Cannabis has been used recreationally and medically for centuries. Despite long experience, relatively little is known about the risks and benefits of its use as a medication. A considerable portion of our ignorance can be attributed to government discouragement of cannabis research. Searching the NIH website brings up many studies of both cannabis abuse and cannabis as a therapeutic agent, but most of the general information available is about cannabis as a drug of abuse.
And there is no doubt about the abuse potential and withdrawal potential of marijuana except among hard core denialists. The data is clear: marijuana discontinuation is associated with a withdrawal syndrome in many users, with some experts likening it in symptoms and severity to nicotine withdrawal.
As with any pharmacologically active substance, there are no “side effects”, only effects which we desire and those we do not. Given that cannabis is clearly a powerful pharmacologic agent, that there is a great deal of anecdotal evidence supporting its use, and that there is scientific plausibility to these claims, its potential use as a therapeutic drug should be investigated seriously. (more…)
Waterbirth has been touted as an alternative form of pain relief in childbirth. Indeed, it is often recommended as the method of choice for pain relief in “natural” childbirth. It’s hardly natural, though. In fact, it is completely unnatural. No primates give birth in water, because primates initiate breathing almost immediately after birth and the entire notion of waterbirth was made up only 200 years ago. Not surprisingly, waterbirth appears to increase the risk of neonatal death.
Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey was published in the BMJ in 1999. Out of 4,030 deliveries in water, 35 babies suffered serious problems and 3 subsequently died. It is unclear if any of the deaths can be attributed to delivery in water. However, of the 32 survivors who were admitted to the NICU, 13 had significant respiratory problems including pneumonia, meconium aspiration, water aspiration, and drowning. Other complications attributable to water birth include 5 babies who had significant hemorrhage due to snapped umbilical cord. In all, 18 babies had serious complications directly attributable to waterbirth. The risk of serious complications necessitating prolonged NICU admissions was 4.5/1000.
Hospitals in Ireland suspended the practice of waterbirth after a baby died from freshwater drowning after delivery in a waterbirth pool.
The most nonsensical aspect of waterbirth is that it puts the baby at risk for freshwater drowning. The second nonsensical aspect is that the baby is born into what is essentially toilet water, because the water in the pool is fecally contaminated. In Water birth and the risk of infection; Experience after 1500 water births, Thoeni et al. analyzed the water found in waterbirth pools both before and after birth. The water in a birth pool, conveniently heated to body temperature, the optimum temperature for bacterial growth, is a microbial paradise.
There are two general approaches to subverting science-based medicine (SBM): anti-science and pseudoscience. Anti-scientific approaches are any that seek to undermine science as the determinant of the standard of care, often overtly advocating for spiritual or subjectively-based standards. Some attack the validity of science itself, usually with post-modernist philosophy.
Pseudoscientific proponents, on the other hand, praise science, they just do it wrong. In reality there is a continuum along a spectrum from complete pseudoscience to pristine science, and no clear demarcation in the middle. Individual studies vary along this spectrum as well – there are different kinds of evidence, each with its own strengths and weaknesses, and there are no perfect studies. Further, when evaluating any question in medicine, the literature (the totality of all those individual studies) rarely points uniformly to a single answer.
These multiple overlapping continua of scientific quality create the potential to make just about any claim seem scientific simply by how the evidence is interpreted. Also, even a modest bias can lead to emphasizing certain pieces of evidence over others, leading to conclusions which seem scientific but are unreliable. Also, proponents can easily begin with a desired conclusion, and then back fill the evidence to suit their needs (rather than allowing the evidence to lead them to a conclusion).
I recently received an announcement for a conference on “Inflammation and Autoimmunity.” The topic sounded interesting, but as I read further I saw some red flags:
A gathering of healthcare leaders with a shared vision.
This event focuses on the the [sic] true causes and effects of inflammatory and autoimmune diseases, including new treatments available for this rapidly emerging crisis.
Both of these comments sound ideology-driven. I would not expect to find language like this for, say, a conference organized by the American Academy of Pediatrics or the American Academy of Allergy, Asthma and Immunology. This conference was organized by the American Academy of Environmental Medicine. I did some checking, and it seems the AAEM is not your average academy, and environmental medicine is not your average specialty.
