Archive for Science and Medicine

Open vs Blinded Peer-Review


The overall goal of science-based medicine is to maintain and improve the standard of science in the practice of medicine at every level. At the heart of the scientific basis of medical knowledge and practice is a process known as peer-review. We have occasionally written about peer-review on SBM, and once again the process is under the microscope over a specific question – should peer review be open or blinded?

What is peer review

The term peer-review refers to a pre-publication process in which a journal editor will send a submitted manuscript to 2-3 experts in a field relevant to the paper to carefully examine every aspect of the paper. They then provide a detailed analysis of the paper: is the research question relevant and appropriate, did the study design properly address the question, were the methods rigorous, was the statistical analysis appropriate, was the data presented fairly, are the conclusions supported by the data, did the authors account for other publications addressing the same issue, and did they address every possible question or objection?

The reviewers’ reports will make specific recommendations for changes that would be necessary to improve the paper, and also make their bottom-line recommendation: accept as is, accept with revisions, or deny. The journal editor(s) then rely upon those reviews, plus their own assessment, to make a final decision.


Posted in: Medical Academia, Science and Medicine

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The Enigma of Chiropractic: A Brief Review with a Perspective on Chiropractic as a Specialty

 Subluxation-based chiropractic care is sustained more by faith than by facts.

Subluxation-based chiropractic care is sustained more by faith than by facts

Much of what is discussed in this article has been said before in previous articles I have written for Science-Based Medicine. But since the audience for SBM has greatly increased over the past few years, some subject matter should be repeated for the new readers and researchers coming to this site for reliable information on health care.

Many consumers now search SBM for articles dealing with controversial alternative treatment methods that have been shown to be ineffective or to be loaded with fraud and quackery. Chiropractic in particular continues to be problematic for its failure to renounce the scientifically indefensible, nonfalsifiable subluxation theory that defines the profession as a whole. A review of chiropractic web sites reveals that many chiropractors continue to base their treatment methods on subluxation theory, encompassing a broad scope of health problems. Some chiropractors are now including use of “functional medicine” which uses “natural tools” to treat diabetes, thyroid disease, neuropathy, and other diseases best treated by conventional medical care. Most alarming of all is the treatment of infants and children by “pediatric chiropractors.” Chiropractors are being certified in 10 different specialties, including a diplomate in Diagnosis and Internal Disorders.

As long as chiropractic is licensed as a health-care profession based on subluxation theory or some other unscientific approach, it will continue to be subjected to scrutiny and criticism by the science-based community. It is, in fact, the moral and ethical responsibility of science-based practitioners to oppose any form of unscientific health care, wherever it might exist, separating sense from nonsense without being influenced by politics, special interest, pseudoscience, or belief systems.


Posted in: Chiropractic, Science and Medicine

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A “Natural Cure” for Eczema Leaves a Young Child in Agony…..


“I swear I had nothing to do with this!”

A short post today, for me at least, but an important one to file away for the next time somebody asks “What’s the harm?” during a discussion on the use of irregular medicine in the care of pediatric (or any) patients.

The case

The September 2015 issue of Pediatrics in Review, the official American Academy of Pediatrics source for continuing medical education, contains a case report that should be of particular interest to readers of Science-Based Medicine. The authors, pediatricians at Children’s Hospital at Albany Medical Center, describe the ordeal of a six-year-old boy, previously healthy except for eczema, suffering with lower extremity pain to the point of crying with attempts to walk or to even bear weight. For those of you who don’t have experience with children of this age, it takes a considerable amount of discomfort or disability to interfere with their determination to remain in a near constant state of motion. Refusal to bear weight is a red flag that we take very seriously as the cause in a young child is often serious, ranging from traumatic injuries and severe infections of the bones or joints to diagnostic dilemmas such as leukemia and juvenile rheumatoid arthritis. (more…)

Posted in: Science and Medicine

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An aspirin a day to prevent heart attacks, strokes, and cancer?

Low dose aspirin is now recommended to prevent heart disease and cancer.

Low dose aspirin is now recommended to prevent heart disease and cancer.

Despite the remarkable advances in medicine over the past 20 years, cardiovascular disease and cancer will still kill half of us. Beyond the deaths, millions survive heart attacks, strokes and cancer, but many are left with disability and a reduced quality of life. While lifestyle changes can improve our odds of avoiding these diseases, they do not eliminate our risk. Finding ways to medically prevent these diseases before they occur, a term called “primary prevention”, is a holy grail in medicine. Primary prevention can be a tough sell, personally and medically. It means taking medicine (which may cause side effects) when you’re well, with the hope of preventing a disease before it occurs.

