Science and Medicine

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Belly Button Healing: Science plus Magic for Only $99?

bellywand

The patient doesn’t choose the Healing Life Wand. The Healing Life Wand chooses the patient.

If you wanted to design and market an ineffective treatment with the best chance of successfully fooling consumers, it would have to include a certain set of key components in order to maximize profit. A connection to nature is extremely important, the more emotional the better. Although trickier to pull off, your product would need to call upon ancient wisdom while also being associated with cutting edge science. But keep the association vague and let the consumers connect the dots. A hint of conspiracy, where the consumer believes that they are being let in on a secret or suppressed cure helps too.

The mechanism of action should be unclear in order to avoid easy refutation, and should preferably involve concepts such as removing toxins and balancing energy or hormones. Again, it’s important to combine science with your magic, so include things like lymphatic drainage or increased blood flow. The ailments your treatment would remedy need to be subjective and likely to respond to numerous placebo effects. And the treatment should be simple, even a bit fun, in both concept and execution. Finally, throw in a catchy slogan or two and you’ll be rolling around on a pile of hundreds in no time at all.
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Posted in: Science and Medicine

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Oxygen water? You can’t breathe through your stomach

Unless you have gills, this won't make you a strong, faster athlete.

Unless you have gills, this won’t make you a stronger, faster athlete.

My exercise of choice is running. Despite the heat I’ve been having a great summer, training for the Chicago marathon. I’ve followed the training schedule fanatically since June. But it all came crashing down in one run last week when I moved from the ranks of “marathoner in training” to “injured runner”.

With the sudden onset of very sharp, radiating back pain, I was struggling to walk. My marathon plans seemed to evaporate. And in that moment of weakness, I became prey. Prey to pseudoscience, and prey to anyone offering a quick fix. (more…)

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

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An Unexpected Miscellany of Medical Malarkey

kidcupping

 

I had originally intended a focused discussion of a single topic, but life circumstances have conspired to prevent me from doing so.  In the place of my intended post, please enjoy the following collection of hastily assembled pseudomedical odds and ends brought to my attention over the past few weeks. (more…)

Posted in: Acupuncture, Science and Medicine

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Do pill organizers help or hurt?

"Blister packs" help people take their medication on the correct schedule.

“Blister packs” help people take their medication on the correct schedule.

In order for medication to work, getting a prescription filled isn’t enough. You have to actually take the medication. And that’s where you (the patient) come in. Estimates vary based on the population and the medication, but a reasonable assumption is that 50% of people given a prescription don’t take their medication as prescribed. In pharmacy terminology we usually call this medication compliance, but because that sounds a bit paternalistic, the term medication adherence is also used. People forget doses, deliberately skip doses, and sometimes even take more than directed. Often, the prescription isn’t finished completely. Perhaps not surprisingly, people are less likely to adhere to their prescribed medication schedule when the condition they are treating has no symptoms. All things being equal, you’re more likely to take your pain control medicine than your hypertensive medications: Pain medications have side effects, but should help you feel better right now. Hypertension medications can only make you feel worse. Statins (as a group of medications) are another good example. We treat high cholesterol to lower the risk of heart disease: heart attacks, strokes, and death. It has no obvious benefit now, nor will we ever be able to point to the benefit we received. We’re taking the medication to reduce the risk of something happening in the future. If the drug isn’t taken regularly (or at all) then you’re not going to get the expected benefits of statin therapy. The “value” that treatment delivers is reduced (or eliminated). And if you stop a medication periodically, then restart it, you might get more side effects than you would have if you just took it regularly. (more…)

Posted in: Medical devices, Pharmaceuticals, Quality Improvement, Science and Medicine

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Patient Groups and Pseudoscience

Patients should get health information from doctors, not quacks.

Patients should get health information from doctors, not quacks.

The biggest challenge we face promoting high standards of science in medicine is not making our case to the community. Our case is rock solid, in my opinion, and backed by evidence and logic. There is no question, for example, that homeopathy is 100% bogus and should not be part of modern medicine.

Our challenge is that there are literally billions of dollars to be made selling fake medicine and dubious treatments. This means that unscientific practitioners have an immediate financial incentive to promote themselves and their treatments, and they will tirelessly do so, on any front they can find. Further, the stars of unscientific medicine have the resources to do so – to intimidate critics, cozy up to politicians, open centers in respected hospitals, and market their brand.