The AAEM is not recognized by the American Board of Medical Specialties.
It is listed as a questionable organization on Quackwatch. And the American Board of Environmental Medicine is listed as a dubious certifying board. (more…)
The National Center for Complementary and Alternative Medicine (NCCAM) has posted three essays about its latest “strategic planning process,” and has invited “stakeholders” to make comments. I have previously made my own opinions clear,* as have fellow bloggers Gorski, Novella, Lipson, and Sampson: the best strategic plan for the NCCAM would be to extinguish itself. Since politics makes that plan unlikely, there are strategies that could minimize the considerable harm now done by the Center, while possibly offering a modest benefit. In summary:
- For both scientific and ethical reasons the NCCAM must dispense with trials of highly implausible claims. It should start by abandoning the ongoing Trial to Assess Chelation Therapy (TACT), its largest and most expensive trial yet, and one that has proven to place experimental subjects in considerable danger. It should publicly acknowledge such mistakes and explain why they must not be repeated—no matter how much political pressure there may be to do so.
- The Center should use its website’s Health Information function to explain what’s known, rather than continue its customary practice of putting the best possible slant on most “CAM” claims, no matter how absurd or disproven.
- The Center should address aspects of “CAM” advocacy that it has previously avoided, the most important being the close affiliation of such advocacy with the anti-vaccination (and autism quackery) movement. The NCCAM should consider itself an important source of rational information for a public that is currently, and dangerously, misled about immunizations. A related example of mischievous “CAM” advocacy, so far also ignored by the Center’s website, involves an imagined, sinister cartel of physicians, the AMA, pharmaceutical companies, and the FDA. The NCCAM should vigorously debunk such myths by providing facts and data.
- The Center should pursue the question of why some people are stubbornly attracted to implausible, unproven, and/or inert treatments. Wally Sampson suggested this idea years ago. It is one of many legacies of the late Barry Beyerstein, among others, whose writings could serve as a template for legitimate NCCAM research topics.
The NCCAM’s Charter and its boosters in Congress make such strategies exceedingly unlikely, as explained here. Therefore, in this and two subsequent postings I’ll address a few of the assertions made in each of the Center’s three “big picture” essays. These will not be comprehensive critiques of those essays, which would require deconstructions of nearly every sentence.
Editor’s Note: Dr. Mark Crislip has been kidnapped by anti-vaccinationists. Fortunately, we have sent our black Illuminati, pharma-funded, vaccine-wielding helicopters to rescue him, but unfortunately, as a result of his trauma, his usual Friday post is likely to be delayed either until this afternoon or Saturday. In any case, fortunately for us our latest addition to the SBM crew, Dr. Tuteur, was willing to fill in on short notice; so here she is. Dr. Crislip will post by tomorrow. To whet your appetite for his patented sarcasm, let me just say that he will be having a little fun with a certain article from The Atlantic about flu vaccines. There, now doesn’t that make you want to check back tomorrow to find out what his take is on the article? I thought it would.
Buried in the midst of it new report, Monitoring emergency obstetric care; a handbook, the World Health Organization acknowledges what obstetricians have been saying for some time. The WHO’s goal of a 10-15% C-section rate lacks any empirical basis.
Earlier editions of this handbook set a minimum (5%) and a maximum (15%) acceptable level for caesarean section. Although WHO has recommended since 1985 that the rate not exceed 10–15%, there is no empirical evidence for an optimum percentage or range of percentages …
Of course, they’re not going to give up their recommendation simply because there is no science that supports it, insisting that “a growing body of research that shows a negative effect of high rates.”
Dr. Marsden Wagner, former head of the Perinatal Division of the WHO, appears to be responsible for the purported optimal C-section rate of 10-15%, the level at which both maternal and neonatal mortality rates are supposedly the lowest. Ironically, Dr. Wagner is a co-author of a recent study that actually demonstrates the opposite.
