If I read one more crappy article about placebos, something’s gotta give, and it’s gonna be my head or my desk. Wired magazine has a new article entitled, “Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why.” Frequent readers of skeptical and medical blogs will spot the first problem: the insanely nonsensical claim that “placebos are getting better”. This not only “begs the question,” but actually betrays a fundamental misapprehension of the concept. I’ve written several times about the nature and ethical implications of placebos, but it’s time for a serious smackdown. (more…)
Archive for Science and Medicine
The President’s Council of Advisors on Science and Technology recently submitted its report to the president in which they stated that this influenza season might kill 30-90,000 people in the US. This forecast of the upcoming season caught the media’s attention and appears to have stoked the public interest in influenza. We have had many requests for more information about influenza here at SBM, and so in this post I am going to discuss the basics of influenza and try to put the current pandemic and upcoming season in perspective.
I find it is best to start at the beginning.
What Is Influenza?
Within the public sphere, “The flu” has become shorthand for “I feel like crap.” I suspect that this is part of the reason why some people think the influenza vaccine doesn’t work. Medically speaking, however, influenza is a very specific family of viruses that cause a reasonably narrow set of problems for humans.
The influenza season in the Northern hemisphere usually runs from October through May, with a peak mid-February. Every season in the US between 5-20% of the US population is infected by influenza, and while the majority of people recover well from an influenza infection, not everyone will. Annually 200,000 people are hospitalized, and on average 36,000 will die either from influenza or its complications.
The classic influenza infection incubates for 1-4 days after exposure. Its onset is rapid, with most people experiencing high fever, headache, muscle aches, dry cough, sore throat, and nasal congestion. Gastro-intestinal symptoms like nausea, vomiting, and diarrhea are less common. Symptoms last from several days to almost two weeks, and a person is contagious from one day before symptoms begin to more than a week after symptom onset.
There are many strains of influenza. The current seasonal influenza is made up of three different influenza subtypes: A(H3N2), A(H1N1), and B. Don’t confuse the seasonal A(H1N1) strain with the current pandemic 2009 A(H1N1); they are distinct. I will refer to them as A(H1N1) for the seasonal strain, and 2009 (H1N1) for the pandemic “swine flu” strain. Influenza B is less common, less virulent, has a slower mutation rate, and is thus a lesser risk; the rest of this discussion is focused on Influenza A. (more…)
I will write occasional posts instead of being on a regular schedule. The reasons: There are more contributors than positions. Newer people to the field have more ambition and belly fire. I have a number of projects and papers to finish in increasingly limited time and decreasing efficiency. So have at it. Meanwhile, some non-random thoughts.
I am as concerned with social and political expression of pseudoscience as with its errors. Health care reformers can be just as pseudoscientific as sectarians who want to restructure the scientific edifice. Political ideologues want to centralize the medical system without solid evidence that their substitute would work, let alone work better. Sectarians already see a national government system as an opportunity for expansionism. Mark Hyman, the Functional Medicine promoter, met with the White House staff, displaying his vision of medicine under a federal plan. Word is out that other sects have also had input. Many hold suspicions that the proposals front for more ambitious formulations. I am suspicious of their confidence – that they can fix a complex, fluxing system using epidemiology, mathematical models, treatment paradigms, and top-down control. I might accept some proposals if it were not that all constructed systems are intrinsically inefficient, political, and corruptible. The closer the agents of control are to the controlled, the more control the controlled have over the controllers – if you can follow that.
- © 2009 msnbc.com
Matt Lauer and NBC have continued the ignominious media tradition of feigning to bring “balance” to the issue of vaccine safety. In the Dateline episode A Dose of Controversy, which aired on Sunday night, Matt Lauer interviewed Andrew Wakefield, the originator of the MMR-causes-autism myth, and highlighted his work at Thoughtful House, the autism treatment center he created in Texas after he was exiled from the U.K. He also interviewed (as “balance”) Dr. Paul Offit, a renowned expert on vaccines and pediatric infectious disease, and Brian Deer, the British journalist whose investigative reporting on Wakefield revealed the true, dark underbelly of the story. Of course, no balance was required to cover this story, since there is no balance from a scientific perspective. There is the evidence – that there is no causal association between the MMR vaccine and autism, and there is the myth, belief, and dogma (and a smattering of fraud) backing the notion that there is. A good piece of journalism covering this topic would have discussed Wakefield only as reference in the narrative of the story. But then that wouldn’t be nearly as good for ratings. Tension, controversy, personalities, that’s what makes for a good story. And that’s just what Dateline provided it’s viewers. Unfortunately, what it probably didn’t do was ease the fears of parents who have been thrown off course by misleading media stories and the speed-of-light trajectory that has characterized this myth. Worse, by simply shining light on the debonair Dr. Wakefield, the show may have misled even more parents into believing this dangerous myth. (more…)
Perhaps the biggest hurdle to broader acceptance of the need for a consistent scientific basis for medical interventions is the attitude that worthless treatments are harmless. I often have the experience, after reviewing the evidence showing lack of efficacy for a specific intervention, of getting the head-tilt and shrug along with some variation of the dismissive attitude, “Well, if people feel better, then what’s the harm?” In my opinion, ethics and intellectual honesty indicate that we have to do better than that.