We simply don’t have the manpower to confront them on every front, and the mainstream scientific and medical communities are frankly just not paying enough attention. They are largely unaware that pseudoscience is infiltrating their profession right under their noses, or they have been lulled into thinking this is a small and benign phenomenon.

Patient groups

These many fronts in which science confronts pseudoscience include the media, hospitals, continuing education, journals, the marketplace, politics and regulation, and research funding.

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Posted in: Health Fraud, Naturopathy, Science and Medicine

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Building a Case for CAM

[Editor’s note: Mark Crislip is taking a well deserved vacation from blogging, and James Thomas has kindly agreed to provide another guest post to fill the gaping need left in all of your lives. Enjoy!]

Building a case for complementary and alternative medicine. This shouldn't be hard!

Building a case for complementary and alternative medicine. This shouldn’t be hard!

According to the Orwellian-named National Center for Complementary and Integrative Health, roughly 33% of adults aged 18-44 and about 37% aged 45-64 use some form of CAM. More disturbing is that 12% of children aged 4-17 used some form of CAM in the last 12 months. If there is good news, it is that the NCCIH takes a broad view of “complementary health approaches” including acupuncture, Ayurveda, biofeedback, chelation therapy, chiropractic care, energy healing therapy, special diets (including vegetarian and vegan, macrobiotic, Atkins, Pritikin, and Ornish), folk medicine or traditional healers, guided imagery, homeopathic treatment, hypnosis, naturopathy, non-vitamin, non-mineral dietary supplements, massage, meditation, progressive relaxation, qi gong, tai chi, and yoga. In fact these approaches range from the wacky (energy healing therapy, homeopathy) to the mainstream (massage, yoga) with nothing alternative about them. With more than 60 million Americans using some form of CAM, it is fair to ask if we can build a case for truly integrating CAM into mainstream medical practice.

So who are these people using CAM and just what are they using it for? CAM users can be found in almost every demographic but the largest cohort is white, female, and fairly well educated. A good deal of CAM is used for common and often vague conditions with back pain being the most commonly cited. But it is also used by cancer patients, for cardiovascular disease, and even for Alzheimer’s disease. The problem is that none of the CAM approaches are useful for any of these conditions; strike that, none of the CAM approaches are useful for anything at all much beyond placebo.

I’m going to keep this essay down to a more reasonable length than my earlier offerings (pauses here for the applause to fade) so I’m not going to talk much about most CAM “modalities.” Reiki is deconstructed here and here, or for those who just want a Crislipian good time, here. Homeopathy is eviscerated here. For the deeper dive go here, or for the full monte, here. If after that you still have questions about homeopathy you should probably get a hobby.

But wait, there’s more!

Chiropractic, and acupuncture, and hypnosis, and chelation, and, and…go to the masthead and enter the CAM of your choice in the box with the little magnifying glass. If some charlatan has offered it as a medical treatment, this is your gateway to good information about it. But (and that ‘but’ was your spoiler alert), none of it has much impact on any measurable medical condition. CAM does not shrink tumors, CAM does not dilate bronchi, CAM does not strip pounds of icky toxins out of your colon. Those claims and most others are easily dismissed by anyone with basic reasoning skills and the URL for Pubmed (here it is: http://www.ncbi.nlm.nih.gov/pubmed).

There are however, two arguments in favor of CAM that deserve a bit more careful consideration: electro-acupuncture for pain relief through the mechanism of stimulating endorphin release, and the more general argument that many patients have needs unmet by the medical mainstream, often psycho-social needs that do not have an ICD-10 (a type of diagnostic code) and for which no treatment infrastructure exists within the mainstream health care delivery system. These are the cases I’ll try to build today. (more…)

Posted in: Critical Thinking, Science and Medicine

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Does acetaminophen during pregnancy raise the risk of behaviour problems?

