Archive for Science and Medicine

No, Purell Does Not Breed Super-Anything

Pictured:  Mechanism of pumpy doom, or savior to us all?  Neither!

Pictured: Superbug spawner, or savior to us all? Neither!

Recently, I was sitting in a meeting and reached for the dispenser of Purell hand sanitizer sitting on the conference room table. A colleague of mine gave a small, rueful shake of her head to the person on her other side. Apparently I had erred. I asked what was the matter, and got a brief answer to the effect of “because superbugs.” We exchanged nothing more about it; the interaction was over before the alcohol had dried from my hands.

I wouldn’t have thought anything of such an interaction with anyone else, but my colleague is a PhD student in immunology, six years older and more schooled than I, doing her doctoral research in a lab run by a physician-scientist — a specialist in infectious disease, no less. A touch ironic.

And so I noticed a need for some mythbusting: alcohol-based hand sanitizers do not breed resistant bacteria. (more…)

Posted in: Epidemiology, Evolution, Public Health, Science and Medicine

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Announcing: Video Lecture Course on Science-Based Medicine

A couple of years ago, the James Randi Educational Foundation commissioned me to develop a series of 10 video lectures on Science-Based Medicine. After a lot of work and many vicissitudes, it has finally gone live on YouTube. The lecture titles are:

  1. Science-Based Medicine vs. Evidence-Based Medicine
  2. What Is CAM?
  3. Chiropractic
  4. Acupuncture
  5. Homeopathy
  6. Naturopathy and Herbal Medicine
  7. Energy Medicine
  8. Miscellaneous “Alternatives”
  9. Pitfalls in Research
  10. Science-Based Medicine in the Media and Politics

The series is accompanied by a Course Guide that can be downloaded as a pdf.



Posted in: Announcements, Science and Medicine

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American Academy of Family Physicians Home Study Course Recommends Non-Science-Based Treatments


Strong medicine…along with a little nonsense

Since passing my board exams in family practice in 1979 I have relied heavily on the American Academy of Family Physicians for continuing medical education via the American Family Physician and the AAFP home study programs. The AAFP prides itself on its evidence-based approach to medicine. In general, it delivers. But the recent FP Essentials Number 432 on “Chronic Pain Management” fell short. It recommended treating chronic pain with acupuncture, chiropractic, touch therapy, and S-adenosyl methionine (SAM-e), presenting them in a way that misled readers into thinking that the recommendations were based on good scientific evidence. They were not.

With 6,500 peer reviewed journals and over two million papers published every year, it is easy to find a study to support pretty much any point of view. John Ioannidis taught us that most published research findings are false, with preliminary studies frequently being overturned by larger, better follow-up studies. When evaluating the evidence for a treatment, it is not enough to find one or two positive studies. It is essential to also look for negative studies and for systematic analyses that weigh all the published evidence, and to put all the available evidence into perspective. The authors failed to do that. (more…)

Posted in: Science and Medicine

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Separating Fact from Fiction in Pediatric Medicine: Ear Infections


Please don’t try chiropractic first, or at all, for any pediatric condition

As discussed numerous times on the pages of Science-Based Medicine, children are increasingly a target of chiropractors, with some even pushing for recognition as primary care practitioners. Despite a thoroughly inadequate training, and a lack of experience with ill pediatric patients, they believe that they have what it takes to recognize and manage common pediatric conditions or refer to an actual pediatric medical professional when they deem it appropriate. While a significant percentage of pediatric illness is self-limited, and thus might appear to respond to chiropractic manipulation, I have seen many deteriorate quickly and with little warning. The idea of an ill child suffering at the hands of a charlatan is terrifying.

Many chiropractors are of course more than happy to see pediatric patients without acting as their PCP. They love to claim that children are at risk of developing misalignment of the bones of the skull and spine, chiropractic subluxations, and numerous other conditions unique to alternative medical reality, particularly during the first few years of life. They tell caregivers that these insults can be subtle, or even silent for years, and that regular maintenance care is required to prevent severe problems, even going so far as to blame SIDS and “shaken baby syndrome” on these fictional entities.

