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A Final Word: On T-Shirts and Teapot Tempests

I wore a T-shirt at The Amazing Meeting 2012 that generated a lot of controversy. You can see a picture of it on my Wikipedia article.  I didn’t want to talk about the T-shirt, but I’ve been repeatedly challenged to explain myself, and I’m afraid I can no longer avoid it. Steven Novella has recommended that we try to give other people’s arguments the most charitable interpretation. I hope my critics will do that, but I’m not optimistic. If past experience is any guide, they will misinterpret my explanation and put it in the worst possible light, which is why I haven’t offered it before. So be it; I have a tough skin. Once this T-shirt explanation is out of the way, I will have done my duty and had my say and will feel free to ignore all these divisive and nonproductive arguments. I don’t plan to write about gender or feminism or the squabbles in the skeptic movement again.

First, a brief digression about charitable interpretations and the whole “queer” discussion. I said “most” people in the LGBT community find the term offensive. Instead of attacking me as totally clueless, a charitable reader might have gently corrected me by providing quantitative evidence that the majority of people in the LGBT community do not find the word offensive (so far, no one has provided such evidence). When shown quantitative evidence, I would gladly have changed the word “most” to “many” or “some” or even “a few,” depending on the actual numbers, and we would all have learned something. What actually happened served as a perfect illustration of the points I made in my “Enemies” article. The ensuing discussion was bizarre, nit-picking, surreal, divisive, unproductive, and failed to emphasize the one thing we ought to all agree on: we don’t want to use labels that others find offensive.  The silly quibbling about my use of the one word “most” just derailed the discussion from the more important issues, and from all the other words in my post.

To set the scene for the T-shirt incident, there was a complex backstory involving Elevatorgate, Richards Dawkins, insults and threats directed at women, a perception that TAM’s anti-harassment policy was not being enforced, objections to a statement JREF President DJ Grothe made, accusations that Grothe had lied about reports of harassment, and numerous other incidents, many of which were blown way out of proportion. All this had left big chips firmly glued to shoulders. (more…)

Posted in: Science and Medicine

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I Am Not Your Enemy: An Open Letter to My Feminist Critics

Note: The previous post is my usual weekly contribution to SBM. I am taking the liberty of posting this additional entry today on an issue that is peripheral to Science Based Medicine. If you are not interested in the recent squabbles within the skeptical movement, you will probably want to skip it. But it does respond to a detailed critique of an article I posted here two weeks ago, and some might find that of interest. We have seen the same kind of behavior on this blog, where commenters have responded not to what we said, but to what they wanted to believe we said.

 


 

I have been falsely identified as an enemy of feminism (not in so many words, but the intent is clear). My words have been misrepresented as sexist and misinterpreted beyond recognition. I find this particularly disturbing and hard to understand, because I’m convinced that my harshest critics and I are basically arguing for exactly the same things. I wish my critics could set aside their resentments and realize that I am not the enemy.

Two weeks ago I published an article on gender differences and the recent divisions in the skeptical community.  Ophelia Benson showed up in the comments. Not unsurprisingly, she disagreed with me about the Shermer incident, but then she said “I like the rest of this article a lot. I particularly like the point about averages and individuals, which is one I make all the time.”

I took that as a hopeful sign that friendly communication might be achieved, but my bubble was quickly burst by a hostile takedown of my article on Skepchick by “Will.”  His critique is demonstrably unfair. He attacks me for things I never said and tries to make it look like I believe the exact opposite of what I believe.

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Posted in: Science and Medicine

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Sex, Gender, and Sexuality: It’s Complicated

When a baby is born, the obstetrician or midwife announces “It’s a boy” or “It’s a girl.” As toddlers, children learn to classify everyone as either boy or girl. When our firstborn was very young, we overheard her talking to herself as she grappled with the concept:

Let’s see… I’m a girl, and Kimberly [her baby sister] is a girl, and Mommy’s a girl… but Daddy’s not a girl… He’s a boy. [Pause followed by exasperated sigh] Cause he doesn’t know any better!

As with most things in science, the concept of boy versus girl is more complicated than it appears at first glance. It’s not a simple dichotomy. We humans like to classify everything into neat pigeonholes, but Nature’s inventiveness outsmarts us at every step.

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Picking Cherries in Science: The Bio-Initiative Report

by Kenneth R. Foster & Lorne Trottier

Science-based medicine is great, but it all depends on how you evaluate the scientific evidence. A bad example is the  BioInitiative Report (BIR), an egregiously slanted review of health and biological effects of electromagnetic fields (EMF) of the sort that are produced by power lines, cellular telephones, Wi-Fi, and other mainstays of modern life. When first released in 2007, the BIR quickly became a key document used by anti-EMF activists in their various campaigns. Early in January 2013, the BIR appeared in a major update, to extensive media coverage.

