The PowerPoint presentation that I gave at the Skeptic’s Toolbox workshop at the University of Oregon on August 7, 2009 is up on their website with the complete text of what I said. The theme of the workshop was scientific method. The title of my talk is “Tooth Fairy Science and Other Pitfalls: Applying Rigorous Science to Messy Medicine.” Click here for the link. It covers a lot of things that are pertinent to the subjects we discuss on this blog, and I thought some of our readers might enjoy it. I put in a lot of information and some good cartoons. Note: this was a talk to the general public, not an academic presentation, and it does not include citations or references.
Archive for Science and Medicine
One of the more bizarre and unpleasant “CAM” claims, but one taken very seriously at the NIH, at Columbia University, and on Capitol Hill, is the cancer “detoxification” regimen advocated by Dr. Nicholas Gonzalez:
Patients receive pancreatic enzymes orally every 4 hours and at meals daily on days 1-16, followed by 5 days of rest. Patients receive magnesium citrate and Papaya Plus with the pancreatic enzymes. Additionally, patients receive nutritional supplementation with vitamins, minerals, trace elements, and animal glandular products 4 times per day on days 1-16, followed by 5 days of rest. Courses repeat every 21 days until death despite relapse. Patients consume a moderate vegetarian metabolizer diet during the course of therapy, which excludes red meat, poultry, and white sugar. Coffee enemas are performed twice a day, along with skin brushing daily, skin cleansing once a week with castor oil during the first 6 months of therapy, and a salt and soda bath each week. Patients also undergo a complete liver flush and a clean sweep and purge on a rotating basis each month during the 5 days of rest.
Veteran SBM readers will recall that in the spring of 2008 I posted a series of essays* about this regimen and about the trial that compared it to standard treatment for subjects with cancer of the pancreas. The NIH had funded the trial, to be conducted under the auspices of Columbia, after arm-twisting by Rep. Dan Burton [R-IN], a powerful champion of quackery, and much to the delight of the “Harkinites.”
In the fall of 2008 I posted an addendum based on a little-known determination letter that the Office for Human Research Protections (OHRP) had sent to Columbia during the previous June. The letter revealed that the trial had been terminated in October, 2005, due to “pre-determined stopping criteria.” This demonstrated that Gonzalez’s regimen must have been found to be substantially worse than the current standard of care for cancer of the pancreas, as ineffective as that standard may be. I urge readers who require a review or an introduction to the topic to read that posting, which also considered why no formal report of the trial had yet been made available.
Now, finally, the formal report has been published online by the Journal of Clinical Oncology (JCO):
The marketing of so-called CAM or integrative medicine continues. These terms are just that – marketing. They are otherwise vacuous, even deceptive, and meant only to conceal the naked fact that most medical interventions that hide under the CAM/integrative umbrella lack plausibility or credible evidence that they actually work.
Medicine that works is simply “medicine” – everything else needs marketing.
Last week in the British Medicine Journal (BMJ) Hugh MacPherson, David Peters, and Catherine Zollman wrote a very telling editorial entitled Closing the evidence gap in integrative medicine, which Edzard Ernst has rightly characterized “a masterpiece in obfuscation.”
The essence of the editorial can be boiled down to this – proponents of integrative medicine are disappointed that scientific research has not validated their failed modalities. Therefore they want to weaken the rules of evidence so that they can get the results they desire.
Doug Bremner has a blog. That blog stinks.
Bremner is an apparently well-regarded psychiatrist, and takes a refreshing look at the influence of industry not just on pharmaceuticals but on the conduct of science itself. His outspoken views have led to attempts to squelch his academic freedoms. But his sometimes-heroic record does not excuse dangerous idiocy.
I can understand how wading into the cesspool that is conflict of interest can leave one cynical. But cynicism and suspicion turned up to “11” is no longer bravery—it’s crankery. It’s not his snarkiness that burns—it’s his inability to separate his biases from the facts.
It’s not like the pharmaceutical industry doesn’t deserve to be taken to the wood shed. Examples of unethical and downright immoral practices abound, such as ghost-writing, fake journals, and a host of other sins. But the industry has also helped develop a most remarkable pharmacopeia which saves and improves countless lives. There is good, and there is bad. And telling the two apart, well, that makes all the difference.
He tends to go for headlines that hit hard, but miss the point entirely. Examples:
- Angioplasty Found to be Useless Waste of Money: he cites a journal article which he says concluded that “not useful for patients with stable coronary artery disease (CAD). ” His title would be accurate if angioplasty were used only in stable CAD—it is not.
- Should I Take Aspirin or Put a Gun To My Head?: here, he sort of gets the difference between primary and secondary prevention, but not really. He also likes to admit that the data contradict his conclusion but he’s nice enough to say, “screw the data”:
Although technically the risk of stomach bleeding is outweighed by the heart benefits of aspirin (which can only be shown when large numbers of patients are studied), in terms of what that means to you the differences are clinically meaningless.
- This Just In: Breast Cancer Screening Essentially Useless: yes, Doug, breast cancer screening doesn’t benefit everyone equally. For example, the prevalence of breast cancers in men is low enough that recommending it for you would be stupid—like your article.
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…)
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.