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Medicine doesn’t come from the hardware store: Don’t drink turpentine

This is not a health food. Don't drink it.

This is not a health food. Don’t drink it.

I enjoy feedback from readers. Yes, there’s the regular hate mail accusing me of being a Big Pharma Shill. But there’s the occasional appreciative comment from someone that found a post helpful or informative. The most gratifying feedback is when someone tells me that something I wrote led to a more informed health decision. Often it’s because I was able to answer a question that they couldn’t find a science-based answer to. I’ve answered thousands of questions in my pharmacy career, and have only blogged a handful of them (so far). One of my most fascinating experiences was a stint working evenings in a pharmacy that happened to have a large “natural” health focus. It’s there I began to scrutinize alternative medicine more closely, because it was virtually all the store sold. Homeopathy, ear candles, copper bracelets and salt lamps were all for sale. If it was unproven, proven ineffective, or defied some law of physics or chemistry, this pharmacy probably sold it. But the customers loved these products. I was dumbfounded. Some would buy dozens of supplements, costing hundreds dollars per month, on the advice of their naturopath, treating some vague or non-specific complaints. Others swore by homeopathic remedies, for themselves and their pets. It was common to meet people who were treating conditions that either didn’t exist, or hadn’t been properly diagnosed, like naturopath-diagnosed “food intolerances” or “hormone imbalances”. There were also the occasional “pH balancing” advocates that insisted I was misguided and uneducated for reassuring them that their body’s pH was just fine, despite what their urine test strips were telling them. (more…)

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Attitudes Predict CAM Use

 From the US Food and Drug Association article "6 Tip-offs to Rip-offs: Don’t Fall for Health Fraud Scams

CAM: More branding than medicine.

One of the persistent themes of SBM is that CAM (complementary and alternative medicine, or integrative medicine) is nothing more than a marketing brand. Its recent popularity is not based upon new evidence or a changing paradigm of medicine as its proponents claim. Its popularity is increasing despite the lack of evidence for specific CAM treatments and despite a dedication to evidence-based medicine within the medical profession.

CAM is also modern mythology, which I guess all really effective advertising and branding is. It floats atop a number of demonstrably false marketing claims. One is that the popularity and use of CAM is surging. This is partly a self-fulfilling prophesy, and no doubt it is increasing, but the degree to which CAM is popular has been consistently exaggerated by proponents (largely as a way to justify its existence).

This myth is largely perpetuated by redefining CAM as needed, including things like prayer, massage, and taking vitamins. I suspect that praying for a sick loved-one has always been popular and doesn’t represent a trend toward CAM. When unequivocal alternative modalities are considered, their use is still tiny and not increasing. The most recent NIH survey found:

Use of acupuncture (1.1%), homeopathic treatment (1.7%) naturopathy (0.2%), and energy healing (0.5%) was miniscule.

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Don’t just stand there, do nothing! The difference between science-based medicine and quackery

Tree of Life - the first-known sketch by Charles Darwin of an evolutionary tree describing the relationships among groups of organisms (Cambridge University Library).

Tree of Life – the first-known sketch by Charles Darwin of an evolutionary tree describing the relationships among groups of organisms (Cambridge University Library).

The Merriam-Webster Dictionary defines science as:

Knowledge about or study of the natural world based on facts learned through experiments and observation.

And:

Knowledge as distinguished from ignorance or misunderstanding.

While this should distinguish science from pseudoscience, those who practice the latter often lay claim to the same definition. But one of the major differences between science and pseudoscience is that science advances through constant rejection and revision of prior models and hypotheses as new evidence is produced; it evolves. This is the antithesis of pseudoscience. At the heart of pseudoscience-based medicine (PBM) is dogma and belief. It clings to its preconceptions and never changes in order to improve. It thrives on the intransigence of its belief system, and rejects threats to its dogma. Despite the constant claims by peddlers of pseudoscience that SBM practitioners are closed-minded, we know that, in fact, PBM is the ultimate in closed-minded belief. Of course, those of us who claim to practice SBM aren’t always quick to adopt new evidence. We sometimes continue practices that may once have been the standard of care but are no longer supported by the best available evidence, or perhaps may even be contradicted by the latest evidence. Often this is a byproduct of habituated practice and a failure to keep current with the literature. While this is certainly a failure of modern medicine, it is not an inevitable outcome. It is not emblematic of the practice of medicine, as it is with PBM. When medicine is science-based, it strives for continual improvement based on modifications around emerging evidence. (more…)

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Legislators want “pharmaceutical cost transparency”. Are they asking the wrong question?