Many chiropractors are also quick to claim that they can prevent or cure some of the most common conditions seen by pediatricians and family healthcare providers, such as viral infections of the upper respiratory tract, asthma, bedwetting, and ear infections to name just a few. By simply improving the function of the nervous system, chiropractors believe that they can “boost” the immune system’s ability to fight infections, improve control over bladder function, and even reduce airway inflammation and bronchoconstriction. If you think that sounds like nonsense, you’re right!


Posted in: Science and Medicine

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On “integrative medicine” and walking and chewing gum at the same time

Walk and chew gum at the same time

I didn’t think I’d be discussing Dr. David Katz again so soon. In fact, when Mark Crislip (who clearly hates me, given how often he sends me links to articles like this) sent me a link to Dr. Katz’s latest article, “Cleaning the House of Medicine“, published—where else?—in The Huffington Post, that home for “reputable” quack-friendly bloviation since 2005, when I first read the article, my first reaction was that Katz must surely be trolling us here at SBM. At first, I wasn’t going to respond to him again. However, Katz’s article represents a very common misconception about science-based medicine that is worth refuting. It is not my intention to be arguing back and forth with Dr. Katz every couple of weeks, but I did think it worth one more round. I think you’ll understand why by the end of this post.

First, however, a brief recap is in order for readers who might not have been following the discussion over the last month or so. It all started a couple of weeks ago, when Jann Bellamy, in response to a special issue of the American Journal of Preventative Medicine edited by Katz and dedicated to making the case for integrative medicine in preventive medicine training, quite correctly discussed how “integrative medicine” is always all about the “potential.” Indeed, after having spent considerable sums of federal grant money studying the “integration” of pseudoscience into medicine with respect to preventive care, the journal couldn’t come up with any concrete examples how integrative medicine adds anything (other than quackery) to medicine. Dr. Katz, who is well-known in the world of quackademic medicine for his infamous 2008 speech in which he asserted that physicians need to use a “more fluid concept of evidence” in evaluating treatments, particularly “complementary and alternative medicine” (CAM), responded with another HuffPo article entitled “Science and Medicine, Fools and Fanatics: The ‘Fluidity’ of Woo“. In lieu of reasonable, science-based arguments, Dr. Katz’ article was little more than a rant that consisted mainly of outrage that mere mortals lacking his awesome academic credentials had had the temerity to question his awesomeness and dedication to science coupled with an accusation that we are just too rigid and simplistic in our thinking to understand the subtle complexities of how different standards of evidence must be applied to complex patients. Steve Novella and I both responded that we understand just fine, explained how doctors do this all the time without using quackery like naturopathy and homeopathy (both of which Katz has advocated), and pointed out his argumentum ad ignorantiam with respect to energy medicine.

There’s where I thought it would end. Unfortunately, I was mistaken. On Friday, Katz launched another broadside at us, couched in the form of an argument that medicine must “clean its own house” before worrying about his quackademic medicine. It’s something I hear often enough that I thought it would be worth responding to, even if Dr. Katz was indeed trolling us.

Posted in: Critical Thinking, Medical Academia, Science and Medicine, Surgical Procedures

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Matt Ridley’s not-so-mythical “myth” of basic science

Matt Ridley: Specious arguments against government research funding.

Matt Ridley: Specious arguments against government research funding.

I’m a clinician, but I’m actually also a translational scientist. It’s not uncommon for those of us in medicine involved in some combination of basic and clinical research to argue about exactly what that means. The idea is translational science is supposed to be the process of “translating” basic science discoveries in the laboratory into medicine, be it in the form of drugs, treatments, surgical procedures, laboratory tests, diagnostic tests, or anything else that physicians use to diagnose and treat human disease. Trying to straddle the two worlds, to turn discoveries in basic science into usable medicine, is more difficult than it sounds. Many are the examples of promising discoveries that appeared as though they should have led to useful medical treatments or tests, but, for whatever reason, didn’t work when attempted in humans.

Of course, if there’s one thing that the NIH and other funding agencies have been emphasizing, it’s been “translational research,” or, as I like to call it, translation über alles. Here’s the problem. If you don’t have basic science discoveries to translate, then translational science becomes problematic, virtually impossible even. Translational research depends upon a pipeline of basic science discoveries to form the basis for translational scientists to use as the starting point for developing new treatments and tests. Indeed, like many others who appreciate this, I’ve been concerned that in recent years, particularly with tight budgets, the NIH has been overemphasizing translational research at the expense of basic research.

