There is an obvious survival advantage to the emotion of disgust – we should fear putting unhealthy, tainted, contaminated, or poisonous substances into our bodies. Emotions, however, are a double-edged sword. They are an effective evolutionary mechanism for motivating creatures to engage in certain behavior, but they also tend to be crude and undiscriminating – inadequate to deal with our complex modern society.
A dispassionate consideration of objective scientific evidence is the optimal strategy for deciding on which foods and substances are safe to consume, but it is far easier to scare people about toxins than to reassure them with data. We see this frequently with the anti-vaccine movement, and also with anti-fluoridation attitudes. It is easy to scare people with the idea that there are “chemicals” in our drinking water.
One company, San Diego Pure Water, seems to have made such scaremongering into a marketing strategy. Their website is full of articles and videos claiming that fluoride is the “the greatest fraud that has ever been perpetrated.”
A correspondent sent me a link to an article about the decision of the Wichita Falls (Texas) Independent School District to recommend that chiropractors be allowed to give sports physicals to junior high and high school students. Current policy limits examiners to physicians, physician assistants, and nurse practitioners. Adding chiropractors to this list would bring the district in line with policies in the rest of Texas, as well as in some other states. And it would “give parents more options.”
The 2012 election campaign is in full swing, and, for better or worse, health care is one of the major defining issues of the election. How can it not be, given the passage of the Patient Protection and Affordable Care Act (PPACA), also colloquially known as “Obamacare,” was one of the Obama administration’s major accomplishments and arguably the largest remaking of the American health care system since Medicare in 1965? It’s also been singularly unpopular thus far, contributing to the Republican takeover of the House of Representatives in the 2010 elections, as well as the erosion of Democratic control of the Senate. Given that this is a medical blog dedicated to discussing the scientific basis of medicine and not a political or health policy blog, I am not going to go into the reasons for a lot of this. What I am going discuss is a recent eruption of the central problem that led President Obama to make the PPACA one of the central policy initiatives, if not the central policy initiative, of his first term. That problem is the issue of people without health insurance, who number roughly 50 million, with a further estimate that 86.7 million people were uninsured at some point during the two year period from 2007 to 2008, representing about 29% of the total U.S. population under 65.
The question that bubbled to the surface last week in the form of a statement by Republican challenger Mitt Romney, and a tear-inducing op-ed piece published yesterday in the New York Times by Nicholas Kristof entitled A Possibly Fatal Mistake, is what the health impact of not having insurance is for those millions of people. This is a question that can be addressed scientifically and is, despite its politically charged nature, correctly within the purview of science-based medicine. What to do about it, in contrast, is a matter for politics and public policy. So first let’s examine the question. (more…)
It is estimated that 5% of people living in Sub-Saharan Africa are infected with HIV – that’s 22.5 million people. Infection rates vary wildly from country to country, with Swaziland having the highest rate at 25.9%. Gambia is below average, at 2% or 18 thousand people, but still has a serious HIV problem, and now finds themselves at the center of the HIV controversy in Africa.
This epidemic has been magnified by unfortunate realities on the ground. Africa has an insufficient public health and medical infrastructure to deal with the massive challenge such an epidemic presents. This has led the World Health Organization to contemplate partnering with local traditional healers, to make them into an extension of the effort to bring modern medical treatment to the HIV-infected in Africa. This desperate strategy is fraught with problems, not the least of which is that most traditional healers have had no prior contact with science-based medicine.
Former South African president Thabo Mbeki seriously set back his country’s HIV efforts by embracing crank HIV denial. Coupled with his denialism was efforts by Health Minister Manto Tshabalala-Msimang to use traditional medicines to treat HIV/AIDS. This combination resulted in restrictions on the distribution of anti-retoviral drugs in South Africa that is estimated to have cost hundreds of thousands of lives.
Countering ideologically motivated bad science, pseudoscience, misinformation, and lies is one of the main purposes of this blog. Specifically, we try to combat such misinformation in medicine; elsewhere Steve and I, as well as some of our other “partners in crime” combat other forms of pseudoscience. During the nearly five year existence of this blog, we’ve covered a lot of topics in medicine that tend to be prone to pseudoscience and quackery. Oddly enough, there’s one topic that we haven’t really written much about at all, and that’s genetically modified organisms (GMOs). GMOs, as you know, are proliferating, and it’s quite worth discussing the potential and risks of this new technology, just as it is worthwhile to discuss the potential benefits versus the risks of any new technology that can impact our health, not to mention the health of the planet. Unfortunately, GMOs have become a huge political issue, and, I would argue, they have become just as prone to pseudoscience, misinformation, and bad science as vaccines, with a radical group of anti-GMO activists who are as anti-science as any antivaccinationist or quack.