The “what’s the harm” refrain is so tired and overused that it prompted a website by that name, documenting direct harm caused by unscientific treatment modalities. This is a helpful reminder that any intervention that actually does something (has biological activity) must also contain some risks. But this site also has significant limitations. First, it is anecdotal. But also it emphasizes direct harm, while the indirect harm of unscientific methods (for example by delaying definitive treatment) likely vastly outweighs the direct harm. However, indirect harm is extremely difficult to quantify.
Studies looking at the net clinical effects of using or relying upon unscientific methods is therefore desirable. Recently Danish researchers have published one such study: Use of complementary and alternative medicines associated with a 30% lower ongoing pregnancy/live birth rate during 12 months of fertility treatment.
Let’s say you have cancer. And let’s say you’re really, really sick of having cancer. And let’s say that you’re also pretty tired of scans, chemo, radiation, hair loss, nausea. And let’s say you’re not really sick and tired of living, but actually pretty happy to be alive.
Finally, let’s say someone says that they can get rid of your cancer, without all of those pesky side-effects. It’s a win-win, no?
It’s easy to believe in promises that are congruent with our wishes. That’s what makes human beings so easy to deceive. A case in point is the VIBE Machine, a discredited quackery device. This thing was marketed until about a year ago. Not surprisingly, Orac has written about this thing in his Friday Dose of Woo. Stephen Barrett, the King of Quack-Busters, has also tracked the sordid history of this rip-off. The device was recalled back in 2008, so this shouldn’t even be a story anymore, except that word of the device still circulates among cancer patients and their friends. The company’s website is down, which is good, but this thing is still out there.
The following is the second adapted excerpt of an upcoming article called “The Untold Story of Acupuncture.” It is scheduled to be published in December 2009 in Focus in Alternative and Complementary Therapies (FACT), a review journal that presents the evidence on alternative medicine in an analytical and impartial manner. This section argues that the current flurry of interest in acupuncture and Oriental Medicine stems predominantly out of postmodern opposition to Enlightenment rationalism, and bears witness to Orientalism and consumerism in contemporary medicine.
In five years, from 1971 to 1975, l directly experienced Est [Erhard Seminars Training], gestalt therapy, bioenergetics, rolfing, massage, jogging, health foods, tai chi, Esalen, hypnotism, modern dance, meditation, Silva Mind Control, Arica, acupuncture, sex therapy, Reichian therapy and More House — a smorgasbord course in New Consciousness.1
Jerry Rubin (1938 – 1994)
Although acupuncture has been known in the US since the 19th Century, its therapeutic claims were dismissed or judged to be “much overrated” by the medical community.2,3 Nonetheless, the publication of a report in the New York Times by James Reston, a reporter in President Nixon’s press corps who had received acupuncture for postoperative cramps in Beijing in 1971 changed this perception, and triggered a flurry of interest amongst the American public and some in the medical community.4 Within the following months, journalists, scientists and physicians rushed to China to withness this peculiar phenomenon, which the popular press and a few scientific journals sensationalized by reporting that thousands of successful operations of all sorts were being carried out in PRC using acupuncture anesthesia; some elaborated on its widespread use for a myriad of conditions, to include paralysis and deafness!5
These unconfirmed claims in the heady social and intellectual climate of the 1970s–meaning the American Counterculture; the rejection of mainstream values, beliefs and ideals; the youth movement, nonconformism and the hippie subculture, the belief in a “New” and “Cosmic” consciousness and the cult phenomenon; revolutionary ideas mixed with environmentalism; organic farming and the avoidance of pollution, agrochemicals and pharmaceuticals; nonconformism and alternative lifestyles; a syncretistic mix of psychedelic drugs, Eastern religions and Native American spiritualities; the resurgence of the taste for mystic, occult, and magical phenomena;6,7 and the belief in the existence of a separate and non-ordinary reality, as upheld by one of the fathers of the New Age movement, Carlos Castaneda8–gave the justification to view acupuncture as a “heal all” therapy based on alternate perceptions of health and disease. This amalgamation happened precisely when a whole generation of disenchanted Westerners were eager to find novel solutions for their existential predicaments; one that would be free from the constraints of the so-called “repressive rationality” of modern science in “overdeveloped” societies.9,10. Most Western publications on acupuncture therefore fostered the belief that Eastern healing arts have crucial characteristics directly and unequivocally opposite to the repressive rationalism of the West.