The US Preventative Services Task Force (USPSTF) released draft guidelines on the primary prevention of cardiovascular disease and colorectal cancer last week. The USPSTF is now recommending daily aspirin in some age groups who have at least a 10% risk of cardiovascular disease in the next 10 years. This isn’t the first guideline that’s recommended aspirin for primary prevention of cardiovascular disease, but it is the first major guideline to endorse aspirin to prevent colorectal cancer. Given these recommendations will apply to millions of people, they have attracted considerable controversy. Is this strategy going to reduce deaths and disability? Or are we about to start “medicalizing” healthy people inappropriately? (more…)

Posted in: Public Health, Science and Medicine

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Here be Dragons: Caring for Children in a Dangerous Sea of sCAM

Here be dragons large map

As a pediatrician working in a relatively sCAM-inclined region, it is not uncommon to find myself taking care of patients who are also being followed by so-called alternative medicine practitioners. This often creates a major obstacle to providing appropriate care and establishing an atmosphere of mutual trust in the provider-patient/parent relationship. It usually makes me feel like I’m battling invisible serpents in a sea of sCAM.

While these double-dipping parents utilize a variety of sCAM providers, including naturopaths, homeopaths, chiropractors, and a smattering of “holistic healers”, most are taking their children to one of a few “wellness” centers near my practice where they are seen by actual medical doctors practicing so-called “integrative medicine”. Many of these children have vague, chronic, usually non-specific complaints that are difficult to explain and thus to treat. Some have behavioral and mental health problems, or neurodevelopmental conditions such as autism for which parents are seeking explanations and treatments.

What I find to be a common theme with these patients is that they and their parents are summarily taken advantage of by their alternative care providers when they are given a fictitious diagnosis and treated with a variety of useless potions, elixers, and false hopes. Often, parents bring their children to these providers because they are frustrated by their child’s chronic complaints of fatigue, pain, or other somatic issues that have eluded a satisfactory diagnosis or treatment. Invariably, the diagnosis that has remained so elusive to me is quickly found and treated by these much more “holistic” and open-minded providers. In fact, I have never seen a consultation note from one of these providers indicating any uncertainty as to diagnosis or treatment regimen. Typically a large battery of expensive, inappropriate, and sometimes outright fraudulent lab tests is ordered, often from equally questionable laboratories. Again, there are invariably interesting findings prompting tailored and bizarre treatments. In typical red-flag sCAM fashion, some of these providers have their own supplement store, available online only to their patients, prominently displayed on their website. These providers are perceived as being more holistically informed about health and wellness then “conventional” doctors like myself, as if there are two distinct ways of treating illness and maintaining health…as if there is truly such a thing as alternative medicine.

It can be very difficult to manage patients who are being simultaneously “treated” by such providers. Sometimes the treatments complicate or confuse the picture, but it always indicates a failure of trust in the “conventional” method of practice, which is science and evidence based, and in science itself.

Below are a few examples of patients cared for by my practice and simultaneously followed by alternative medicine practitioners. They provide a good picture of just how problematic these co-practitioners can be. No names or identifying information are revealed. (more…)

Posted in: Diagnostic tests & procedures, Herbs & Supplements, Naturopathy, Pharmaceuticals, Science and Medicine

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Are guidelines for calcium and vitamin D rooted in evidence, or vested interests?

B0003853 Osteoporotic bone - fully focused image Credit: Professor Alan Boyde. Wellcome Images Scanning electron micrograph of osteoporotic bone. This sample shows the 4th lumbar vertebra of an 89 year old woman with osteoporosis showing very thin, and some fractured trabeculae. This SEM image has been reconstructed from a series of images in different focal planes to give a completely focused picture of the bone. This enables a much clearer picture to be gained of the osteoclast resorption activity within the bone. The field of view is 2.7mm wide. Scanning electron micrograph Published:  -   Copyrighted work available under Creative Commons by-nc-nd 2.0 UK, see

Osteoporotic bone. Are the mainstay treatments for osteoporosis prevention, calcium and vitamin D, truly useless?