The BIR concerns possible biological effects and health hazards of electromagnetic fields in two very different frequency ranges: at extremely low frequencies ELF’s of the sort emitted by power lines and appliances, and at radiofrequencies (RFs) of the sort that are transmitted by mobile phones, Wi-Fi and a host of other technologies. Both ELF and RF fields (which are subsumed under the more general EMF) are part of the electromagnetic spectrum, which includes infrared energy, light, ultraviolet energy, as well as X-rays.

ELF and RF fields are nonionizing, in that the energy of their photons is far too low to break chemical bonds, an effect that makes ionizing radiation such as X-rays so hazardous. Fields from power lines are at 50 or 60 Hz or cycles per second; those from mobile phones and other RF communications and broadcasting systems are in the range of hundreds or thousands of MHz (megahertz or million cycles per second). Simple physics tell us that a photon of 1GHz frequency has an energy of 6 millionths of an electron volt (eV), while the average thermal energy of a molecule is 0.03 eV and the ionization energy of a chemical bond is on the order of 1 eV

There are, of course, well-established hazards from excessive exposures to ELF and RF fields, which are mainly associated with electric shock (ELF) and excessive heating of tissue (RF). Such problems, however, require exposure to fields at vastly higher levels than anything that would be encountered in ordinary life. Most countries around the world have adopted roughly similar exposure limits that are designed to protect against these known hazards.

The possibility that the electromagnetic fields at much lower exposure levels can be bad for you has been a matter of public concern for many years. Countless public, scientific, and legal battles have been waged about possible health hazards produced by fields from power lines, cellular base stations, broadcasting facilities, and other technologies, despite the fact that public exposures from such technologies are invariably far below government exposure limits.
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Who takes dietary supplements, and why?

If you’re a regular reader of this blog, I’ll bet you’re not a regular consumer of vitamins or supplements. I’m in that group. Aside from sporadic vitamin D in winter, I don’t take any vitamins or supplements routinely, nor do I give any to my children. Your reasons may be close to mine: There is little to no evidence suggesting that dietary deficiencies are widespread, nor is there good evidence to suggest that vitamin supplements are beneficial in the absence of deficiency. I don’t have any need for an other supplements, nor am I confident in the scientific evidence for many of them.This position of “no supplements” is a cautious and conservative one, but is based on a consideration of the scientific evidence. I view decisions about healthcare as evaluations of risk and benefit, and then cost if necessary. Given supplementation (with some exceptions) has no demonstrable benefits and, in some cases, a little risk, the odds favour not supplementing in most cases. Add in costs, and it’s even less attractive as a routine health strategy.

Yet a decision not to take vitamins or supplements regularly is becoming a minority position. Supplement use has grown over the past 40 years among Americans, with the National Health and Nutrition Examination Survey (NHANES) showing steadily increasing utilization among younger and older adults:
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Posted in: Herbs & Supplements, Nutrition, Science and Medicine

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Mouse Model of Sepsis Challenged

A recent study published in the Proceedings of the National Academy of Sciences calls into question the standard mouse model of sepsis, trauma, and infection. The research is an excellent example of how proper science investigates its own methods.

Mouse and other animal models are essential to biomedical research. The goal is to find a specific animal model of a human disease and then conduct preliminary research on the animal model in order to determine which research is promising enough to study in humans. There are also non-animal assays and “test tube” type research that is used to screen potential treatments, but scientists still prefer a good animal model.

It is also understood that animal models are imperfect – mice are not humans, after all. Animal research is therefore not a substitute for human research. I and other SBM authors have regularly criticized proponents of dubious treatments who make clinical claims based upon preliminary animal research. Until something is studied in humans, we cannot make any reliable claims about its safety and efficacy in people.

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Posted in: Clinical Trials, Science and Medicine

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Honey Boo Boo

My son has been coughing for several weeks, and the cough will probably persist for another 2 or 3 weeks. Coughs last a long time. Patients think a cough will go away in less than a week but in reality they are likely to last several weeks.

Coughs are a pain for the patient and an annoyance for the people around them. You never really know if the cougher in the row behind you has asthma,  a post infectious cough or  is actively spewing TB or influenza all over the airplane.  I learned from Clinton the importance of not inhaling, especially on airplanes.

