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Say it ain’t so, Mickey! A holiday measles outbreak makes the happiest place in the world sad

disneyland

Last week, the self-proclaimed “happiest place on earth” wasn’t so happy.

One of the disadvantages of posting once a week is that, unless I muscle in on someone else’s day I can’t respond rapidly to stories that appear early. Of course the flip side of that is that if a story appears over the weekend it’s all mine, and, besides, I have my not-so-super-secret other blog to respond to issues that occur earlier in the week. Another advantage is that, if I do decide to write about something from earlier in the week, I have the advantage of time to think.

You’ve probably figured out that what I’m referring to is the latest measles outbreak. Not surprisingly, it happened in the Los Angeles area. Surprisingly (or perhaps not so much), it happened at Disneyland. I say “not surprisingly” because it’s been well-publicized over the last few years that there are pockets of low vaccine uptake and high personal belief exemptions in California, complete with measles and pertussis outbreaks. This is thanks to pockets of affluent, entitled parents full of the Dunning-Kruger effect who think that they can learn as much about vaccines and autism via Google University as pediatricians and researchers who have devoted their entire professional careers to studying them. Of course, these parents are also facilitated by pediatricians who cater to their fears, the most famous of whom is Dr. Bob Sears, whose The Vaccine Book is a very popular, reasonable-sounding (to parents not aware of the antivaccine tropes within) bit of antivax lite, but there is also our old buddy Dr. Jay Gordon and a host of others.

So what happened at Disneyland? On January 7, the California Department of Public Health confirmed seven measles cases:
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Posted in: Public Health, Vaccines

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Skeptic’s Guide to Debunking Claims about Telomeres in the Scientific and Pseudoscientific Literature

The New Year starts with telomeres as the trendiest of trendy biomarkers. As seen in Time, telomeres are the means to monitor our well-being so we can protect ourselves from all sorts from threats, including early death.

A skeptic needs to do considerable homework in order to muster the evidence needed to counter the latest exaggerated, premature, and outright pseudoscientific claims about telomere length being a measure of “cellular aging” and therefore how long we’re going to live.

a-telomere-006

What is a telomere and why does its length matter?

Harriet Hall recently described telomeres:

Every chromosome has a telomere, a repeated sequence of nucleotides at the end of the DNA strand. It is a disposable section that carries no genetic information. For vertebrates, the nucleotide sequence is TTAGGG; this repeats from 300 to several thousand times according to the species of animal. Telomeres are sort of like the aglet, that little hard piece on the end of a shoelace that keeps it from unraveling. They protect the end of the chromosome and keep it from losing important genes or sticking to other chromosomes.

By Ian W. Fieggen (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Telomeres are sort of like aglets. Photo by Fieggen CC BY-SA 3.0 via Wikimedia Commons

Talk of telomeres isn’t just being used to sell dubious diagnostic tests and dietary supplements. There is a strong push to make telomere length the currency of how we think, measure, and do science about our health and well-being, and how we target our health interventions. Strong efforts are made to attach the science of telomeres to urgings that we take up yoga, meditation, and “being there” to save our lives.

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Posted in: Basic Science, Nutrition, Science and Medicine, Traditional Chinese Medicine

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SfSBM at NECSS

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A day of Science-Based Medicine, a weekend of science and skepticism

Registration for NECSS, the North-East Conference on Science and Skepticism, is now open. Included in the program will be a day of Science-Based Medicine.

Speakers will be Harriet Hall, Jann Bellamy, David Gorski, Steve Novella and Mark Crislip.

NECSS will be held April 9th–15th, 2015, in New York City at the Fashion Institute of Technology. The SfSBM part of the program will be Friday, April 9 10 (that’s the 10th, not the 9th) and you can attend one or more of the days. $95 for one day or $195 for the entire conference.

The precise program will be announced soon.

For more information and to register, go to NECSS or this registration page.

The Society for Science-Based Medicine is a co-sponsor of NECSS and paid SfSBM members can get a 15% discount using the code SFSBM2015.

Posted in: Announcements

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Mel asks and I do my best to answer.

Several snarks were painfully maimed in the writing of this blog post

Several snarks were painfully maimed in the writing of this blog post

I read a lot of the pseudo-medical websites. The writing is at best pedestrian, often turgid, and, at its worst, incoherent. It is rarely either engaging or clever.

Wit, the clever bon mot, the amusing turn of phrase or retort, is rare at best. So rare I cannot think of an example. It is ironic that those who engage in fantastical treatments are so often lacking in cleverness with language and thought. The closest you get to humor are the painfully-lame cartoons at the Natural News. I am sure that the readers will flood the comments with examples of all the clever writing I have missed in the world of pseudo-medicine just to prove me wrong. Not that the reality-based world is much better. It is the rare author on the internet whose style keeps me coming back for more.