EDITOR’S NOTE: Dr. Jones is off this week; fortunately, we have this guest post by Tim Kreider, our science-based medical student. Enjoy!
My first clerkship of my third year of medical school was Family Medicine, and I had a great experience. After the first two years spent mostly with books and then a three-year interlude in a basic science lab, these past five weeks were my first extended foray into the world of patient care. I had a few lectures and seminars on campus, but most days were spent in a primary care office learning on the job. I was assigned to an office attached to a community hospital with a Family Medicine residency program, so I was able to work with both attending physicians and residents in training. I learned a lot and gained some much needed confidence regarding my clinical exam skills, which were rather rusty after grad school.
I have heard as a criticism of the SBM mission that practicing medicine “in the real world” is different from what evidence-obsessed, ivory tower dwellers think it should be. Therefore I approached my Family Medicine clerkship as my first chance to see the challenges and realities of practice outside the university setting. How would the practice of community-based physicians compare to the perhaps lofty ideals espoused by academics? (more…)
The anti-vaccine movement is nothing if not plastic. It “evolves” very rapidly in response to selective pressures applied to it in the form of science refuting its key beliefs. For instance, when multiple studies looking at the MMR vaccine and autism failed to confirm the myth that the MMR causes autism or “autistic enterocolitis,” most recently late last year, it was not a problem to the anti-vaccine movement. Neither was it a major problem to the movement when multiple studies similarly failed to find a link between mercury in the preservative thimerosal that used to be in most childhood vaccines and is no more (except the flu vaccine) and autism. No problem! Andrew Wakefield is alleged, based on strong evidence, to have falsified his data alleging a link between the MMR vaccine and “autistic enterocolitis”? Fuggedabouddit! The anti-vaccine movement simply pivoted neatly, de-emphasized points that the evidence was so clearly against that even they couldn’t spin it to a positive anymore, and found new bogeymen. These days, it’s the “toxins” (such as formaldehyde and the latest antivax bogeyman, squalene), and “too many too soon” (a gambit given seeming respectability by Dr. Bob Sears and Dr. Jay Gordon, apologists for and supplicants to the anti-vaccine movement both.
However, there is one trait of the anti-vaccine movement that, however its camouflaging plumage may evolve, never, ever changes. It is as immutable as believers say that God is. That trait is that, whatever other claims, the anti-vaccine movement makes, at its core it is always about the vaccines. Always. No matter how often science fails to find a link between vaccines and autism or vaccines and whatever other horreur du jour the anti-vaccine movement tries to pin on vaccines, no matter how many studies do not support the viewpoint that vaccines cause autism, no matter how much the anti-vaccine movement tries to deny and obfuscate by saying that it is not “anti-vaccine” but rather “pro-safe vaccine,” at its core the anti-vaccine movement is about fear and loathing of vaccines. Always. When inconvenient science doesn’t support their views, anti-vaccine activists either ignore the science, distort the science, or launch ad hominems against the people doing the science or citing the science. And, as I said before, the claims of the anti-vaccine movement evolve. Never again will the anti-vaccine movement make the horrific mistake of yoking itself to a hypothesis that is as easily testable as the hypothesis that mercury in vaccines causes autism. The claim that mercury in vaccines causes autism predicted that, if thimerosal were removed from vaccines or reduced to pre-“epidemic levels” of the early 1990s, then autism rates should plummet. Thimerosal was removed from nearly all childhood vaccines (the sole exception being some flu vaccines), reducing infant mercury exposure from vaccines to levels not seen since the 1980s; yet autism rates continue to rise. This is about as resounding a refutation of the hypothesis that mercury in vaccines is a major cause or contributor to autism that even the anti-vaccine movement has backed away from the pure claim, which has now evolved to unnamed “environmental toxins,” either in concert with mercury or with other nasty things, as being the Real One True Cause of Autism.
It’s evolution in action. These new claims are much “fitter” because they are much harder to falsify through scientific research, epidemiology, and clinical trials.