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NCCIH and the true evolution of integrative medicine

NCCIH and the true evolution of integrative medicine

There can be no doubt that, when it comes to medicine, The Atlantic has an enormous blind spot. Under the guise of being seemingly “skeptical,” the magazine has, over the last few years, published some truly atrocious articles about medicine. I first noticed this during the H1N1 pandemic, when The Atlantic published an article lionizing flu vaccine “skeptic” Tom Jefferson, who, unfortunately, happens to be head of the Vaccines Field at the Cochrane Collaboration, entitled “Does the Vaccine Matter?” It was so bad that Mark Crislip did a paragraph-by-paragraph fisking of the article, while Revere also explained just where the article went so very, very wrong. Over at a blog known to many here, the question was asked whether The Atlantic (among other things) matters. It didn’t take The Atlantic long to cement its lack of judgment over medical stories by publishing, for example, a misguided defense of chelation therapy, a rather poor article by Megan McArdle on the relationship between health insurance status and mortality, and an article in which John Ioannidis’ work was represented as meaning we can’t believe anything in science-based medicine. Topping it all off was the most notorious article of all, the most blatant apologetics for alternative medicine in general and quackademic medicine in particular that Steve Novella or I have seen in a long time. The article was even entitled “The Triumph of New Age Medicine.”

Now The Atlantic has published an article that is, in essence, The Triumph of New Age Medicine, Part Deux. In this case, the article is by Jennie Rothenberg Gritz, a senior editor at The Atlantic, and entitled “The Evolution of Alternative Medicine.” It is, in essence, pure propaganda for the paired phenomena of “integrative” medicine and quackademic medicine, without which integrative medicine would likely not exist. The central message? It’s the same central (and false) message that advocates of quackademic medicine have been promoting for at least 25 years: “Hey, this stuff isn’t quackery any more! We’re scientific, ma-an!” You can even tell that’s going to be the central message from the tag line under the title:

When it comes to treating pain and chronic disease, many doctors are turning to treatments like acupuncture and meditation—but using them as part of a larger, integrative approach to health.

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Posted in: Acupuncture, History, Medical Academia, Naturopathy, Science and the Media

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Florida strikes out against Brian Clement

CBC interview with Brian Clement.

CBC interview with Brian Clement.

Brian Clement is a charlatan. Unfortunately, that doesn’t seem to be a problem for the State of Florida. I made two (which turned into three) attempts to get the state to take action against Clement or the Hippocrates Health Institute, where he serves with his wife Anna Maria Gahns-Clement as co-director. All of them failed. Brian Clement slithered through the cracks in Florida law each time.

Before we get into the details of Florida’s failure to act, a bit of history (and there is plenty of it) is in order.

In recent months, Clement’s sordid cancer quackery has been well-documented in the media as well as in the science “blogosphere”. (I’ve listed what I hope is a — but almost certainly isn’t — complete blog archive at the end of this post. Many of the Canadian Broadcasting Corporation [CBC] and other news reports are linked in these posts.) Most of the coverage has centered on two Canadian girls suffering from lymphoblastic leukemia whose parents pulled them from conventional cancer therapies, which gave them an excellent chance of survival, in favor of treatment at the Hippocrates Health Institute (HHI), a sprawling spa in West Palm Beach, Florida, licensed as a massage establishment by the state.

Clement gave a talk in Canada, in 2014, claiming “we’ve had more people reverse cancer than any institute in the history of health care.” (“We” is the operative word here, because it later served as Clement’s ticket to avoid prosecution by the Florida Board of Medicine, as you shall soon find out.) The girls’ families were impressed.

Sadly, one of the girls, Makayla Sault, died earlier this year. The other, identified only as “JJ” in the media because of a publication ban, has returned to conventional treatment. However, her mother apparently remains under the influence of Clement: JJ is restricted to a raw foods diet and is still being followed, if that is the right word, by HHI. (more…)

Posted in: Cancer, Health Fraud, Legal, Nutrition, Politics and Regulation, Science and the Media

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Bill Maher: Still an antivaccine crank after all these years

Bill Maher (right) pays rapt attention to Robert F. Kennedy, Jr. (left) as he gives pointers about how to be a crankier antivaccine crank.

Bill Maher (right) pays rapt attention to Robert F. Kennedy, Jr. (left) as he gives pointers about how to be a crankier antivaccine crank.