But for some reason I found “Dear Science Based Medicine, Just a Few Questions About Acupuncture” funny and engaging, at odds with most of the purple quasi-paranoid articles I normally read. Just the right amount of chatty snarkiness to be enjoyable, at least for me. So refreshing given the style of the usual pro-acupuncture comments. Your millage may vary. (more…)

Posted in: Acupuncture, Critical Thinking, Energy Medicine, Traditional Chinese Medicine

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2014: Chiropractors, naturopaths and acupuncturists lose in state legislatures

I am happy to report some good news: chiropractors, naturopaths, acupuncturists and assorted other practitioners of pseudo-medicine didn’t fare too well in the 2013-2014 state legislative sessions.

We’ve been following their legislative efforts all year over at the Society for Science-Based Medicine. Some state legislatures meet in yearly sessions. At the end of the year, pending bills die with the session. Some meet only every other year. Others meet in two-year sessions and, in some of these, legislation introduced in one year carries over to the next year. All states with two-year sessions ended these sessions at the close of 2014, except New Jersey and Virginia. If you want to see how your state operates, several websites can help you: MultiState Associates, National Conference of State Legislatures and StateScape.

Chiropractors

Chiropractors are already licensed in all 50 states and all of their practice acts permit the detection and correction of the non-existent subluxation. Having achieved that goal, the focus of chiropractic legislative efforts is to expand their scope of practice (the holy grail, for some, being primary care physician status), turf protection and mandates requiring insurance reimbursement or their inclusion in various activities, such as sports physicals, concussion treatment, and scoliosis detection programs.

The most interesting chiropractic bill, one from Oklahoma, didn’t fall into any of those categories:

Chiropractic physicians in this state shall obtain informed, written consent from a patient prior to performing any procedure that involves treatment of the patient’s cervical spine and such informed consent shall include the risks and possible side effects of such treatment including the risk of chiropractic stroke.

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Posted in: Acupuncture, Chiropractic, Diagnostic tests & procedures, Herbs & Supplements, Homeopathy, Legal, Naturopathy, Politics and Regulation, Traditional Chinese Medicine

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Neuroscience and Destiny

brainA newly-published review of neuroscience research looking at the predictive value of functional and anatomical imaging raises interesting questions about the role of such studies in learning, psychiatric treatment, and even the treatment of criminals. “Prediction as a Humanitarian and Pragmatic Contribution from Human Cognitive Neuroscience” by Gabrieli, Ghosh, and Whitfield-Gabrieli and published in Neuron, does a thorough job of explaining the current state of the research and pointing to where future research is needed.

The basic idea is to use noninvasive imaging to look at the structure or function of the brain as a way of predicting future behavior, and then using those predictions to help guide treatment and education interventions, and perhaps decisions regarding parole or further treatment of criminal behavior. This concept raises many issues, including the technology being used, the state of the research, the ultimate potential for this line of research, and ethical considerations.

The major question underlying this entire endeavor is, to what extent is brain anatomy and function destiny? (more…)

Posted in: Science and Medicine

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Is the Ebola Crisis a Reason to Skip RCTs?

Ebola virus

 

In a recent “Perspective” article in The New England Journal of Medicine, three physicians (Drs. Cox, Borio, and Temple) make a strong case for not letting the rush to save Ebola patients tempt us to deviate from good science and skip the randomized controlled trial (RCT). Their arguments cut to the essence of the scientific approach to medicine, and they deserve careful consideration.

Ebola is uniquely scary

Ebola is the kind of threat that really gets our attention. The virus was first identified in 1976, and prior to 2013 there were several small outbreaks in Africa with death rates as high as 90%. This time the death rates are lower, but the numbers are much greater. It has spread to several African countries, and a few cases have even reached the US and Europe due to infected travelers and health care workers. We face a risk that Ebola may become endemic, smoldering along as a constant presence in Africa.

There is no known effective treatment. Fear of Ebola has sparked bizarre conspiracy theories and claims of “natural” cures and prevention kits from homeopaths, alternative medicine advocates like Mercola, and purveyors of remedies like colloidal silver and essential oils. These have been covered on SBM here, here, and here. (more…)

Posted in: Clinical Trials, Science and Medicine

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Is cancer due mostly to “bad luck”?

One of the more difficult conversations to have with a patient as a cancer doctor occurs when a patient, recently informed of her diagnosis of, for example, breast cancer, asks me, “Why did I get this? What caused it?” What almost inevitably follows is an uncomfortable conversation in which explanations of the multiple known causes of breast cancer do not satisfy the patient. The reason, of course, is because when a patient asks, “What caused it?” she doesn’t mean what causes breast cancer in general or in statistical terms. Rather, she means, what caused my breast cancer? It’s a question that can only occasionally be answered. For instance, if it’s lung cancer and the patient is a smoker, then it was almost certainly smoking that caused the cancer, because lung cancer is a relatively rare cancer in the absence of smoking. In the case of breast cancer, contrary to the prevailing belief that leads women with breast cancer to be puzzled about how they could get it when there’s “no cancer” in their families, only around 5-10% of cases have a familial or genetic component. That means that around 90% of breast cancers are what we call “sporadic,” which means that we can’t identify a specific cause. Or, as I like to say, “We just don’t know.” Worse, in the case of breast cancer, the environmental factors we know about appear to contribute modestly at best to the risk of cancer. (More on this later.)

