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Archive for Science and Medicine

Psychology Journal Bans Significance Testing

p-valuesThis is perhaps the first real crack in the wall for the almost-universal use of the null hypothesis significance testing procedure (NHSTP). The journal, Basic and Applied Social Psychology (BASP), has banned the use of NHSTP and related statistical procedures from their journal. They previously had stated that use of these statistical methods was no longer required but can be optional included. Now they have proceeded to a full ban.

The type of analysis being banned is often called a frequentist analysis, and we have been highly critical in the pages of SBM of overreliance on such methods. This is the iconic p-value where <0.05 is generally considered to be statistically significant.

The process of hypothesis testing and rigorous statistical methods for doing so were worked out in the 1920s. Ronald Fisher developed the statistical methods, while Jerzy Neyman and Egon Pearson developed the process of hypothesis testing. They certainly deserve a great deal of credit for their role in crafting modern scientific procedures and making them far more quantitative and rigorous.

However, the p-value was never meant to be the sole measure of whether or not a particular hypothesis is true. Rather it was meant only as a measure of whether or not the data should be taken seriously. Further, the p-value is widely misunderstood. The precise definition is:

The p value is the probability to obtain an effect equal to or more extreme than the one observed presuming the null hypothesis of no effect is true.

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Posted in: Basic Science, Clinical Trials, Science and Medicine

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Placebo, Are You There?

By Jean Brissonnet, translation by Harriet Hall

Note: This was originally published as “Placebo, es-tu là?” in Science et pseudo-sciences 294, p. 38-48. January 2011. It came to my attention in the course of an e-mail correspondence with the editors of that magazine, where one of my own articles was published in French translation in January 2015. I thought this was the best explanation of placebo that I had ever read. It covers the same points my colleagues and I have addressed and more. It describes the pertinent research and uses particularly effective graphs to illustrate the principles (a picture is worth a thousand words). The author, Jean Brissonnet, kindly gave his permission for me to translate it and share it with our readers.


In fact, you don’t need to give a placebo to get a placebo effect and therefore we can now think about how we can maximize the placebo component of routine care.

~ Damien Finniss, 2010

The scene takes place in a surgical suite where they are preparing to do a cataract operation. The patient is lying on the operating table. A few minutes earlier the anesthetic gel was applied to the cornea to permit an operation under simple local anesthesia. The surgeon arrives in the company of the anesthetist. They are engaged in a spirited discussion and don’t seem to be agreeing.

“It has been proven,” says the surgeon, “that 30% of the action of a medical treatment is due to the placebo effect.”

“I doubt that,” retorts his interlocutor, “I think that placebo story is one of those medical myths on a par with the idea that we only use 10% of our brain, that nails and hair grow after death, or that cellphones create interference in hospitals.”[1]

“No,” insists the surgeon with a superior tone, “the fact is established and has been proven by numerous studies.”

The anesthetist shakes his head with a slight smile, but he doesn’t reply. As for the patient, who might have much to say on the subject, he keeps quiet, because it would not be prudent to argue with someone who is about to suck the lens out of your eye.

This true anecdote would not be of interest if it didn’t concern two members of the medical profession. Why such uncertainty? Why such lack of knowledge about such a fundamental subject? This faith in an all-powerful, magical, and mysterious placebo is common among the general public and it serves as justification for resorting to unconventional medicines that have never been able to show solid proof of efficacy; but we see that it still persists among the medical profession.

To know whether the placebo effect is real or should be relegated to the same category as poltergeists, it will help to go back in history.

cartoon

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Posted in: Clinical Trials, Science and Medicine

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Traditional Chinese Pseudo-Medicine Hodgepodge

Qing Dynasty (1662-1722) painting, traditional Chinese medical view of the human viscera from the back.  Image L0039962 from the Wellcome Trust image library, via the Wikimedia Commons.

Qing Dynasty (1662-1722) painting, traditional Chinese medical view of the human viscera from the back. Image L0039962 from the Wellcome Trust image library, via the Wikimedia Commons.

As I have noted before, more is published on acupuncture and traditional Chinese pseudo-medicine than the other SCAM. Here are some of the articles that drew my attention.

Captain Hook and acupuncture

Here is one of the more curious articles on acupuncture I have yet to find, “Psychophysical and neurophysiological responses to acupuncture stimulation to incorporated rubber hand.”

I did not know this, but you can fool a person into thinking that a rubber hand is their own.