It is with reluctance that I decided to write about this topic again, given how many times I’ve written about it over the last decade, both here and at my not-so-super-secret other blog and given how little his fans seems to care when I do. I’m referring to the antivaccine stylings of comedian and political pundit Bill Maher, something I’ve been writing about for over a decade now. Indeed, a little more than five years ago, I stirred up a bit of trouble in the skeptical community through some particularly harsh criticisms of Bill Maher, in particular of the Atheist Alliance International’s (AAI) decision to award Maher the Richard Dawkins Award. More than once, I’ve likened giving Bill Maher an award that lists “advocates increased scientific knowledge” anywhere in its criteria, not to mention being named after Richard Dawkins, to giving Jenny McCarthy an award for public health, given that, at least when it comes to medicine, Maher is anti-science to the core. Along the way, I’ve ruffled the feathers of some of both Dawkins’ and Maher’s fans.

Arguably Maher reached his peak of antivaccine advocacy through his weekly HBO talk show, Real Time With Bill Maher, five years ago, when the H1N1 pandemic was going on and public health officials were working hard to persuade people to get vaccinated against H1N1 influenza. Indeed, it got so bad that his own guests, such as Bill Frist and Bob Costas, were openly dissing him on his own show for his antivaccine views. Perhaps my favorite example came from Bob Costas, who in response to a wild claim by Maher that he doesn’t worry about getting the flu, even in the crowded confines of an airplane because of his superior lifestyle that apparently made him immune, blurted out, “Oh, come on, Superman!” Even worse, a friend of Maher, Michael Shermer, published an “Open Letter to Bill Maher on Vaccinations” in—of all places—The Huffington Post, which led Maher to respond, both on his show (in which he referred to vaccination as a “risky medical procedure”) and in a post on HuffPo himself entitled “Vaccination: A Conversation Worth Having“. It was, as a certain “friend of the blog” put it, a pyre of stupidity.
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Posted in: Science and the Media, Vaccines

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“America’s Quack” strikes back

Wile E. Coyote or Dr. Henry Miller? You be the judge!

Wile E. Coyote or Dr. Henry Miller? You be the judge!

Those of you who read my not-so-super-secret other blog (or who follow the news) familiar with this, but I feel that what happened over the last couple of weeks with respect to a man to whom I like to refer as “America’s Quack” is worth posting right here, in modified form.

Last week, a group of ten doctors led by Dr. Henry Miller, most of whom were affiliated either with the Hoover Institution or the American Council on Science and Health (ACSH)—or both—wrote a letter to Lee Goldman, MD, the Dean of the Faculties of Health Sciences and Medicine at Columbia University complaining that Dr. Mehmet Oz shouldn’t be faculty at Columbia University because of his “disdain for science and for evidence-based medicine, as well as baseless and relentless opposition to the genetic engineering of food crops” and “an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain.” The letter produced a fair amount of media attention a week ago. I originally mildly approved of it, but over the course of a few days after the letter was released, my opinion on it soured. The reasons were several and included a profound distaste for threatening letters sent to a person’s employers, admittedly based in part on my own experiences having been at the receiving end of such intimidation tactics, as well as a concern that the letter had been written with no clear purpose behind it other than as a publicity stunt to embarrass Dr. Oz and Columbia. When I learned that Dr. Oz was planning to answer the letter on his show this week, there were predictions that this particularly bone-headed publicity stunt would backfire spectacularly. And it did.
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Posted in: Herbs & Supplements, Homeopathy, Science and the Media, Traditional Chinese Medicine

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Less benefit, more risk. Our assumptions about health treatments are probably wrong.

Patient discussing treatment options with a pharmacist.

Patient discussing treatment options with a pharmacist.

I’m a health professional, but sometimes a patient as well. And like most patients, I generally don’t want health decisions being made without my input. Yes, I want the best medical information, and the advice of medical professionals, but ultimately I want to make my own decisions about my care. That’s the norm in health care today, but relatively new in the history of medicine.

Medical paternalism, where patient preferences are secondary (or even ignored), is disappearing. Even informed consent, where patients are given information on risks and benefits, doesn’t adequately describe the drive towards a two-way exchange, with an empowered, engaged patient. Today the goal is shared decision making, which describes a mutual decision that is informed by a health professional’s medical knowledge and advice, but also incorporates a patient’s own preferences and wishes. Truly shared decision-making includes an explicit consideration of a treatment’s expected benefits and potential harms, yet reflects patient values.