Pregnant1

In my career as a pharmacist I’ve answered a lot of questions about medication use in pregnancy. Pharmacists are among the most accessible health professionals, and we’re usually found near a wall of medicines and supplements.  Many don’t trust Dr. Google, and for good reason: There are conflicting answers online. When it comes to medication use in pregnancy and effects on the fetus, we have no perfect data. Since no-one is randomizing women to drug treatment or placebo, we must rely  on weaker, less definitive evidence. An appropriate response from a health professional will describe known risks and expected benefit, summarizing what we know, and how confident we are in that answer. One of the most popular drugs used in pregnancy is acetaminophen (sometimes called paracetamol or APAP), and commonly known by the brand name Tylenol. An emerging concern with acetaminophen is whether use during pregnancy raises the risk of attention deficit hyperactivity disorder (ADHD) and related behavioural problems. While I covered this question once, back in 2014, there’s a new paper that’s putting this issue back in the news. From Evie Stergiakouli and colleagues is the paper, “Association of Acetaminophen Use During Pregnancy With Behavioral Problems in Childhood: Evidence Against Confounding“, published this week in JAMA Pediatrics. (more…)

Posted in: Epidemiology, Obstetrics & gynecology, Science and Medicine

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Dana-Farber Cancer Center’s Integrative Medicine Expansion

Dr. Sidney Farber, shown here not believing in reiki or reflexology.

Dr. Sidney Farber, shown here not believing in reiki or reflexology.

In June, an article in the Boston Globe covered yet another incursion of pseudoscience into a major academic medical center, this time at the Dana-Farber Cancer Institute. Dana-Farber, located just a couple of miles from the library where I’m writing this post, has provided world-class care for children and adults with cancer since 1947. It’s kind of a big deal.

Sidney Farber, already known as the “father” of pediatric pathology, was the first person to induce remission in pediatric acute lymphoblastic leukemia, which had a 100% mortality rate up to that point. He then went on to earn the title of “father” of modern chemotherapy by also curing Wilm’s tumor, a rare pediatric cancer of the kidneys. Farber, who was featured in the phenomenal book The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee, would almost certainly be opposed the double standard being employed to justify quackery in the facility bearing his name (or anywhere else).

To Farber, a scientific approach to treating pediatric cancer patients was paramount, even to the point where he at first refused to initiate the combination therapy that would open the age of modern chemotherapy because he wanted to protect children from a potentially haphazard rush to cure them. He wanted strict scientific protocols in place and assurances that the evidence would be followed regardless of the outcome, so that the intense desire to find a cure for children that otherwise faced only suffering and death would not add to that suffering. (more…)

Posted in: Science and Medicine

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In Pursuit of Patient Safety

[Editor’s note: With Dr. Gorski enjoying a vacation to recharge his batteries, we present a second offering from contributor James Thomas. Enjoy!]

From the

This might hurt a little…
From the Wellcome Trust Image Librar via the Wikimedia Commons

Advocates of CAM* (Complementary and Alternative Medicine) have long argued that mainstream medicine is a dangerous undertaking using toxic drugs and invasive interventions that often do more harm than good, while the various quackeries huddled under the CAM umbrella are said to use natural interventions that aid the body in healing itself. A recent BMJ article naming medical errors as the third leading cause of death in the United States was trumpeted as proof of that claim and predictably enough unleashed a maelstrom of pearl-clutching commentary from the CAMsters. David Gorski has already deconstructed the ‘medical error is the third leading cause of death’ argument comprehensively. Rather than re-till that ground, I will use this essay to examine the allied accusation that medicine has little interest in the actual inherent dangers of medicnie, and less interest still in addressing those dangers. (more…)

Posted in: History, Science and Medicine, Surgical Procedures

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Separating Fact from Fiction in Pediatric Medicine: Facial Nerve Palsy

An infant with a left facial nerve palsy

An infant with a left facial nerve palsy

There are numerous medical conditions that are seemingly designed to allow proponents of “irregular medicine” to proclaim their treatments to be effective. These conditions tend to be chronic and subjective in nature, or to have waxing and waning courses such that a parent or patient might easily be fooled into assigning a causal relationship between a bogus intervention and a clinical improvement. Brief, self-limited maladies are also quite convenient for people with nothing to offer but false information and false hope. After a recent encounter with a patient, I’ve added a new one to the list: idiopathic facial nerve palsy.

What is idiopathic facial nerve palsy?

Although not the first to do so, facial nerve dysfunction resulting in the sudden and unexplained weakness of all muscles on one side of the face was most famously described by Scottish neurophysiologist Sir Charles Bell in 1830. Hence it is commonly, if not always accurately, referred to as “Bell’s palsy.” Since then our understanding of the condition has progressed considerably, thanks to scientific investigation and improved diagnostic testing. In particular, we have learned that many cases are the result of infection, with ear infections, various human herpes viruses, and the spirochete responsible for Lyme disease being the most common culprits in children. (more…)

Posted in: Science and Medicine

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