Drug Costs

If science-based medicine is unaffordable, then your care won’t be science-based. Prescription drug costs are one of the biggest concerns in health care today. There seems to be no upper limit on prices, with some new treatments costing over $1,000 per day. The arrival of new drugs to treat (and cure) hepatitis C has created a perfect pharmaceutical storm: highly effective treatments, a large population of potential patients, and huge per-patient costs. It’s renewing the debate about whether important medical treatments are being priced out of the reach of the patients that need them. It’s not just hepatitis. Cancer drug costs are rising as well, driven by more patients and new drugs that in some cases are transforming our expectations about what cancer drugs can do. And while many of us rely on some form of drug insurance to protect us from high drug costs, insurers are struggling with balancing coverage and premiums: A report by Express Scripts paints a grim picture:

An estimated 576,000 Americans spent more than the median household income on prescription medications in 2014. This population of patients grew an astounding 63% from 2013. Further, the population of patients with costs of $100,000 or more nearly tripled during the same time period, to nearly 140,000 people. The total cost impact to payers from both patient populations is an unsustainable $52 billion a year.

This isn’t just an issue in the United States. Prescription drug costs are climbing around the world, because we’re effectively all in this together: We all rely on private companies to bring new drugs to market, and we’re largely buying the same drugs from the same small group of companies. Because ready access to safe and effective prescription drugs is so important to the practice of medicine and the delivery of health care, the pharmaceutical industry is heavily regulated – not just by the FDA, but by regulators worldwide. Yet despite the dual requirements of regulatory disclosure and the financial obligation to be transparent (as many pharmaceutical companies are publicly-held), little is known about how much it costs to bring drugs to market, and how manufacturers arrive at their selling prices. Pharmaceutical manufacturers claim that high drug costs reflect the high costs of research and development (R&D), and provide the incentives for companies to invest heavily and take risks, when many drugs may never make it to market. Are they correct? (more…)

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Lyme Testimony

The Lyme tick

The Lyme tick

As the saying goes, when you do not have the facts, argue the law. This tried and (?) true approach was successful in New York where a law was passed protecting those who are, shall we say, creative in treating patients with Lyme and ‘chronic’ Lyme.

The bill protects those from investigation of misconduct:

based solely on treatment that is not universally accepted by the medical profession.

The major bone of contention has been extended courses of IV antibiotics for ‘chronic’ Lyme, but there are a wide variety of treatments that may be used by so called “Lyme literate” doctors.

The number of therapies divorced from reality that are offered to Lyme patients is remarkable. I do not know if chronic Lyme patients have greater use of pseudo-medical therapies than other pseudo-diagnoses, but I am impressed by the offerings in a recent review:

Results. More than 30 alternative treatments were identified, which fell into several broad categories: these included oxygen and reactive oxygen therapy; energy and radiation-based therapies; nutritional therapy; chelation and heavy metal therapy; and biological and pharmacological therapies ranging from certain medications without recognized therapeutic effects on Borrelia burgdorgeri to stem cell transplantation. Review of the medical literature did not substantiate efficacy or, in most cases, any rationale for the advertised treatments.

Conclusions. Providers of alternative therapies commonly target patients who believe they have Lyme disease. The efficacy of these unconventional treatments for Lyme disease is not supported by scientific evidence, and in many cases they are potentially harmful.

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Homeopathy and the UK’s National Health Service

Homeopathy in the UK, flag, small

Homeopathy is arguably the silliest form of alternative medicine: the published studies show no evidence of anything beyond nonspecific contextual effects, and the underlying premise is incompatible with the existing body of scientific knowledge. Homeopathy has increasingly been questioned or denounced by organizations in several countries, most recently in FDA hearings in the US.

I recently spoke at the QED conference (Question, Explore, Discover) in Manchester, England. Another speaker, Michael Marshall, gave a talk on homeopathy and the National Health Service. He presented information that was new to me and that I thought was worthy of sharing with SBM readers. (more…)

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“Science.” You keep using that word. I do not think it means what you think it means.

Science

I’ve discussed on many occasions over the years how antivaccine activists really, really don’t want to be known as “antivaccine.” However, if there’s one thing that rivals how much antivaccinationists detest being called “antivaccine,” it’s how much they detest being called antiscience. To try to deny that they are antiscience, they will frequently invoke ridiculous analogies such as claiming that being for better car safety does not make one “anti-car” and the like. It is here that the Dunning-Kruger effect comes to the fore, wherein antivaccine activists think that they understand as much or more than actual scientists because of their education and self-taught Google University courses on vaccines, that their pronouncements on vaccines should be taken seriously. If there are two antivaccine blogs that epitomize the Dunning-Kruger effect, they are Age of Autism and, of course, the most hilariously inappropriately named The Thinking Moms’ Revolution (TMR). It is the latter of these two that late last week produced a tour de force of Dunning-Kruger, coming, as the most hilariously off-base posts on TMR usually do, from the “Thinking Mom” known as “The Professor.” I shouldn’t be surprised, given her history, but nonetheless it’s worth taking a look at her latest post, Anti-science: “You Keep Using That Word. I Do Not Think It Means What You Think It Means.”

