Science and Medicine

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Betraying the Science on Vegan Nutrition

vegan-betrayal-cover

Ed. Note: After the prolonged comment thread in Harriet Hall’s review of this book in July, given the controversy, we were willing to consider a guest post offering another perspective. In this case, the perspective is very similar to Harriet’s, the main difference being primarily in emphasis.

As a dietitian working in the area of vegan nutrition, I see no shortage of outrageous claims about vegan diets. They come from both sides of the debate. Advocates for veganism sometimes ascribe unsubstantiated benefits to vegan diets while downplaying concerns about meeting nutrient needs.

On the other side of the debate are bloggers and authors who insist that a vegan diet is a dangerous choice and that it can’t support health over the long term. Prominent voices for this perspective include those whose health failed on a vegan diet and who eventually returned to eating meat, dairy and eggs. They are now on a mission to prove that humans require animal foods.

Mara J. Kahn is the latest author to try to capitalize on that story. Her book Vegan Betrayal has already been reviewed on Science Based Medicine and the nutrition information was deemed evidence-based. I came away with a different impression when I read the book.

I don’t feel any particular need to prove that a vegan diet is the only healthful way to eat; that’s not the point of veganism. The term was coined in 1944 by the founders of England’s Vegan Society and was defined as:

a philosophy and way of living which seeks to exclude — as far as is possible and practical — all forms of exploitation of, and cruelty to, animals for food, clothing or any other purpose.

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Posted in: Book & movie reviews, Nutrition, Science and Medicine

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Cleveland Clinic Subscription Box Service Introduces Integrative Medicine to Curious Consumers

A young child opening a CAMCrates for Kids box, hoping for relief for her Childhood-Onset Qi Deficiency (COQD).

A young child opening a CAMCrate for Kids! box, hoping for relief from her Childhood-Onset Qi Deficiency (COQD)

Cleveland, OH- Cleveland native Kelly Anderson is looking forward to the end of the month like a young child anxiously awaiting Christmas morning. That’s because on a day between the 20th and the 28th of December, she will receive the gift of hope. Anderson, a 43-year-old mother of five who was diagnosed with chronic Lyme disease and numerous nutritional imbalances earlier this year by a Naturopathic doctor during a visit to discuss her unexplained fatigue, is part of a growing number of people interested in an alternative path to wellness.

CAMCrate, a new monthly subscription box service developed by the experts at Cleveland Clinic’s Center for Integrative and Lifestyle Medicine, will deliver boxes of high quality and thoroughly tested alternative medical experiences right to customer’s doorstep starting this month. Anderson, who learned about the new service during a routine check-up at the office of her Cleveland Clinic affiliated primary care doctor, is quick to point out that she loves her conventional medical doctor. “I’m not against Western scientific medicine, I’m just looking to augment it with something different, something special. Who doesn’t want a little magic and mystery in their lives?” (more…)

Posted in: Humor, Science and Medicine

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Drug therapy is still sending too many people to the emergency department

emergency-room-sign
No drug is free of risks, or the potential for causing harm. Every decision to take a drug needs to consider expected benefits and known risks. One of the ways we can reduce harms is by studying drug use rigorously. Only by understanding the “real world” effects of drugs can we understand the true risks (and benefits) and design strategies to reduce the risk of iatrogenic harm — that is, harms caused by the intervention itself. Adverse events related to drug treatments are common. Some lead to hospitalization. Studies suggest 28% of events are avoidable in the community setting, and 42% are avoidable in long-term care settings. That’s a tremendous amount of possible harm from something prescribed to help. A new study published this week shows that adverse drug events (ADEs) continue to cause significant problems, sending over a million Americans to the emergency room every year.

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Posted in: Pharmaceuticals, Public Health, Quality Improvement, Science and Medicine

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Add-on Services for IVF – The Evidence

ivf

In vitro fertilization (IVF) is the only option for many couples who want to have their own genetic child. This is an expensive procedure – it can cost up to $20,000 per attempt, with about a 40% success rate overall.

