiency or medical need with the belief we’re better off for taking it. A survey backs this up – 48% reported “to improve overall health” as the primary reason for taking vitamins. Yes, there is some vitamin and supplement use that is appropriate and science-based: Vitamin D deficiencies can occur, particularly in northern climates. Folic acid supplements during pregnancy can reduce the risk of neural tube defects. Vitamin B12 supplementation is often justified in the elderly. But what about in the absence of any clear medical need? (more…)