I knew milk alternatives were becoming mainstream when a new bakery/café appeared in my neighborhood. I ordered a latte and learned that they didn’t use milk. At all. Not only were the baked goods vegan, organic, “natural” and some were gluten-free, they were completely dairy-free for their coffee beverages. While everything looked and smelled great, I was shocked that they had no milk on the premises. The milk alternative made with soy didn’t taste bad, but it didn’t taste like milk. I left with my coffee, wondering how long the place would survive. I was wrong. It’s been a few years and the shop is still here, suggesting there’s a sizable appetite (at least in my laid-back, coffee-shop-saturated neighborhood) for milk-free, wheat-free vegan food and drinks. I shouldn’t be surprised. The number of people on restricted diets seems to be growing, and so have the food choices to meet their dietary demands. There have always been people that avoided milk, but the reason was traditionally lactose intolerance or dairy allergies. Now more are simply choosing to avoid it. I’m often asked about the merits of milk and the multiple milk alternatives, as the assessments of dairy seems to take one of two positions: Either milk is the dietary equivalent of unicorn tears, a nearly perfect food, or it is poison that’s almost certainly killing us. What’s clear is that we have more choice than ever for milk-like beverages. My local grocery is pictured above, where cow’s milk is just one small section. Who knew you could milk cashews? (more…)
It is long past time to close the door on homeopathy. After thousands of studies, homeopaths are still unable to produce convincing evidence that homeopathy works for any indication. Multiple reviews of the evidence have come to this conclusion, and now we have one more to add to the pile – the Australian National Health and Medical Research Council (NHMRC) just published their report after reviewing the clinical evidence and have concluded that homeopathy doesn’t work for anything.
Homeopathy is a prescientific medical philosophy based upon the fanciful notions that like cures like (which is really an expression of sympathetic magic) and that extreme dilutions of a substance can retain the magical essence of the substance. These ideas were silly two centuries ago when they were invented. The scientific advances we have made since them have only deepened this conclusion. Homeopathy should have been tossed onto the scrap heap of history along with phrenology, humoral theory, mesmerism, and other quaint ideas. Its persistence is testimony to the power of cultural inertia.
Despite the fact that homeopathic potions have essentially zero scientific plausibility (as close to zero as we can get in science), a great deal of resources have been wasted testing homeopathy clinically. The recent NHMRC review identified more than 1,800 studies, of which 225 were of sufficient size and rigor to include in the review. They report:
The review found no good quality, well-designed studies with enough participants to support the idea that homeopathy works better than a placebo, or causes health improvements equal to those of another treatment.
Although some studies did report that homeopathy was effective, the quality of those studies was assessed as being small and/or of poor quality. These studies had either too few participants, poor design, poor conduct and or [sic] reporting to allow reliable conclusions to be drawn on the effectiveness of homeopathy.
According to CEO Professor Warwick Anderson, “All medical treatments and interventions should be underpinned by reliable evidence. NHMRC’s review shows that there is no good quality evidence to support the claim that homeopathy works better than a placebo.”
In 2013 the NHMRC published a review of the clinical evidence for homeopathy, and they broke this down by medical condition. Of the 68 medical conditions they examined, for 7 of them there was no quality evidence from which to draw any conclusions. For 61 of the conditions there was evidence for lack of efficacy – not just a lack of evidence showing that homeopathy works, but evidence showing that homeopathy does not work. (more…)
In 2008 I wrote about neuroplasticity as presented in Norman Doidge’s book The Brain That Changes Itself. I urge you to click on the link and read what I wrote there before you continue. The science is fascinating. The brain is far more malleable than we once thought. Areas of the cortex devoted to a sensory input shrink when that input is lost. Neurons from other parts of the brain can be co-opted to take over lost functions. Learning a new skill actually changes the structure and function of the brain: the areas of the cortex devoted to that skill enlarge as the new skill is practiced and perfected.