One issue that keeps coming up time and time again for me is the issue of screening for cancer. Because I’m primarily a breast cancer surgeon in my clinical life, that means mammography, although many of the same issues come up time and time again in discussions of using prostate-specific antigen (PSA) screening for prostate cancer. Over time, my position regarding how to screen and when to screen has vacillated—er, um, evolved, yeah, that’s it—in response to new evidence, although the core, including my conclusion that women should definitely be screened beginning at age 50 and that it’s probably also a good idea to begin at age 40 but less frequently during that decade, has never changed. What does change is how strongly I feel about screening before 50.
My changes in emphasis and conclusions regarding screening mammography derive from my reading of the latest scientific and clinical evidence, but it’s more than just evidence that is in play here. Mammography, perhaps more than screening for any disease, is affected by more than just science. Policies regarding mammographic screening are also based on value judgments, politics, and awareness and advocacy campaigns going back decades. To some extent, this is true of many common diseases (i.e., that whether and how to screen for them are about more than just science), but in breast cancer arguably these issues are more intense. Add to that the seemingly eternal conflict between science and medicine communication, in which a simple message, repeated over and over, is required to get through, versus the messy science that tells us that the benefits of mammography are confounded by issues such as lead time and length bias that make it difficult indeed to tell if mammography—or any screening test for cancer, for that matter—saves lives and, if it does, how many. Part of the problem is that mammography tends to detect preferentially the very tumors that are less likely to be deadly, and it’s not surprising that periodically what I like to call the “mammography wars” heat up. This is not a new issue, but rather a controversy that flares up periodically. Usually this is a good thing.
And these wars just just heated up a little bit again late last week. (more…)
There is a movement in the US to oppose a public health measure that is backed by impressive evidence showing it is safe and effective, as well as highly cost effective. For as long as the government has supported this health measure, there have been those opposed to it, claiming (against the evidence) that it is unsafe, ineffective, and represents a violation of personal freedom and the right to refuse an unwanted medical intervention. I could be talking about vaccines and the anti-vaccine movement, but in this case I am talking about the fluoridation of public water supplies and the antifluoridation movement.
This social debate (there isn’t much of a scientific debate) crops up in the news every now and then – mostly prompted by an antifluoridation activist or group making noise, or by a local referendum to block fluoridation in a community. Recently there has been a Harvard study making the rounds of social media, Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. The actual findings of the study do not show that there is any risk to public water fluoridation (if anything, they show that it is safe), but the study was seized upon by antifluoridation activists and distorted for their propaganda purposes. Unfortunately, the internet is now fertile ground for the spreading of propaganda.
The NYS Coalition Opposed to Fluoridation put out a press release distorting the findings of the study. Their press release (“Harvard Study Finds Fluoride Lowers IQ – Published in Federal Gov’t Journal”) was then printed as a science news item by many online news outlets. Reprinting press releases, without any editorial filter, is a cheap and easy way to add news-like content to your website. The Sacramento Bee, for example, published the press release under their “News” tab. Near the top of the page, in small print, they did put a disclaimer (which is better than most sites):
This section contains unedited press releases distributed by PR Newswire. These releases reflect the views of the issuing entity and are not reviewed or edited by the Sacramento Bee staff. More information on PR Newswire can be found on their web site.
That’s better than nothing, but I wonder how many people reading the press release will notice and read the disclaimer. In my opinion, a news outlet should not reprint press releases sent out from advocacy organizations clearly intended to promote an agenda. They especially should not print them under the banner of “News.” The disclaimer is not adequate. The spreading of this “news item” around Facebook and other social media demonstrates this.
Many of the specific issues that the Governor and the Legislature asked the Commission to review have festered because the [California] Acupuncture Board has often acted as a venue for promoting the profession rather than regulating the profession.
— Little Hoover Commission, Regulation of Acupuncture: A Complementary Therapy Framework: September 2004, page 63.
On March 12, 2012, during a brief Sunset Review hearing, the California Senate Committee on Business, Professions and Economic Development asked the California Acupuncture Board (the Board) to respond to a set of harsh criticisms.