Couples going for IVF are often desperate to have their own child, and the uncertainty of success can be emotionally and financially draining. For this reason they are an especially vulnerable population when it comes to optional services (“add-on services”) that promise to increase the chances of success.

A recent BMJ article reviewed the evidence for 38 IVF add-on services typically offered in the UK: “Lack of evidence for interventions offered in UK fertility centres.” The title gives away the punch line – of the 38 services they reviewed, only one had any compelling published evidence of efficacy, endometrial scratch (causing minor trauma to the uterine wall to enhance the probability of embryo implantation). Even then the evidence was only “moderate.” The authors write:

Our appraisal of the evidence shows only one intervention, endometrial scratching, for which the review evidence robustly supports an increase in live birth rate, yet even this evidence is of only moderate quality, and the observed benefit is only in women with more than two previous embryo transfers.

That could easily be just random noise in the research. If you look at 38 different treatments, what are the odds that at random one of them will have an excess of false positive studies, and only in one subgroup (which is a red flag)?

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Posted in: Acupuncture, Science and Medicine

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“Functional medicine” in practice

Functional Medicine practitioners like to make patients think that this diagram actually means something.

Functional Medicine practitioners like to make patients think that this diagram actually means something.

I’ve frequently written about a form of medicine often practiced by those who bill themselves as practicing “complementary and alternative medicine” (CAM) or “integrative medicine” (or, as I like to refer to it, “integrating” quackery with medicine). I’m referring to something called “functional medicine” or, sometimes, “functional wellness,” which Wally Sampson first introduced to readers of this blog way back in 2008, and continued to educate our readers over multiple posts. Over the years, I’ve tried to explain why the term “functional medicine” (FM) is really a misnomer, how in reality it is a form of “personalized medicine” gone haywire, or, as I like to refer to it, as “making it up as you go along.” Unfortunately, thanks largely to its greatest popularizer, Dr. Mark Hyman, FM is popular, so much so that Bill and Hillary Clinton count Hyman as one of their medical advisors and the Cleveland Clinic, not satisfied with embracing prescientific traditional Chinese medicine, has gone “all in” for FM by hiring Dr. Hyman two years ago to set up a functional medicine clinic. Unfortunately, it’s been “wildly successful” there.

Unfortunately its success is not deserved, at least from a scientific standpoint.
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Posted in: Acupuncture, Basic Science, Diagnostic tests & procedures, Science and Medicine, Traditional Chinese Medicine

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Phenibut Is Neither Proven Nor Safe As A Prosocial Wonder Drug

Editor’s note: With Mark Crislip away on yet another vacation, we present an inaugural guest post from Abby Campbell, a practicing MD, Ph.D and contributor at HealthyButSmart.com. Welcome Abby!

Ball-and-stick diagram of the phenibut molecule

Ball-and-stick diagram of the phenibut molecule

On average for the past year, phenibut has been typed into google 49,500 times a month. Phenibut is a supposed wonder drug that claims to promote sociability and lessen anxiety.

When people run that search in Google, they find stores that sell phenibut, as well as blogs and forums where people discuss and make recommendations for the use of phenibut. The main qualification of these people is that they themselves have taken the drug.

What a searcher doesn’t find is any reference to any credible research. Yet another supplement market has been born driven by anecdotal social marketing, and no one seems to care about the evidence.

What is phenibut?

Phenibut is a designer drug which was synthesized by a group of Russian scientists in the 1960s. Perekalin and his colleagues in St. Petersburg added a phenyl ring to butyric acid to make what we now call phenibut. The addition of the phenyl group to the butyric acid enables the compound to cross the blood-brain barrier and enter the brain.

This basic chemical structure of the compound explains the origins of the name ‘phenibut’. Phenibut is also known as fenibut and is sold under the brand names of Noofen and Citrocard.

Phenibut is structurally similar to the neurotransmitter GABA (gamma amino butyric acid). GABA occurs naturally in the human nervous system and has a calming effect on the brain.