Posted in: History, Politics and Regulation, Science and Medicine

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Everything you always wanted to know about fermented foods 

Delicious homemade Kimchi (fermented cabbage). It's alive!

Delicious homemade Kimchi (fermented cabbage). It’s alive! Click for a closer look.

Fermented foods, such as sauerkraut and kombucha, have become popular for health reasons. I have made my own sauerkraut in the past and have recently made the tasty, fermented Korean side dish, kimchi. I did it not only for the taste but also for the hope that the bacteria responsible for the fermentation of the cabbage — lactic acid bacteria (LAB) — would contribute to the diversity of my gut microbiota.

As a research scientist in the field of bacterial pathogenesis, this made sense to me. Now that I have started blogging about health and fitness and have been writing more in depth articles about health related topics, I started wondering what research has been done on the health benefits of fermented foods. Can the bacteria in fermented foods even survive the harsh conditions of the human gastrointestinal (GI) tract, particularly the stomach?

I was amazed to learn that the fermentation of food has been used by humans for thousands of years as a way to preserve foods, and that the health benefits go beyond their microorganisms (don’t worry, citations are provided below). The fermentation process enhances the nutritional quality of food by contributing beneficial compounds such as vitamins, and by increasing the bioavailability of minerals. Probiotics, including those found in kimchi, have a range of positive effects on health, including the improvement of various intestinal inflammatory conditions, positive impacts on the immune system and even weight loss, and can alter the composition of the gut microbiome.

However, these effects mostly depend on whether the bacteria actually make it in sufficient numbers to the colon. And let me tell you, the journey to the colon is one harsh and dangerous ride!


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

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Whole Body Cryotherapy


Last week a Hawaiian woman living in Las Vegas, Chelsea Ake, was found dead in a cryotherapy chamber where she works. Apparently she was using the chamber unsupervised and accidentally locked herself in or passed out, and was found 10 hours later. Her death, of course, is tragic and we have nothing but sympathy for her and her family.

The event, however, was the first time many people heard of whole body cryotherapy (WBC) and prompted many questions. Three months ago Zachary Hoffman published a guest post on SBM about cryotherapy, showing that the science is just not there. He focused mainly on using ice packs to treat sprains and sports injuries (which is surprisingly not evidence-based, but also perhaps not unreasonable), I am going to focus on using WBC for general health.

What is whole body cryotherapy?

As is often the case, perfectly legitimate or perhaps preliminary medical procedures are hijacked by entrepreneurs and hyped into a bogus “spa” therapy, snake oil, or medical device. Preliminary evidence or legitimate uses are then used to justify the pseudoscientific extrapolations. Stem cells are a legitimate area of medical research, but I would not go to a stem cell clinic in China to treat your ALS.


Posted in: Science and Medicine

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The Time a Pulitzer Prize Winning Journalist Got Manipulated by a Chiropractor


You have WiFi allergy, chronic Lyme, multiple chemical sensitivity, and menopause!

Katherine Ellison won a Pulitzer Prize in 1985, not for science journalism but for coverage of the monetary mayhem perpetrated by Ferdinand and Imelda Marcos on the people of the Philippines. I was nine at the time and have little recollection of the impact of her work, but I will assume that it was meaningful in light of the award. And she went on to win numerous additional accolades for her writing on politics, economics, and human rights.

Her most recent work, “Chiropractic Care Grows, and Gains Acceptance“, will likely not be considered for any journalism awards. The article, published on the New York Times Health and Wellness blog, reveals a terribly flawed understanding of chiropractic practice and philosophy and a preternatural ability to interpret fleecing at the hands of an obvious quack as a positive experience. She displays few if any signs of an ability to think critically when it comes to medicine and gives no indication of having done more than cursory research on the subject of chiropractic.

Sometimes the apple does fall far from the tree

The inspiration for Ellison’s article was a trip to the chiropractor after having injured her tail bone during a spin class. She does this despite having grown up with a surgeon father who apparently did not think highly of “alternative healers,” particularly chiropractors. Right off the bat she brings up the history of the AMA’s stance on the chiropractic profession:

Of course, this was in the 1960s, when the American Medical Association was still waging war on the profession via its Committee on Quackery, which labeled chiropractors as an “unscientific cult.”