It is not the first time that the dysfunctional Board — which falls under the Department of Consumer Affairs — is being scrutinized by the legislator. The Board has a long history of operating in an inefficient manner, misreading its governing statutes, and potentially endangering the public by refusing to promulgate regulations concerning the sterilization of acupuncture needles or the wear of medical gloves by practitioners.
In the past, members and affiliates have even been investigated for taking bribes and selling licensing exam answers. The Board was replaced several times in order to clean up the quasi-anarchic and corrupt practice of acupuncture and Oriental medicine in California.
This time, the Senate Committee listed 10 major issues in a Background Paper, which is a worthwhile read for those interested in the regulation of acupuncture. The Senate expressed serious concerns about many administrative, educational, licensing, enforcement, consumer protection and budgetary matters. In response, the Board Chair and Executive Director offered little explanation. The Board now must respond to the Background Paper in specifics. (more…)
Voodoo science is a sort of background noise, annoying but rarely rising to a level that seriously interferes with genuine scientific discourse… The more serious threat is to the public, which is not often in a position to judge which claims are real and which are voodoo. Those who are fortunate enough to have chosen science as a career have an obligation to inform the public about voodoo science.
Imagine you are an ordinary person with limited knowledge of science and medicine, and you see this 2010 video on tai chi and qi gong by the National Center for Complementary and Alternative Medicine (NCCAM) — one of the agencies that make up the National Institutes of Health (NIH). I am certain that the solemn voice of the Director of NCCAM, Dr. Josephine Briggs, talking about “rigorous scientific research” and “accurate, authoritative information on complementary and alternative medicine,” will leave you with a strong sense of confidence in her message.
In addition, despite the fine-print and the disclaimer, the appearance of Dr. Briggs in the video could be broadly viewed as a sign of tacit endorsement. Often, the very fact that a treatment is associated with the government is already a de facto stamp of approval and a warranty of efficacy. For instance, the publication below by the California Department of Consumer Affairs states that the NIH formally “endorses” acupuncture, simply because in 1997, a panel of scientists assessed its use and effectiveness for a variety of conditions. Since 1997 the scientific review of acupuncture by NIH has become synonymous with its endorsement, despite the fact that as a federal research agency, the NIH does not endorse any product, service, or treatment.
In October 26, 2011, a few weeks after Steve Jobs’ death, Josephine Briggs decided to do something she has never done before: she put an explicit disclaimer on her blog:
When making treatment decisions, unproven “alternative medicine” approaches should not replace conventional medical care approaches known to be useful or helpful. Simply put, the evidence is not there (emphasis added).2
Three paragraphs down the page, she goes on — with a candor rarely seen from her — that given the recent news about Steve Jobs’ choices for cancer treatment, all health decisions “should be guided by the best available evidence.” (more…)
The Princes Foundation for Integrated Health closed shop in 2010. Now the company that ran the foundation has officially closed. The foundation was a vanity project by Prince Charles, who had a soft spot for so-called alternative medicine and natural therapies. The foundation was established in 1993 and in the last 19 years has misinformed the public about CAM therapies, promoted nonsense like homeopathy, and has been an official royal seal of approval on the anti-science in medicine movement in the UK.
In short the foundation was an excellent example of why political ideology should not interfere with the normal process of science. The website for the charity no longer exists, but this is what it said about it’s mission:
“The Prince’s Foundation for Integrated Health is a UK charity championing an integrated approach to health.
“The Foundation works towards a culture of health and wellbeing with people and communities taking more responsibility for their own health, and where health professionals collaborate and share learning in the best interests of their patients.
“Integrated health means an approach to health which:
“emphasises prevention and self-care
“looks at the person in the round, taking into account the effects on health of lifestyle, environment and emotional wellbeing
“brings together the safest and most effective aspects of mainstream medical science and complementary healthcare.”
This is typical CAM bait and switch. Preventive medicine, healthy lifestyles, and taking a complete approach to health is not alternative or complementary – it is part of mainstream science-based medicine. All of that is actually a misdirection from the real goal of the CAM or “integrative” movement – to promote health products and services that fail to meet minimal standards of evidence and plausibility, or which have already been shown to be ineffective. The Prince’s Foundation was not exception, promoting over the years every form of quackery from homeopathy to Reiki.