Understandably, patients hate hearing “We just don’t know,” some vague handwaving about genes, and that there is nothing that we know of that they did that caused their cancer. People—including oncologists—really don’t like the concept of “sporadic” cancer, mainly because humans crave explanation. The default assumption is that everything must happen for a reason and there must be a cause for every disease or cancer. Perhaps the most ridiculously emphatic statement of this that I’ve encountered thus far comes from (who else?) über-quack Mike Adams when he heaped contempt on the idea of sporadic disease as “spontaneous disease.” He did this in the context of a story describing how, after Dr. Mehmet Oz had followed recommended care and undergone screening colonoscopy to look for polyps, he was shocked that he actually had some. This led Adams, in his usual inimitable fashion, to construct a straw man so massive that it could be seen from space when he set it on fire, declaring that “colon polyps, in other words, appear without any cause!” and that “mainstream medicine…believes in the theory of ‘spontaneous disease’ that ‘strikes’ people at random.”

Not exactly.

On the other hand, there is a lot of randomness in disease, not just cancer, as hard as it is for Mike Adams, or anyone to accept. Just because there is a varying amount of randomness in who gets a disease does not mean that mainstream medicine claims there is no cause to these diseases. Rather, for diseases like cancer, it’s a stochastic process, meaning that chance can play a role—sometimes a big role—in determining who gets sick. Indeed, just last week there was more evidence supporting this idea published in Science. Unfortunately, much of the mainstream press coverage presented the message of the paper a bit too simplistically. Even more unfortunately, it was the authors who encouraged this, as did the Johns Hopkins University press release about the study, which was entitled “Bad Luck of Random Mutations Plays Predominant Role in Cancer, Study Shows“. Yes, I groaned when I read this title.
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Posted in: Basic Science, Cancer, Epidemiology, Science and the Media

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Acupuncture for Withdrawal Symptoms in Critically Ill Infants

weebleswobble

Like acupuncture, Weebles wobble, but they don’t fall down.

The practice of medicine, particularly our pharmaceutical and surgical interventions, involves a constant struggle between risk and benefit. If the physiology or anatomy of the human body is altered, even with the best of intentions, there is always a potential downside. There are certainly instances where the risk to benefit ratio is extremely favorable or unfavorable and the right recommendation is obvious, and unfortunately there are times when it isn’t entirely obvious what the next step should be. But there has been a trend of steady progress in regards to improved safety and efficacy over the past several decades.

The treatment of pain has of late been one of those areas where the picture is becoming a bit less cloudy. We are learning more and more about the potential negative outcomes related to the long term use of opioid medications, such as physical dependence, addiction and even chronic pain. The way that these drugs have been prescribed in many patients has caused more harm than expected, and in some instances more hurt than help. Doctors generally strive to alleviate pain and suffering but, once again, good intentions don’t decrease risk.

In the neonatal and young infant population, the management of pain has had a rocky history. I’ve written about pediatric pain in the past, in particular the potential difficulties in managing acute pain. I won’t go into detail (read my prior post), but we have truly come a long way since the days of performing major surgery on newborns without any analgesia at all. There are areas where we need to do better, however. Children are still less likely than adults to be adequately treated for pain.

But things have improved. And as more children receive appropriate management for pain, the side effects of that management must increasingly be dealt with by healthcare professionals, the patients and their families. One of the issues that is typically observed and managed in neonatal and pediatric intensive care units is physical dependence and the subsequent occurrence of withdrawal symptoms.
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Posted in: Clinical Trials

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Detox: What “They” Don’t Want You To Know

Happy New Year! Today’s post was some old material, dusted off, repackaged, and updated for 2015.

New Year, New You, right? We’re just into 2015, and you’ve resolved to finally get serious about your health. Starting today. But first need to cleanse yourself, eliminating last year’s lifestyle and dietary sins. You’ve seen the ads and the Facebook links, all suggesting you need a “detox”, “cleanse” or “flush” to be healthy. Supplements, tea, homeopathy, coffee enemas, ear candles, and footbaths promise you a detoxified body. Amazon has entire detox and cleansing categories in supplements and books. The descriptions all suggest detoxing will deliver a renewed body and better health – it’s only seven days and $49.95 away. Dr. Oz has several detox plans – you just need to decide which one. The local naturopath sells detoxification protocols, including vitamin drips and chelation. Even your pharmacy probably has a wall of products for sale. Wouldn’t a purification from your sins of 2014 be a good idea to start the year? Unfortunately, there’s something very important that detox promoters aren’t telling you. (more…)

Posted in: Health Fraud, Herbs & Supplements, Homeopathy, Naturopathy

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