The synchronous tactile stimulation of the real hand of an individual and rubber hand leads to the feeling that the rubber hand is incorporated with the body of that individual. This is referred to as the rubber hand illusion (RHI), and it occurs because the brain is attempting to interpret the interaction of the visual, tactile, and proprioceptive systems of the body, which in turn, leads to a re-calibration of the touch and the felt position of the hand. The multimodal visuotactile stimulation inherent in the RHI induces the brain to temporarily incorporate external objects into its body image. In addition, when the experimenter threatens the rubber hand with a needle during this illusion, it generally elicits an enhanced sympathetic response and a measurable cortical anxiety response, which indicates that the bodily ownership of the rubber hand causes changes in the interoceptive system of the brain.

Cool. Check out this video to see how it is done. So what happens when you do acupuncture on a rubber hand that the brain thinks is its own?

The findings of the present study clearly demonstrate that acupuncture stimulation to a rubber hand resulted in the experience of the DeQi sensation when the rubber hand was fully incorporated into the body.

As judged by fMRI findings (always taken with a grain of salt substitute) and patient reports. DeQi is what dey feel when de needle is twirled in de skin. (more…)

Posted in: Acupuncture, Science and Medicine, Traditional Chinese Medicine

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Reporting Research Misconduct

Perhaps one of the greatest threats to the enterprise of Science-Based Medicine is research fraud and misconduct. Rigorous research methods can be used to minimize the effects of bias, but when those methods themselves are the problem there is no easy fix. Related to this is the need for transparency. When fraud or misconduct is uncovered it erodes confidence in the system because it provokes speculation about how much fraud and misconduct has not been uncovered.

A recent study published in JAMA looks at one aspect of this issue – reporting of misconduct uncovered by the FDA. The good news here is that FDA trials, those that will be used to apply to the FDA for approval of a drug, are carefully monitored and inspected by the FDA. This is an important quality control measure. When the FDA uncovers misconduct it takes steps to correct it. If the misconduct is severe enough then any data that is associated with the poor research practices will be excluded from the trial so as not to taint the results. Even an entire study can be disqualified if necessary.

The problem highlighted by the study is that there is no systematic way for the FDA to communicate its findings through the peer-reviewed literature. Tainted studies, or ones that require a correction or retraction (because the violations were discovered after publication) may therefore persist in the peer-reviewed literature without any indication of the uncovered misconduct.

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Posted in: Science and Medicine

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Hot-Zone Schools and Children at Risk: Shedding light on outbreak-prone schools

The subject of parental vaccine refusal and the impact that has on disease outbreaks has been covered many times on SBM and elsewhere. I apologize to our readers who are growing tired of the subject, but there is perhaps no subject more deserving of focus and repetition. There’s also an important angle to the discussion that I’ve written on previously and which deserves more attention, and that is the importance of the pro-vaccine parent voice, and the need for that voice to be heard.

It never ceases to amaze me how few of the parents I know think about the risk to their own children from vaccine-exempt children in their schools and communities. Even parents who do think about this rarely seem concerned enough to speak up or even discuss it with others, let alone become active in doing something about it. With the rise in vaccine-preventable disease outbreaks, including the current high-profile Disneyland measles outbreak, and the ongoing pertussis epidemic in California, the tide seems at least to be turning slightly. The dramatic impact that vaccine refusal and the resultant decline in herd-immunity can have on a community is now penetrating the public consciousness. My hope is that parental awareness and outrage grow regarding the flagrant disregard of science, common sense, and citizenship exhibited by those parents who refuse to properly vaccinate their children. My hope is that the culture of tolerance of this intolerable anti-science threat begins to turn, and that it is no longer seen as acceptable for some parents to put the safety of others at risk.

Which brings me to the focus of this post. (more…)

Posted in: Epidemiology, Legal, Public Health, Science and Medicine, Vaccines

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Are skin-lightening glutathione injections safe and effective?

A Toronto naturopath’s advertisements were recently criticized on social media for insensitivity and racism:

Glutathione Advertisement TTC Jean-Jacqques Dugoua

Picture used with permission of @emilyknits

Naturopath Jean-Jacqques Dugoua sells glutathione injections, claiming it will give “brighter, lighter and glowing skin”. His URL, lightnaturalskin.com seems to imply that lighter skin is more natural, and he claims the following:

After over 3 years of treating patients for skin concerns, Dr. JJ has developed the Skin Brightening IV, which includes glutathione, vitamin C and other vitamins/minerals. Not only is this treatment effective for most people, it is also safe. The Skin Brightening IV glutathione is a good alternative to skin bleaching creams, which can damage, scar, inflame, discolour or irritate the skin, or microderm abrasion, which is painful and may also irritate the skin and sometimes worsen hyper-pigmentation.