This is exciting stuff, with potential therapeutic applications in chronic pain, brain damage, and chronic illness. When I reviewed that book, I said I thought Doidge was a bit overenthusiastic; and now he has written a follow-up book that is even more overenthusiastic. In The Brain’s Way of Healing: Stories of Remarkable Recoveries from the Frontiers of Neuroplasticity, he slips into unscientific speculations and relies on anecdotes about patients who have allegedly benefited from practical applications of brain plasticity science. The title is accurate: these are stories, not scientific studies. I continue to find the subject fascinating and to believe that neuroplasticity offers a lot of potential for human healing, but I don’t believe we have learned much about practical ways to accomplish that. Doidge’s book goes beyond the science. (more…)
A few months ago, Steve Novella and I published an article in Trends in Molecular Medicine entitled “Clinical trials of integrative medicine: testing whether magic works?” It was our first foray together into publishing commentary about science-based medicine versus evidence-based medicine, using a topic that we’ve both written extensively about over the years on this blog and our respective personal blogs. Specifically, we discussed whether it is worthwhile to do randomized clinical trials (RCTs) testing highly improbable treatments, such as reiki and homeopathy, both of which have no physical basis to believe that they do anything whatsoever. As I’ve said many times before, reiki is simply faith healing in which Eastern mysticism is substituted for Christian beliefs, and homeopathy, as we’ve discussed many times here on SBM, is vitalistic sympathetic magic with no evidence to support its two laws.
To our surprise, that article generated a fair amount of press (for example this), with accounts of it showing up in the media in various places and Steven and I being asked to do a fair number of interviews. Part of the reason, I suspect, is that the editor made the article available for free for a month after its initial publication. (Unfortunately it’s back behind the pay wall again.) Part of the reason is that, intuitively, it makes sense to people not to waste money testing what is, at its core, magic. When I followed up that publication with an article criticizing “integrative oncology” in Nature Reviews Cancer entitled “Integrative oncology: Really the best of both worlds?“, the target was well and truly on my back. Indeed, let’s just say that the Society for Integrative Oncology and the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) are quite unhappy with me. When both their letters to the editor are published (right now, only one is), I might even blog about them.
In the meantime, I want to deal with criticism published in an unexpected place, albeit not by unexpected critics. The reason is that this criticism relies on a common straw man caricature of what we are saying when we advocate science-based medicine (SBM) that considers prior plausibility in determining what modalities to test in clinical trials and understands Bayesian thinking in which prior plausibility affects posterior plausibility that a “significant” result is not a false positive in contrast to the current evidence-based medicine (EBM) paradigm, which relegates basic science knowledge, even well-established principles of science that show that something like, say, homeopathy or reiki is impossible under the current understanding of physics, chemistry and biology, to the lowest rung on the EBM pyramid. It’s also a criticism that comes up frequently enough that, even though it’s been addressed before in various ways by various SBM bloggers, it’s worth revisiting from time to time. In this case, that’s particularly so because one of the two critics taking Steve and me to task is currently embroiled in a controversy about testing homeopathy for attention deficit hyperactivity disorder (ADHD) at the University of Toronto (more details on that later). Let’s just say, the criticism of Steve and me gives me an “in” to address a story that I thought had passed me by, and I intend to take it.
We all construct our narrative based on our biases and spin the facts so that the narrative confirms our biases. Among other characteristics, what separates an SBM provider from a SCAM provider is realizing that biases are always active and apply to me as well as everyone else.
My biases are simple: I am skeptical that humans can reliably understand reality without assistance and the best source of assistance is science.
I have a job where the expectation is that I will change practice as information changes. How I practiced medicine 30 years ago is very different from how I practice it today. Still, I note it is harder and harder to change my approaches as I get older. I get more set in my ways and it takes more effort to change as new studies are published. Sometimes it seems almost physically difficult.
Again, it is expected that not only will I change my mind over time, as the sole ID doctor at my hospitals, I will be the one to lead the change. Imagine how much harder it would be to change your mind if you were committed to a universal truth such as those that are alleged to underlie reiki or chiropractic. Years committed to a pseudo-medicine probably renders changing one’s mind virtually impossible. (more…)
Note: In addition to this brief endorsement of Britt’s website, I have also posted my regular every-other-Thursday post, this week discussing the actions taken by the State of Florida to prevent Brian Clement, of the Hippocrates Health Institute, from practicing medicine.
Another note: since this post, Britt has started writing for SBM. See “ND Confession, Part 1: Clinical training inside and out.”
Britt Marie Deegan Hermes had a bad experience with a medical doctor, which piqued her interest in naturopathy. Eventually, she graduated from Bastyr University with an N.D. degree and practiced as a naturopath for about 3 years. But her confidence in naturopathy withered as she watched fellow naturopaths practice in Tucson, Arizona. Her disenchantment with naturopathy drove her back to medicine and science. Britt left naturopathic practice behind and is now a student in the Medical Life Sciences program at the University of Kiel, in Germany, a Master’s of Science program focusing on biomedical research. Britt is not turning her back on those who suffer from what she calls the “blatantly false, unethical, and dangerous practices” she saw during her time as a naturopath. Nor is she willing to remain silent while other idealistic young people are drawn into studying what she describes as
a system of indoctrination based on discredited ideas about health and medicine, full of anti-science rhetoric and ineffective and sometimes dangerous practices.