GABA itself does not cross the blood brain barrier and so is not viable as a drug or supplement to reduce anxiety. The addition of the phenyl ring by the Russian scientists overcame the problem of penetration into the brain. However this means that phenibut is not totally identical to human GABA which means that we can’t just extrapolate information on GABA to phenibut, as some websites have done. (more…)

Posted in: Basic Science, Herbs & Supplements, Science and Medicine

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Homeopathic Syrup for the Treatment of Pediatric Colds: Randomized Controlled Nonsense is Still Nonsense

coughkid
According to the authors of the latest study claiming to demonstrate effectiveness of homeopathic remedies, colds are common in the pediatric population. They further explain that colds and cough symptoms are a frequent impetus for parents to seek pediatric medical care. Finally, they add that evidence in support of decongestants, antihistamines and cough suppressants for the treatment of pediatric cold symptoms is lacking and that there are significant potential risks with their use in young children.

All of this is true and information I give to medical learners and patient caregivers all the time. I only wish they had quit while they were ahead. Sadly, the authors of “A randomized controlled trial of a homeopathic syrup in the treatment of cold symptoms in young children” continued:

One option for treating cold symptoms in young children is with homeopathy. Because the concentrations of active ingredients in homeopathic medications are extremely dilute, they are generally considered to be safe. However, there is a widely held belief that any efficacy related to use of homeopathic remedies is related to a placebo effect.

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Posted in: Science and Medicine

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What are health professionals telling consumers about dietary supplements?

Is that pharmacist making an evidence-based recommendation?

Is that pharmacist making an evidence-based recommendation?

The popularity of dietary supplements continues to grow. A few weeks ago I described how dietary supplements have become a $34 billion industry, despite the fact that there’s very little evidence to support their use. While there are absolutely some medical circumstances where specific supplements may be warranted, the vast majority of supplements are taken for general purposes, such as “wellness” or to prevent perceived deficiencies. There’s also the belief that “more is better”, a sentiment that seems unique to supplements (compared with drugs), perhaps because supplements are widely believed to be safe, effective and yet simultaneously free of any adverse effects. While none of these assumptions are inherent to any “supplement”, this thinking has had a clear influence on regulators and consumers: (more…)

Posted in: Herbs & Supplements, Science and Medicine

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Blue Light. Special?

blaulicht
I do not sleep as well as I used to. Perhaps it is being tormented by guilt and worry combined with profound existential angst.

Or maybe it is my iPad. I gave up on most dead tree editions. I miss the smell and feel of books and magazines, but nothing is better than being able to increase the font size to 18. So I usually finish the day reading on the iPad.

I have noted programs that will remove the blue light from computer screen to aid in sleep. There is a night mode in iOS 9.3 and a program for the Mac I have on now that filter out the blue. Makes the screen oddly colored but it more restful on the eyes. I think. I am more in need of existential angst filter. (more…)

Posted in: Basic Science, Medical devices, Science and Medicine

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A New Collaborative in Neuroscience

connectome3

A recent comment in the journal Nature makes a bold proposal – to form a true multi-lab cooperative to perform collective research into the deep questions of neuroscience. There are two aspects of this proposal that are extremely interesting: the potential to make significant progress in answering the biggest questions in neuroscience, and the collaborative approach to research being proposed.

How does the brain work?

It is often difficult to answer questions about the current state of scientific knowledge to the general public because there is a lot of background knowledge about science itself that is necessary. As a result I find two common tropes – that scientific knowledge is binary (we either understand something or we don’t) and that we “have no idea” how something works, even when we have lots of ideas. Communicating about the brain almost always falls for these tropes.

Scientific knowledge is better understood using a metaphor of depth. The real question is not whether or not we understand how the brain works, but how deep is our knowledge about brain function. Because the brain is so complex we can simultaneously say that we know a great deal about brain function and there is a great deal we don’t understand.

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Posted in: Neuroscience/Mental Health, Science and Medicine

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