The A.M.A.’s Committee on Quackery is long defunct, having gone out of existence after a lawsuit by chiropractors led to a 1987 federal district judge’s ruling that the medical association had tried to destroy the chiropractic profession.

Well, not exactly. The AMA absolutely was vehemently opposed to chiropractic and its practitioners and, as Dr. Harriet Hall describes, they are far from beyond reproach in the methods they used. In fact, I think you would be hard pressed to find anyone that would defend their tactics today. But the Committee on Quackery actually disbanded in 1974, two years prior to the filing of the infamous Wilk v. AMA antitrust lawsuit and at a time when all 50 states were licensing chiropractors. Louisiana, as backwards as my home state can be when it comes to science and medicine, was the last to give in that same year.


Posted in: Science and Medicine, Science and the Media

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Naturopathy vs. Science: Diabetes Edition

Diabetes Mellitus
Does naturopathy offer something special or uniquely effective for the treatment of diabetes? Naturopaths are alternative medicine practitioners who claim to provide primary care, like medical doctors. Among naturopaths and their supporters, it’s regularly claimed that naturopathy offers something that “conventional” medicine does not: Naturopaths are described as “doctors plus”, using unconventional approaches to coax the body to “heal itself” with methods that are claimed to be safer and more effective than conventional drugs and medical interventions. The superiority of naturopathy over conventional medicine is an argument that showed up in the comments to my last post, when I pointed out that this year’s Nobel Prize in Physiology or Medicine failed to validate either naturopathy or herbalism. Here’s one example:

Someone diagnosed with pre-Type 2 diabetes could visit a Naturopathic Doctor and stop the disease in its tracks. The doctor would recommended a simple diet change to a high-fat, low-carb, zero refined sugar diet, maybe some supplements, and exercise. Bye, bye, Type 2 diabetes. The same person could visit an MD, and before you know it would be taking insulin and Metformin (and other horrible drugs) for the rest of his or her life. An added bonus with the insulin is weight gain. Notice that the diabetes commercials feature overweight actors and actresses? Yes, there are natural cures. Is this is a site promoting good health, or is it a front for the pharmaceutical companies?

You can follow the comment thread for the discussion that followed. The same commenter continued in Mark Crislip’s post on Friday about the difference between naturopathy and conventional medicine:

Allopath – you will be taking insulin, Metformin and other drugs for the rest of your life. Your diabetes will be managed, but there will be a slow deterioration in the quality of your life.

Naturopath – we can reverse this with a change in your diet, along with exercise.

Naturopath wins.

Now this individual never claimed to be a naturopath – but testimonials like these are not surprising. I’ve written several posts in the past about the claims made by naturopaths, and how they stack up against the scientific evidence. Naturopaths offer an array of disparate health practices like homeopathy, acupuncture and herbalism that are linked by the (now discarded) belief in vitalism – the idea we have a “life force”. From this philosophy can sometimes emerge sensible health advice, but not because naturopaths are following the evidence. As long as a treatment is viewed as being congruent with the naturopathic belief system, it’s acceptably “naturopathic”. In past posts I’ve looked at the naturopathic perspectives on fake diseases, infertility, autism, prenatal vitamins, vaccinations, allergies, and even scientific facts themselves. Britt Hermes is a former naturopath and has written extensively about naturopathy from the perspective of an insider, and her evaluation is scathing: There are no naturopathic standards of care, naturopathic training is much different than what naturopaths purport, and the accreditation of naturopathic schools is questionable. Now, diabetes is a widely prevalent chronic disease. It causes a huge burden of illness on society. And while we have a fair understanding of its causes and how to treat it, there are still far too many people suffering from complications of the disease. Diabetes already requires care from multiple medical professionals, including physicians, nurses, dietitians, and pharmacists. Should naturopathy be included? Is there any evidence that demonstrates that naturopathy can “stop” diabetes? And how does advice from a naturopath differ from “conventional” medical advice? (more…)

Posted in: Naturopathy, Science and Medicine

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