Note: Also posted today is a brief profile of a new blog, Naturopathic Diaries: Confessions of a Former Naturopath, by Britt Marie Deegan Hermes, a trained naturopath who became disillusioned with her profession. I encourage you to have a look!
The State of Florida has finally taken action against Brian Clement.
David Gorski, Orac, and the Canadian media, especially the Canadian Broadcasting Corporation (CBC), have done an excellent job of chronicling the activities of “Dr.” Clement. All have reported on Florida’s taking action against Clement. I’ll give a brief background here, most of which comes from Dr. Gorski’s most recent post, as well as add some information and observations to theirs.
Hippocrates Health Institute, located in West Palm Beach, Florida, is licensed as a massage establishment by the state and run by Brian Clement and his wife, Anna Maria Gahns-Clement. Clement and Hippocrates came to the attention of the Canadian media when, last year, the families of two Canadian aboriginal girls withdrew their children from conventional cancer treatment, including chemotherapy. Prior to that, Clement had basked in the glory of fawning reports from local media, one of which described him as having an “inimitable, engaging style.” Another described him as coming “fresh from a detoxifying sauna” to the interview.
Had they completed conventional treatment, both girls had a very good chance of survival. The families opted instead for traditional medicine as well as “alternative medicine” at Hippocrates. Each paid a reported $18,000 for participation in a “Life Transformation Program” there. This included, for at least one of the girls, cold laser therapy, vitamin C injections and a strict raw vegetable diet.
Positive change not only requires a valid argument, it requires political will. My colleagues and I have been pointing out for years that vaccines are safe and effective, and the anti-vaccine movement, which is built largely on misinformation, threatens the public health by eroding herd immunity. These arguments are no more valid today than they were five or ten years ago (except that new scientific evidence continues to support our conclusion).
We also predicted that it will likely take the significant return of vaccine-preventable diseases to muster the political will to effectively push back against the anti-vaccine movement. Parents need to be more afraid of infectious disease than the false fearmongering surrounding vaccines. We, of course, did not want this to happen, we just thought this was a likely scenario.
I did not think, however, that it would be so sudden and dramatic. The Disneyland measles outbreak created an undeniable media and popular backlash against the anti-vaccine movement. Recent evidence for this is the Jimmy Kimmel segment in which he blasted anti-vaxxers and showed a fake PSA in which real doctors express their frustration over vaccine refusers. Anti-vaxxers replied with their usual shrill nonsense, comparing Kimmel’s statements to hate speech and falsely accusing him of attacking autistic children. Kimmel responded with still more ridicule, making a mockery of anti-vaxxer tweets attacking him. Being the butt of late night comedian jokes is a reasonable sign of popular backlash.
Popular opinion, which is turning against vaccine refusers for threatening the public health, translates into political will. In the case of vaccines there is a specific focus for this political will – state laws allowing exemptions from the requirement for children to be up to date on their vaccines in order to attend public school.
Chronic fatigue syndrome (CFS) is a controversial diagnosis that has also been called myalgic encephalomyelitis (ME or ME/CFS), post-viral fatigue syndrome (PVS), chronic fatigue immune dysfunction syndrome (CFIDS), Iceland disease, “yuppie flu,” and many other names. A new report from the Institute of Medicine (IOM) says that none of those names really fit the disease and recommends it be re-named systemic exertion intolerance disease or SEID.
ME/CFS is thought to affect as many as 2.5 million Americans. The cause remains unknown, but in many cases it appears to have been “triggered by an infection or other prodromal event, such as immunization, anesthetics, physical trauma, exposure to environmental pollutants, chemicals and heavy meals, and rarely blood transfusions.” Some doctors question its very existence and interpret the symptoms as imaginary or psychological.
The IOM examines the evidence base
At the request of several government agencies including the NIH and the FDA, the IOM convened a committee of 15 experts to examine the evidence base for ME/CFS. They reviewed over 9,000 published studies and heard testimony from patients and advocates. Before publication, an additional 15 experts were asked to provide peer review. The full text of the report is available free online. (more…)
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.