Actually, it does. And if The Professor is going to spend nearly 7,000 words riffing on a bit of dialogue from The Princess Bride, surpassing in verbiage all but a small minority of my posts, it almost makes me want to make this post 8,000 words.

Fortunately, for you, I resisted that temptation and instead merely retort: “Science. You keep using that word. I do not think it means what you think it means.” Then I demonstrate why.
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Separating Fact from Fiction: The “Magic” of Epigenetics?

Watch as I pull a rabbit out of my hat using the power of epigenetics!

Watch as I pull a rabbit out of my hat using the power of epigenetics!

Every few years, it seems, a new concept emerges as the favorite go-to means of marketing unproven and highly implausible approaches to health care. Explanations of the proposed healing properties of homeopathic remedies incorporating quantum mechanics immediately comes to mind as an example of this phenomenon. Or how proponents of the most absurd treatments will just add “Nano” to anything and claim scientific miracles of healing.

From the Nano SRT website:

Q: What Is Stress Reduction Therapy?
A: SRT is a remarkable new procedure that combines the disciplines of Acupuncture, Biofeedback and Homeopathy with Laser Light technology. A computerized scan or test is done to see what your body is sensitive to, and how it is out of balance, then help it learn not to be.

Q: What does the Nano SRT do?

A: Substance specific frequencies converted to a digital format, and presented in the form of sound and light, are what allow for patient assessment and therapy down to the molecular level. The frequencies are what make it possible to assess thousands of substance sensitivities in mere minutes, then allow the brain and nervous system to record a new association that is positive or neutral instead of the inappropriate ones that were previously stored in memory. This breaks the link between the stimulus and response, makes symptoms unnecessary, creates balance and harmony, from dis-ease and disharmony, and allows the body to function better.

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Activated charcoal: The latest detox fad in an obsessive food culture

charcoal lemonade2Our diet is either the cause of, or solution to, all of life’s problems. I’m paraphrasing a great philosopher. We just can’t seem to let food be food. Today each ingredient we eat seems to be demonized or glorified. Gluten is the latest evil. It used to be fat. At some point in the past, it was MSG. Or it’s a superfood, preferably local, organic and GMO-free. Even on the healthiest diet, however, we’re apparently still ingesting too many harmful chemicals. After all, this is apparently a toxic environment we live in. Gwyneth Paltrow says so. So does the Food Babe. In an era of daily television quackery and loony internet health conspiracy websites, one might think that bizarre food ideas are a recent phenomena. But worries that we’re being poisoned from within are probably innate. One of the oldest surviving written documents is an Egyptian papyrus from the 16th century BCE that linked the cause of disease to digestive wastes in our colon. Since that time, our scientific knowledge about the cause of disease has advanced, but the underlying obsession with diet and elimination hasn’t waned. Anecdotally, it seems to be growing. The idea that our bodies need to “detox” is thriving, despite the fact that it has no scientific basis or validity. Part of the modern appeal of “detox” may be that detoxification is a legitimate medical term and treatment. However, in the alternative-to-health perspective, the word has been co-opted, but the science part has been ignored. Fake “detox” is easy. And now proponents of “detox” have taken it one step further. They’re using real medicine for a fake “detox” with. That’s how activated charcoal has become the latest health fad. (more…)

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What Should We Do in the Absence of Evidence?

Pictured: Smarter than you.

Pictured: Smarter than you.

For every complex problem, there is an answer that is clear, simple—and wrong.

– H.L. Mencken

Despite my multiple personalities, it seems that only the OCD doctor gets anything done. The Goth cowgirl persona? Lazy. And the NBA playoffs are sucking up an inordinate amount of time. Go Blazers. Just not very far. Sigh. But what are you going to do. Work needs doing and someone has to do it.

This week was one of deadlines. In June I am giving a series of talks at the SMACC conference in Chicago and I have to have all my talks ready to go today. So sometimes to meet all my deadlines I need to re-purpose other material.

Spoiler alert: if you are going to be at SMACC and hear my lectures, stop reading here. Everything I am going say in 6 weeks will follow. And really even if you are going to SMACC, it is a content-free post. You might be better off spending your time elsewhere. (more…)

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