[Editor Note: This is a greatly expanded version of my initial thoughts on a study about mammography published in the New England Journal of Medicine last week on my not-so-super-secret other blog. It’s such an important topic that I thought SBM should see my discussion too, and I couldn’t just cut and paste it. You deserve original material.]
I knew it. I just knew it. I knew I couldn’t get through October, a.k.a. Breast Cancer Awareness Month, without a controversial mammography study to sink my teeth into. And I didn’t. I suppose I should just be used to this now. I’m referring to the latest opus from H. Gilbert Welch and colleagues that appeared in the New England Journal of Medicine last week, “Breast-Cancer Tumor Size, Overdiagnosis, and Mammography Screening Effectiveness.” Yes, it’s about overdiagnosis, something I’ve blogged about more times than I can remember now, but it’s actually a rather interesting take on the issue.
Before 2008 or so, I never gave that much thought to the utility of mammographic screening as a means of early detection of breast cancer and—more or less—accepted the paradigm that early detection was always a good thing. Don’t get me wrong. I knew that the story was more complicated than that, but not so much more complicated that I had any significant doubts about the overall paradigm. Then, in 2009, the United States Preventative Services Task Force (USPSTF) dropped a bombshell with its recommendation that mammographic screening beginning at age 50 rather than age 40 for women at average risk of breast cancer. Ever since then, there have been a number of studies that have led to a major rethinking of screening, in particular screening mammography and PSA testing for prostate cancer. It’s a rethinking that affects discussions even up to today, with advocates of screening arguing that critics of screening are killing patients and skeptics of screening terming it useless. Depending on the disease being screened for, the answer usually lies somewhere in between. Basically, screening is not the panacea that we had once hoped for, and the main reason is the phenomenon of overdiagnosis. Before I go on, though, remember that we are talking about screening asymptomatic populations. If a woman has symptoms or a palpable lump, none of this discussion applies. That woman should undergo mammography.
Fluorine atom showing its 1S and 2S/2P electron orbitals (hybridized) with atomic nucleus at centre
[Editor’s note: With no further ado, and with no introduction necessary, here is a second post from Craig Pearcey; Witness his science and despair, quacks of the world!]
First for the basic chemistry
There is one particular word that tends to get many CAM supporters very vocal and the conspiracists thinking about running for their home-made bunkers in a basement somewhere. It is the word “fluorine” or any of its analogues. However, before getting into their anti-fluorine claims, we need to briefly review it properties as both an element and in various molecular forms. Without this background it may be possible to make certain assumptions about fluorine that are baseless for a given molecular structure and application. It is this very type of error that the antivaxxers and many in the CAM field make in regards thimerosal – i.e. Ethyl(2-mercaptobenzoato-(2-)-O,S) mercurate(1-) sodium, methyl-mercury, and elemental mercury. All three have significantly differing chemical properties based on their molecular structure, but some individuals/groups continue to attribute the toxicity and chemical properties for elemental mercury to thimerosal (Ethyl(2-mercaptobenzoato-(2-)-O,S) mercurate(1-) sodium). Similarly, drawing conclusions on thimerosal toxicity from methyl mercury is equally flawed. In addition, in their instance in equating the three they refuse to provide any viable mechanism how thimerosal is converted into either elemental mercury of methyl mercury, or how they can be attributed the same chemical properties. (more…)
Prevention has long been a priority of conventional medicine
One of the common criticisms we hear from alternative and integrative medicine proponents is that doctors don’t do anything to prevent illnesses and have no interest in prevention. They claim that doctors are only trained to hand out pills to treat existing illnesses. Sometimes they even accuse them of deliberately covering up cures and wanting to perpetuate illnesses like cancer so they can make more money by treating patients. Nothing could be more absurd. Every reputable doctor would rather prevent illnesses than treat them. In his book Heart 411, cardiologist Steven Nissen even said he would be glad to see his specialty become obsolete: “Don’t worry about us; we will gladly hang up our scalpel and stethoscope if we can find a better way to lead you to a heart-healthy life.”
Doctors own prevention. They invented it, from vaccines to clean water to preventive screening tests. Mainstream medicine was responsible for the greatest preventive achievement in history: the smallpox vaccine campaign succeeded in preventing anyone from ever getting smallpox again. I defy you to comb through historical records and find any doctor who ever said “Let’s stop vaccinating for smallpox so we can make more money treating its victims.”
Prevention is one of the six fundamental principles of naturopathy. Alternative practitioners pride themselves on prevention, but they don’t actually do a very good job of it. In fact, there is evidence that their patients are less likely to get immunizations and some of the standard preventive screening tests recommended by the USPSTF. Instead of rigorously implementing evidence-based preventive strategies, they tend to offer other speculative, untested recommendations.
And now if you excuse me, I’m going to get back to trying to hit Infernape with golf balls. That’s how Pokémon Go works, right?
I don’t have much to write about this week. Yeah, yeah, I know. How is that different than the last 50 blog entries? And I will have even less to say next time.
But nothing of real interest has crossed my screen the past two weeks, not that I have really been looking. One of my favorite stories as a kid was Ray Bradbury’s All Summer in a Day. It takes place in the Oregon of my memory.
It is summer in the great Pacific NW and the outdoors and sunshine beckon. Who wants to skim the SCAM when there is hiking, biking, and golf? Golf has become more interesting this year. I tend to hit the links late and we play until dark. It has been a challenge not no kill the Pokémon Go players who wander the course at sunset, roaming in the gloaming clueless as to the dangerous projectiles flying by. Fore! Those are Titleists, not Poké Balls.
Once the sun goes down it has been the conventions that have trumps my attention, so why not a short entry touching on a few aspects exploring issues and controversies in science, medicine, and politics? (more…)
How do we deal with parents who would rather their babies face diseases than vaccines?