Screening is a textbook example of why shared decision-making should be our goal. Given the benefits of a disease screening program may be modest, and not without harms, understanding and incorporating individual preference is essential. Some may value the small but incremental benefits of screening, and choose to be screened despite the risks of false positives, investigations, and possible overtreatment. Given the exact same circumstances, another individual may opt to forgo screening, making a different, yet equally acceptable decision. While there are some health interventions for which the benefits are unequivocal, and others for which the harms are just as clear, most health treatments (and interventions like screening) have both benefits and potential harms that must be carefully assessed within the context of patient preferences. Research published earlier this year has identified a significant barrier to truly effective shared decision-making and risk assessment: Across a wide range of interventions, we routinely overestimate the benefits of health treatments, and underestimate their risks. (more…)

Posted in: Diagnostic tests & procedures, Pharmaceuticals, Science and Medicine, Science and the Media

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Stem cells versus Gordie Howe’s stroke, part 3

Gordie Howe in his Red Wings days.

Gordie Howe in his Red Wings days.

Here I am in Philadelphia attending the 2015 American Association for Cancer Research (AACR) meeting to imbibe the latest basic and translational science about oncology. So what am I doing in my non-conference time? I’m holed up in my hotel room near Rittenhouse Square writing a DoD Grant and this post. Fortunately, I am nearly done with the grant, with nothing I can do until I receive one last letter of support from a person who, as much as he’s my bud, is incredibly annoying and always makes me sit on pins and needles waiting for his letter of support. (Those of you who’ve applied for a lot of grants know what I mean.) Then tomorrow I will have to assemble the PDF package to get to my grants office two days before the deadline, which is pushing it to make sure they get it uploaded to Grants.gov in time. Fun times.

With the Stanley Cup playoffs just getting underway (complete with the ugly faux “Stanley Cup” made out of garbage cans our next door neighbor’s son puts on his lawn every year, bathed in red light for the Red Wings), it’s also the perfect time to revisit a story I’ve written about a couple of times before right here on this very blog. I’m referring (this time) to the story of hockey legend Gordie Howe and news stories of his “miraculous” recovery from a serious stroke suffered back in October due to treatment at a stem cell clinic in Tijuana back in December. Of course, when I looked into it, there were a lot of holes in the story and clearly a lot of hype on the part of several parties: Howe’s son Murray Howe, whose love for his father apparently blinded him to some rather obvious issues with the care that his father was receiving and whether it was responsible for his recovery; Stemedica, the American stem cell company based in San Diego that sells its stem cells to a dubious Mexican stem cell company, Novastem, for use outside its U.S. clinical trials; and, of course, the credulous sports media, led by that most credulous of the credulous (with respect to Gordie Howe), Keith Olbermann, who was none too pleased with a certain not-so-pseudonymous “friend” of SBM and completely embarrassed himself in the process of attacking anyone who questioned whether stem cells caused Howe’s recovery. The whole story did have one salutary effect, though. It introduced me to a real stem cell scientist, Paul Knoepfler, who did a guest post for us.

It’s been a couple of months since I last paid attention to what was going on with Gordie Howe’s recovery. Fortunately, our very own Scott Gavura tweaked me by sending me a story by Avis Favaro and Elizabeth St. Philip that appeared over the weekend in the Toronto Star, entitled “A closer look at the startling recovery of Gordie Howe.” Accompanying the story is a broadcast on CTV’s W5 entitled “Gordie’s Comeback”. (See part 1, part 2, part 3.) Also accompanying all of this is a press release discussing how a Canadian stem cell researcher visited Novastem and left unimpressed.
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Posted in: Clinical Trials, Neuroscience/Mental Health, Science and the Media

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Cancer Centers and Advertising Practices

Video advertisement for the Cancer Treatment Centers of America, hosted on their website. Note at the bottom the statement “No case is typical. You should not expect to experience these results” (click to embiggen).

You have probably seen the TV commercials or other ads for Cancer Treatment Centers of America. They make it sound like “the place to go” if you have cancer. They claim to be “different,” to combine the best cancer technologies with natural therapies in a humane, patient-centered approach that helps you fight the disease and maintain your quality of life. They offer a kinder, gentler, more effective oncology. Those ads are misleading.

Dr. Gorski has written about the practices of Cancer Treatment Centers of America here and here. He has shown how they “integrate” real medicine with nonsense like homeopathy and how they misrepresent components of science-based medicine like exercise and diet, re-branding them as “alternative.”