Do osteoporosis guidelines overstate the benefits of calcium and vitamin D supplements? And is their continued presence due to vested interests and conflicts of interest? That’s the provocative argument made by Andrew Grey and Marc Bolland, two endocrinologists who recently detailed their analysis in The BMJ, in a paper entitled “Web of industry, advocacy, and academia in the management of osteoporosis” [PDF]. They introduce their case by noting:

For many years, recommendations for prevention and treatment of osteoporosis have included increasing calcium intake (by diet or supplements) and use of vitamin D supplements. Since the average dietary calcium intake in most countries is much less than that recommended by guidelines, many older people are advised to take calcium supplements to prevent osteoporosis. The recommendations have been implemented successfully: over half of older Americans take calcium and vitamin D supplements, either prescribed or over the counter, and bone health is the most common specific motivation for use of nutritional supplements. However, this behaviour does not reflect evidence that has emerged since 2002 that such supplements do not reduce the risk of fracture and may result in harm. Guideline bodies also continue to recommend calcium and vitamin D supplements. Here, we argue that change is made difficult by a complex web of interactions between industry, advocacy organisations, and academia.

Osteoporosis is a medical condition for which supplements have been considered an accepted part of conventional medicine for some time. Are conflicts of interest trumping good science? And are calcium and vitamin D supplements truly useless? Like many clinical questions, there is evidence to  support a range of opinions, and it’s very  difficult to state, with certainty, that one position is the correct one. Despite this, that’s the case that Grey and Bolland make in their analysis. (more…)

Posted in: Herbs & Supplements, Science and Medicine

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The price of a naturopathic education

Editor’s Note: I’m on vacation in London and won’t be doing my regular Monday post this week. In its place, here’s another guest post from Britt Hermes of, about her extraordinary student debt from her abandoned naturopathy career. If you’re in London, join me at the London Skeptics’ Skeptics in the Pub on Monday night at The Monarch Bar at 7:30 PM! I won’t be giving a talk (I am, after all, on vacation), but after being in contact with some London skeptics I decided that this was the best way for me to meet as many SBM readers as possible without disrupting our vacation to the point where my wife would start to become irritated with me. :-) ~ Dr. David Gorski

Dr. Nick of Hollywood Upstairs Medical College

Dr. Nick graduated from Hollywood Upstairs Medical College

This morning, I checked my student loan balance from earning a doctorate in naturopathic medicine from Bastyr University. I owe a little over $333,000. Since graduation, my loans have accumulated interest while I deferred payments during my naturopathic residency and again after I quit practicing naturopathy.

To call this amount daunting or depressing is an understatement.

Since I thought an ND degree meant I’d have job prospects as a real primary care physician, I assumed I’d have no problem paying back my student loans, just like most medical doctors. I also thought I’d be eligible for federal loan repayment programs. I quickly learned, as have my former colleagues, that naturopathic doctors have dismal job prospects and earnings.

The average naturopathic doctor makes $60,000 a year in private practice. To put this in perspective, the average primary care physician income is about $186,000. Despite Bastyr insisting that naturopaths are trained as primary care physicians, their income certainly does not reflect it. (Nor does their training.)


Posted in: Science and Medicine

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(Dys-)Functional Medicine Comes to Dentistry

Now there is some functional dentistry!

Now there is some functional dentistry!

The great philosopher Deepak Chopra wrote: “I do not believe in meaningless coincidences. I believe every coincidence is a message, a clue about a particular facet of our lives that requires our attention.” So when SBM author extraordinaire Jann Bellamy emailed me last week with an article about so-called “Functional Dentistry” with the comment “Blog fodder?”, I looked it over with interest and then promptly filed it away in my brain along with other things that I might get around to doing but probably won’t. The very next day, Dr. Clay Jones – also an SBM bloggist extraordinaire – asked me if I’d mind pinch-hitting and write a blog post for his upcoming Friday morning time slot while he was away on vacation.


Personally, I find it more plausible that Jann and Clay secretly conspired to have me write this article in order to lure me into a rage spiral, than the notion that The Universe was sending me a message about a particular facet of my life that required my attention. But we are at Point B now, are we not? Regardless of whether the first domino was pushed by The Universe or by Jann and Clay, I suppose it is now incumbent upon me to share with the SBM readership yet another way where pseudo-scientific practices and deceptive branding and marketing tactics have trickled down from medicine into dentistry.

In this blog post, I will review what Functional Medicine (FM) is, what is wrong about it and what is right about it (yes, there are aspects of FM that are legitimate, if not admirable), and how it has infiltrated (some say contaminated) the field of dentistry. I think you’ll find that, when you pull back the curtains, the reality of FM as a “new and improved” medical/dental paradigm is vastly embellished and overstated, and the Great and Powerful Functional Medicine Oz is really just an old geezer pulling the levers of spin and hyperbole and pushing the buttons of pseudo-science. (more…)

Posted in: Dentistry, Science and Medicine

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Medical Theater

Me and my wife, in a very small number of years from now.  YOU KIDS GET OFF MY LAWN!