As long as there have been vaccinations, there has been an antivaccine movement, and as long as there has been an antivaccine movement, there have been parents who refuse to vaccinate. In a past that encompasses the childhood of my parents, polio was paralyzing and killing children in large numbers in yearly epidemics, the fear of which led to the closure of public pools every summer. In such an environment, the new polio vaccine introduced by Jonas Salk in the mid-1950s wasn’t a hard sell. In fact, satisfying the initial demand for it was the problem, not parents refusing to vaccinate their children. Since then, more and more vaccines have been developed to protect more and more children from more and more diseases, to the point where the incidences of most vaccine-preventable diseases is so low that, unlike 60 years ago, most parents today have never seen a case or even known other parents whose child suffered from a case. Even as recently as the 1980s, Haemophilus influenza type B was a dread disease that could cause meningitis, pneumonia, sepsis, and death. Since the introduction of the the Hib vaccine a mere quarter century ago, Hib has been virtually eliminated. Most pediatricians in residency now have never seen a case.
As much of a cliché as it is to say so, unfortunately vaccination has been a victim of its own success, at least in developed countries. Parents no longer fear the diseases childhood vaccines protect against, which makes it easy for antivaccine activists to provide what I like to call “misinformed consent,” by spreading misinformation that vastly exaggerates the risk of vaccines compared to the benefit of vaccinating. Parents who believe the misinformation conclude, based on a warped view of the risk-benefit ratio of vaccines, that not vaccinating is safer. Add to the mix fear mongering against the MMR based on Andrew Wakefield and his dubious 1998 case series that popularized the then-recent idea that vaccines cause autism, and it’s no wonder that parents decide that not vaccinating is safer than vaccinating. If you believe the misinformation, it’s not an entirely unreasonable conclusion. Then add to that the easy availability of “personal belief exemptions” to school vaccine mandates in many states, which include anything from religious exemptions to parents just signing a form that says they are “personally opposed” to vaccination, and it isn’t a huge surprise that vaccine uptake has fallen in some areas to the point where outbreaks can occur. It was happening in California and my own state of Michigan. (more…)
AMA members voting on the issue of gun violence research.
On June 14th the American Medical Association’s (AMA) House of Delegates in Chicago, IL voted almost unanimously to adopt a resolution supporting the idea that gun violence is a public health issue. The resolution also called for lobbying Congress to eliminate the ban on research into the causes of gun violence. The AMA reports:
“With approximately 30,000 men, women and children dying each year at the barrel of a gun in elementary schools, movie theaters, workplaces, houses of worship and on live television, the United States faces a public health crisis of gun violence,” said AMA President Steven J. Stack, M.D. “Even as America faces a crisis unrivaled in any other developed country, the Congress prohibits the CDC from conducting the very research that would help us understand the problems associated with gun violence and determine how to reduce the high rate of firearm-related deaths and injuries. An epidemiological analysis of gun violence is vital so physicians and other health providers, law enforcement, and society at large may be able to prevent injury, death and other harms to society resulting from firearms.”
The resolution is aimed primarily at a congressional ban on research into gun violence by the Centers for Disease Control (CDC). I will discuss this ban further, but first let’s address the underlying issue. (more…)
The National Consortium for Credentialing of Health & Wellness Coaches (NCCHWC) and the National Board of Medical Examiners (NBME) signed an agreement last month for the launch of a national certification for individual health and wellness coaches in the U.S. According to a joint press release, the agreement is a landmark in the efforts of a dedicated group of individuals who have been working for years to establish professional practice and educational standards for health and wellness coaching.
What is “health and wellness coaching?” According to NCCHWC’s website:
Health and Wellness Coaches partner with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and, thereby, enhance well-being. In the course of their work health and wellness coaches display unconditional positive regard for their clients and a belief in their capacity for change, and honoring that each client is an expert on his or her life, while ensuring that all interactions are respectful and non-judgmental.
The zombie story that cell phones cause cancer has risen from the grave yet again.
There are certain myths that are frustratingly resistant to evidence, science, and reason. Some of these are basically medical conspiracy theories, where someone (industry and/or big pharma and/or physicians and/or the government) has slam-dunk evidence for harm but conspires to keep it from you, the people. For example, despite decades worth of negative studies, the belief that vaccines are harmful, causing conditions ranging from autism to sudden infant death syndrome, to all varieties of allergies and autoimmune diseases, refuses to die. Fortunately, this myth is one that, after more than a decade of hammering by scientists, skeptics, and public health advocates, has finally taken on enough of the patina of a fringe belief that most mainstream news sources no longer feel obligated to include the antivaccine side in stories about vaccines for “balance.” It is a zombie myth, one that, no matter how often it is “killed,” always seems to rise again. Unfortunately, the same cannot be said for the myth that cell phones cause cancer, as some very credulous reporting late last week demonstrated in the form of headlines like this:
Despite the fact that numerous scientific and health organizations around the world have examined the evidence regarding the safety of genetically modified organisms (GMOs) and found them to be completely safe, there remains a public controversy on this topic. In fact a Pew Poll found that while 88% of AAAS scientists believe that GMOs are safe for human consumption, only 37% of the public do – a 51% gap, the largest in the survey.
This gap is largely due to an aggressive anti-GMO propaganda campaign by certain environmental groups and the organic food industry, a competitor which stands to profit from anti-GMO sentiments. There is also a certain amount of generic discomfort with a new and complex technology involving our food.
Because of all this, the National Academy of Sciences put together an expert committee to systematically review all the evidence regarding this new technology. Their thorough 407 page report is now available.
They pulled together experts with diverse backgrounds, and also took public comment and solicited input from a wide range of interests. They decided specifically not to rely on any previous review, but to conduct their own review of the primary literature. (more…)