A recent study by Vater et al. published in the Annals of Internal Medicine asked “What are cancer centers advertising to the public?” They found that the ads appealed to emotion, failed to provide important information, falsely portrayed testimonials as typical, and should be viewed as critically as any other advertising. (more…)

Posted in: Cancer, Medical Ethics, Science and the Media

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On the “right” to challenge a medical or scientific consensus

Jenny McCarthy flaunting her "expertise" at the antivaccine "Green Our Vaccines" rally in Washington, DC in 2008

Jenny McCarthy flaunting her “expertise” at the antivaccine “Green Our Vaccines” rally in Washington, DC in 2008

The major theme of the Science-Based Medicine blog is that the application of good science to medicine is the best way to maintain and improve the quality of patient care. Consequently, we spend considerable time dissecting medical treatments based on pseudoscience, bad science, and no science, and trying to prevent their contaminating existing medicine with unscientific claims and treatments. Often these claims and treatments are represented as “challenging” the scientific consensus and end up being presented in the media—or, sadly, sometimes even in the scientific literature—as valid alternatives to existing medicine. Think homeopathy. Think antivaccine views. Think various alternative cancer treatments. When such pseudoscientific medicine is criticized, frequently the reaction from its proponents is to attack “consensus science.” Indeed, I’ve argued that one red flag identifying a crank or a quack is a hostility towards the very concept of a scientific consensus.

Indeed, I even cited as an example of this attitude a Tweet by Jane Orient, MD, executive director of the American Association of Physicians and Surgeons (AAPS). This is an organization of physicians that values “mavericky-ness” above all else, in the process rejecting the scientific consensus that vaccines are safe and effective and do not cause autism or sudden infant death syndrome (SIDS), that HIV causes AIDS, and that abortion doesn’t cause breast cancer, to name a few. Along the way the AAPS embraces some seriously wacky far right wing viewpoints such as that Medicare is unconstitutional and that doctors should not be bound by evidence-based practice guidelines because they are an affront to the primacy of the doctor-patient relationship and—or so it seems to me—the “freedom” of a doctor to do pretty much damned well anything he pleases to treat a patient.
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Posted in: Critical Thinking, Science and the Media, Vaccines

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A brief bit of shameless self-promotion…The Prince of Wales edition

PrinceCharles-590x350

In an effort to expand the Gorski empire almost to the level of the Crislip empire and to try to make it to somewhere within two or three orders of magnitude of the Novella empire, I’ve published an article on Slate.com about Prince Charles’ visit to our fine country entitled “Prince of Pseudoscience“. Consider this the mandatory shameless self-promotion that all SBM bloggers take advantage of from time to time to publicize their activities elsewhere.

Enjoy! (I hope.)

I’m told that Dana Ullman has made an appearance in the comments. I might have to head on over after work tonight…

Posted in: Announcements, Homeopathy, Politics and Regulation, Science and the Media

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The Gerson protocol, cancer, and the death of Jess Ainscough, a.k.a. “The Wellness Warrior”

The Wellness Warrior website now redirects to this photo.

The Wellness Warrior website now redirects to this photo.

Less than four days ago, a young Australian woman died of a very rare type of cancer. Most of my American and probably many of my European readers have never heard of her, but in Australia she had become quite famous over the last seven years as a major proponent of “natural health.” Her name was Jess Ainscough, but, like a certain American woman who has become famous for promoting dubious science, she was better known by her “brand” name. That brand name was The Wellness Warrior.

I first encountered Ms. Ainscough about a year and a half ago and have been intermittently following her career ever since. I’ve even blogged about her three or four times during that period over at my not-so-super-secret other blog. However, for whatever reason, even though it was my intent to write about her here on Science-Based Medicine, I never got around to it. Her death prodded me to write now, because her tale is a cautionary one important enough that I believe there should be something written here about it. Given that, those of you who follow my cubical other self will find some of this post repetitive. However, think of it as the first opportunity I’ve had to tell the story from beginning to end, along with a major deconstruction of the Gerson protocol. (Yes, unfortunately the Gerson protocol figures heavily in this story.) It’s a story that has led to the deaths of at least two people, and whose harm to others is impossible to quantify, given that the reach of The Wellness Warrior was long, at least in Australia.
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Posted in: Cancer, Herbs & Supplements, History, Science and the Media

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