I’m very pleased to announce that Dr. Amy Tuteur, otherwise known as The Skeptical O.B., has joined Science-Based Medicine. Dr. Tuteur will fill in an area where we are lacking, namely an expert in women’s health and childbirth. For those of you who don’t know Dr. Tuteur, she is an obstetrician-gynecologist. She received her undergraduate degree from Harvard College and her medical degree from Boston University School of Medicine. Dr. Tuteur is a former clinical instructor at Harvard Medical School. Her book, How Your Baby Is Born, an illustrated guide to pregnancy, labor and delivery was published by Ziff-Davis Press in 1994. She runs the website AskDrAmy.com and has her own iPhone app, the Ask Dr. Amy Am I Pregnant Quiz. Dr. Tuteur blogs at The Skeptical OB.
We expect great things from Dr. Tuteur, and hope you will join us in welcoming her to the fold. She will begin tomorrow and will post new material every Thursday. Finally, with the addition of Dr. Tuteur, it should also be noted that, due to the demands of her day job, Dr. Val Jones will decrease her posting frequency from every Thursday to every other Thursday. She will thus not be posting this week, and her next post will be on Thursday, November 12.
The last two weeks have brought good news to those who seek to hold chiropractic to the standard of evidence and science-based medicine.
In the first bit of good news, on October 14th Simon Singh was granted permission to appeal the High Court ruling on meaning of the term “bogus” within his original article. I’m sure most readers of this blog are familiar with Simon Singh’s legal battle with the British Chiropractic Association (BCA) regarding an article in The Guardian entitled “Beware the Spinal Trap.” We’ve covered it several times over the last year and will continue to do so as the case progresses. The nuances of the British legal system (or any legal system for that matter) are beyond my ken, and are far better explained by Jack of Kent here. The take-home point is that gaining permission to appeal the ruling on meaning was virtually essential if Simon were to have any real chance of winning this lawsuit.
Even if the BCA should win its lawsuit for libel against Singh, it seems likely to be something of a pyrrhic victory. After all, in the year since this story began, we’ve been belatedly provided with the BCA’s best evidence in support of chiropractic’s efficacy, and promptly treated to its subsequent evisceration. (more…)
Charlene Werner is getting a lot of attention she probably did not anticipate or desire. She is the star of a YouTube video in which she explains the scientific basis of homeopathy. Before you watch it, make sure you are sitting down, relax, and brace yourself for an onslaught of profound scientific illiteracy combined with stunning arrogance. For those with more delicate constitutions I will give you the quick summary:
Einstein taught us that energy equals matter and light, but because matter can be condensed down to a very small space if you remove all the empty space between the elementary particles (I am paraphrasing to make her statements minimally coherent), we can mostly ignore matter. Therefore energy is light, and we are all made of energy – not matter (or at least so little matter, you can ignore it). Stephen Hawking then came up with string theory, which tells us that all matter (which we can ignore) is made of vibrating strings. Therefore we are made of vibrating energy. All diseases are therefore caused by unhealthy vibrational states, and all disease can be treated by returning the body to a previous healthy vibrational state. This can be done with homeopathy, which extracts the vibrational energy out of stuff and places it in a small pill that can be used at any time.
Got it? This is now my favorite example of meaningless pseudobabble from a CAM proponent. Also, I am not picking on some unrepresentative crank – this is as good as homeopathy gets. Werner may be more clumsy and fumbling than more eloquent homeopathy proponents, but when you strip it down, magical vibrations is what you get. But Werner does a fabulous job of exposing the gaping holes is homeopathic nonsense.
For those who battle tirelessly against the never ending onslaught of anti-vaccine propaganda, misinformation, and fear, there was great news the other day from Merck. The pharmaceutical company, and maker of the MMR vaccine against measles, mumps, and rubella, has decided not to resume production of the individual, or “split”, components of the vaccine. A Merck representative made the announcement during a meeting of the CDC Advisory Committee on Immunization Practices (ACIP) on Tuesday. During previous ACIP meetings, science experts on that committee presented compelling arguments against continued, large scale production of the monovalent components of the MMR vaccine, which were echoed by scientists in Merck’s vaccine division. In a moment, I’ll discuss the arguments against the split vaccine, and why this is so important a decision. First, some background on the issue of splitting the MMR.