I tend to leave most symptoms alone if the they are not life threatening or otherwise unbearable for the patient. Codeine is the only really good cough suppressant and none of the over the counter cough medications are effective.  I assume that coughing with infection, like diarrhea, is beneficial. Key to treating all infections is to physically remove it. Undrained pus doesn’t heal, and a good cough is the most efficient way I know to remove potential pathogens from the lungs.

If there are benefits to suppressing the cough associated with acute respiratory infections I can’t find any and we have all seen people who, because of inability to cough secondary to rib fractures, develop severe pneumonia.  As a resident I had an elderly male die of just such a series of unfortunate events.

I suffer from a mild form the the naturalistic fallacy. I tend to let normal physiologic processes run their course unimpeded as long as they pose no harm to the patient.  So I do not treat infectious coughs, in part because medications are not effective, in part there is no benefit  and in part because the medications that are effective, and those that are not, have side effects.  (more…)

Posted in: Clinical Trials, Herbs & Supplements, Science and Medicine

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One Flu Into the Cuckoo’s Nest*

“I don’t seem able to get it straight in my mind….”
― Ken Kesey, One Flew Over the Cuckoo’s Nest

Influenza is going gangbusters at the moment. I like going to Google Flu trends as well as the CDC flu site to see what flu is doing. Using Google searches as a surrogate for infections is an interesting technique that public health officials have tried with less success in other illnesses but is not without utility. Behaviors of populations can presage a problem, my favorite example is the first hint of the 1993 massive Cryptosporidia diarrhea outbreak in Milwaukee was a sudden shortage of Kaopectate and Peptobismol. It appears there are more patients with flu like symptoms this year than  at the height of the H1N1 epidemic of 2009. We have lots of flu like illness, and per the CDC there are buckets of confirmed influenzaflu, but so far the season, while probably having more cases than 2009, the outbreak is clinically not the same.

Compare and contrast, the two words that defined undergraduate liberal arts essay assignments. Get out your blue books and compare and contrast influenza outbreaks from 2009 and 2013. You have one hour. (more…)

Posted in: Clinical Trials, Epidemiology, Public Health, Science and Medicine, Science and the Media, Vaccines

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The Placebo Narrative

Science journalist Sharon Begley wrote a recent piece in The Saturday Evening Post about Placebo Power. The piece, while generally better than the typical popular writing on placebos, still falls into the standard placebo narrative that is ubiquitous in the mainstream media. The article is virtually identical to a dozen other articles I have read on placebo effects in the popular press, and most significantly fails to even question that narrative.

Begley is generally one of the better science journalists, although I have had my disagreements with her – specifically over her attitude toward the relationship between skeptics and the media. She seems to have a distorted and negative view of skeptics and does not think that the media can or should help us in our “debunking crusade.” (The term itself speaks of a fundamental misunderstanding of the modern skeptical movement.)

I have also parted ways with Begley over her view of the relationship between science and medicine. She seems to have a fairly negative view of doctors, fueled in part by her imperfect grasp of medical science. This is the risk with even the best lay science journalists – science is often complex and it is difficult to master the nuances if you are not an expert and steeped in the evidence and the community. Further there is a tendency for people in general (including journalists) to go along with an appealing and available narrative. (For journalists those narratives that are appealing are the ones that make good headlines.) These shortcomings are present throughout her recent article on placebos.

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Posted in: Science and Medicine, Science and the Media

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SCAMlandia

I quite like Portlandia. I find it funny and it captures a part of Portland. I recognize large swaths of the city’s culture in the show. Other representations of the city I recognize less. Sunset publishes beautiful photographs of the NW, but when I look at the photos I think, that section of the city never looks that good. It is quite wonderful how Photoshop can improve on reality.

Like most major cities, Portland has a monthly magazine, Portland Monthly. The city represented in that magazine is mostly alien to me. I look at the advertisement, the articles, the photographs, and wonder when did Portland become a city with an average 7 figure income? The Portland in which I grew up and currently live is rarely found in the pages of Portland Monthly. If you are extremely well to do, I suppose you are in the demographic Portland Monthly. But when I flip through the pages of the magazine, I see little I recognize, but I have never completely abandoned the hippie/grunge aesthetic of my younger days.

Every January they have the best Doctors issue* and this year, for the first time, they offer The Portland Alternative Medicine Guide. Well, less a guide and more an extended infomercial filled with ‘facts’ that deserve the quotes. (more…)

Posted in: Acupuncture, Chiropractic, Dentistry, Energy Medicine, Homeopathy, Legal, Naturopathy, Politics and Regulation, Science and Medicine, Traditional Chinese Medicine

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