Me and my wife, in a very small number of years from now. YOU KIDS GET OFF MY LAWN!

And all the men and women merely players;

They have their exits and their entrances,

And one man in his time plays many parts,

His acts being seven ages. At first, the infant,

Mewling and puking in the nurse’s arms.

Then the whining schoolboy, with his satchel

And shining morning face, creeping like snail

Unwillingly to school. And then the lover,

Sighing like furnace, with a woeful ballad

Made to his mistress’ eyebrow. Then a soldier,

Full of strange oaths and bearded like the pard,

Jealous in honor, sudden and quick in quarrel,

Seeking the bubble reputation

Even in the cannon’s mouth. And then the justice,

In fair round belly with good capon lined,

With eyes severe and beard of formal cut,

Full of wise saws and modern instances;

And so he plays his part. The sixth age shifts

Into the lean and slippered pantaloon,

With spectacles on nose and pouch on side;

His youthful hose, well saved, a world too wide

For his shrunk shank, and his big manly voice,

Turning again toward childish treble, pipes

And whistles in his sound. Last scene of all,

That ends this strange eventful history,

Is second childishness and mere oblivion,

Sans teeth, sans eyes, sans taste, sans everything.

As You Like It, Act II, Scene VII

This summer my wife and I have been transitioning somewhere between stage 5 and 6. My eldest left Tuesday for law school in Boston and my youngest leaves for college next week in LA. So we will soon be empty nesters. As part of the change we have been making a point of going out, to dinners, bars, concerts and theater. (more…)

Posted in: Science and Medicine, Science and the Media, Vaccines

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The Woo Boat, or: How far Andrew Wakefield has fallen

Sadly, this is not the crew of the Woo Boat, which is not the Love Boat. It would be awesome if that were the case, but it's not. I wonder if they'll be letting the astrologist navigate. The trip might end up being longer than expected.

Sadly, this is not the crew of the Woo Boat, which is not the Love Boat. It would be awesome if that were the case, but it’s not. I wonder if they’ll be letting the astrologist navigate. The trip might end up being longer than expected. Oh, and I couldn’t resist crossposting this from another blog because this is so damned hilarious.

File this one under the category: You can’t make stuff like this up. (At least, I can’t.)

Let’s say you’re a diehard all-conspiracy conspiracy theorist and alternative medicine believer (a not uncommon combination). You love Alex Jones and Mike Adams and agree with their rants that there is a New World Order trying to suppress your rights. You strongly believe that vaccines not only cause autism, sudden infant death syndrome, a shaken baby-like syndrome, autoimmune diseases, premature ovarian failure, and even outright death, but are a depopulation plot hatched by Bill Gates and the Illuminati who support his agenda. Heck, you even believe that black helicopters are keeping an eye on those who have discovered this plot. To you, genetically modified organisms (GMOs) are part of the same plot, pure poison and pure evil. And, of course, you just know that there is a cure for cancer—nay, cures for all diseases—out there but those evil pharmaceutical companies are keeping them from the people, the better to bolster their profits, just as they are preventing Brave Maverick Doctors like Andrew Wakefield, Mark Geier, and Sherri Tenpenny from telling the world the truth about vaccines. Heck, you just know that these same nefarious forces are even going so far as to kill vaccine “skeptic” heroes like Jeff Bradstreet (and, of course, make it look like a suicide) and holistic “pioneers” like Nicholas Gonzalez (and make it look like a heart attack).

And you like cruises.

So where do you go when you want to go on a cruise? Normal cruises are filled with people who just want to have a good time and tend to roll their eyes when you regale them with your ideas about how there is a shadowy conspiracy out there that is promoting toxic pharmaceuticals and vaccines and preventing natural cures from being used by the people, while simultaneously promoting GMOs to make people sick so that they think they need more of those pharmaceuticals and vaccines and more pliable so that their New World Order agenda faces less opposition. By the time you get to how they’re also using chemtrails as another means of control, AIDS is not caused by HIV, and Ebola can be cured with homeopathy, in other words, by the time you’ve been on the cruise a couple of days, you’ll find yourself basically shunned, eating alone at dinner, and drinking alone at the bar. When you sit down at a table, everyone suddenly finds a reason to be elsewhere.

Fear not! There is now a cruise for you. See the Conspira-Sea Cruise next January, embarking in Los Angeles and taking you on a cruise through the Mexican Riviera:

Posted in: Science and Medicine

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