This safe and natural treatment involves principally the use of intravenous (IV) vitamins (excluding vitamin A), minerals and amino acids, including glutathione. All ingredients are regulated by Health Canada and obtained from pharmacies or pharmaceutical companies in Canada or the United States. The treatment is performed in compliance with licensure in Ontario.

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Posted in: Science and Medicine

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Does a Common Treatment for Childhood Constipation Cause Autism?

constipatedkid

Last week an article published by the New York Times entitled “Scrutiny for Laxatives as a Childhood Remedy” made the rounds. The article raised the question of a possible link between the use of a popular over-the-counter laxative, PEG (polyethylene glycol) 3350, and neurological or psychiatric problems in children. This wasn’t the first time this particular journalist wrote a piece on this topic, however. In 2012, she wrote about the popularity of the treatment among pediatricians despite a lack of FDA approval for use by children, a fact which applies to many if not most of the drugs commonly prescribed by pediatricians. (more…)

Posted in: Science and Medicine

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Skeptic’s Guide to Debunking Claims about Telomeres in the Scientific and Pseudoscientific Literature

The New Year starts with telomeres as the trendiest of trendy biomarkers. As seen in Time, telomeres are the means to monitor our well-being so we can protect ourselves from all sorts from threats, including early death.

A skeptic needs to do considerable homework in order to muster the evidence needed to counter the latest exaggerated, premature, and outright pseudoscientific claims about telomere length being a measure of “cellular aging” and therefore how long we’re going to live.

a-telomere-006

What is a telomere and why does its length matter?

Harriet Hall recently described telomeres:

Every chromosome has a telomere, a repeated sequence of nucleotides at the end of the DNA strand. It is a disposable section that carries no genetic information. For vertebrates, the nucleotide sequence is TTAGGG; this repeats from 300 to several thousand times according to the species of animal. Telomeres are sort of like the aglet, that little hard piece on the end of a shoelace that keeps it from unraveling. They protect the end of the chromosome and keep it from losing important genes or sticking to other chromosomes.

By Ian W. Fieggen (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Telomeres are sort of like aglets. Photo by Fieggen CC BY-SA 3.0 via Wikimedia Commons

Talk of telomeres isn’t just being used to sell dubious diagnostic tests and dietary supplements. There is a strong push to make telomere length the currency of how we think, measure, and do science about our health and well-being, and how we target our health interventions. Strong efforts are made to attach the science of telomeres to urgings that we take up yoga, meditation, and “being there” to save our lives.

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Posted in: Basic Science, Nutrition, Science and Medicine, Traditional Chinese Medicine

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Neuroscience and Destiny

brainA newly-published review of neuroscience research looking at the predictive value of functional and anatomical imaging raises interesting questions about the role of such studies in learning, psychiatric treatment, and even the treatment of criminals. “Prediction as a Humanitarian and Pragmatic Contribution from Human Cognitive Neuroscience” by Gabrieli, Ghosh, and Whitfield-Gabrieli and published in Neuron, does a thorough job of explaining the current state of the research and pointing to where future research is needed.

The basic idea is to use noninvasive imaging to look at the structure or function of the brain as a way of predicting future behavior, and then using those predictions to help guide treatment and education interventions, and perhaps decisions regarding parole or further treatment of criminal behavior. This concept raises many issues, including the technology being used, the state of the research, the ultimate potential for this line of research, and ethical considerations.

The major question underlying this entire endeavor is, to what extent is brain anatomy and function destiny? (more…)

Posted in: Science and Medicine

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Is the Ebola Crisis a Reason to Skip RCTs?

Ebola virus

 

In a recent “Perspective” article in The New England Journal of Medicine, three physicians (Drs. Cox, Borio, and Temple) make a strong case for not letting the rush to save Ebola patients tempt us to deviate from good science and skip the randomized controlled trial (RCT). Their arguments cut to the essence of the scientific approach to medicine, and they deserve careful consideration.

Ebola is uniquely scary

Ebola is the kind of threat that really gets our attention. The virus was first identified in 1976, and prior to 2013 there were several small outbreaks in Africa with death rates as high as 90%. This time the death rates are lower, but the numbers are much greater. It has spread to several African countries, and a few cases have even reached the US and Europe due to infected travelers and health care workers. We face a risk that Ebola may become endemic, smoldering along as a constant presence in Africa.

There is no known effective treatment. Fear of Ebola has sparked bizarre conspiracy theories and claims of “natural” cures and prevention kits from homeopaths, alternative medicine advocates like Mercola, and purveyors of remedies like colloidal silver and essential oils. These have been covered on SBM here, here, and here. (more…)

Posted in: Clinical Trials, Science and Medicine

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