Articles

Australian Chiropractor Ian Rossborough Promises to Stop Treating Children…for Twenty Days

kangaroochiro

An Australian chiropractor treating a baby kangaroo makes as much sense as treating a human child

Before I begin this brief update to my recent post on Australian baby chiropractor Ian Rossborough’s “crack heard round the world,” I want to give a quick thanks to Jann Bellamy for organizing our day of Science-Based Medicine at NECSS last week. It was an amazing experience sharing the stage with the SBM crew for my first public presentation, and finally getting to meet Scott, John, and Saul. I’ve given hundreds of lectures to residents and students, and even a grand rounds or two, but this was orders of magnitude more exciting and stressful. I may be biased, but I think we nailed it.

With NECSS prep taking up a significant percentage of my time and a rough current work week making up for days off, my post today is a little shorter than usual. My overall average word count still gives Gorski a run for his money however. Well, that’s not actually true. Gorski is in another league.

Rossborough provides an undertaking?

Chiropractor Ian Rossborough, who I recently discussed in a post on the backlash against pediatric chiropractic in Australia, has received the slap on the wrist I sadly expected. According to the Australian Health Practitioner Regulation Agency website, which has jurisdiction over the Chiropractic Board of Australia when it comes to “professional conduct, performance or health of registered health practitioners,” Rossborough has promised to leave them kids alone:
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Posted in: Chiropractic, Science and Medicine

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Where science meets supplements

Various herbal remedies and supplements.

Various herbal remedies and supplements.

For those of you that missed the Science-Based Medicine day at NECSS last week, I’ve put the highlights in the following post:

The supplement industry is big business, and the popularity of these products seems to keep growing. I once worked at a small independent pharmacy that specialized in supplements, homeopathy and “alternative medicine” as way to differentiate itself from the big chain pharmacies. A lot has changed in a decade. Today, even national chain pharmacies have aisles and aisles of herbal remedies, dietary supplements, and even homeopathy. Yet despite the preponderance of products on store shelves, there is little evidence to suggest that supplements are necessary or even improve health (and may even cause harm). The right for consumers to buy products for themselves, and make their own self-care decisions, is an important one that respects individual autonomy. Regrettably, the regulations of these products are so weak and ineffective that the sale of these products quite possibly harms, rather than helps, the average consumer. The system is rigged against consumers, and it prevents the use of supplements in an evidence-based way. (more…)

Posted in: Herbs & Supplements

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National Academy of Sciences Report on GMOs

NASGMOreportDespite the fact that numerous scientific and health organizations around the world have examined the evidence regarding the safety of genetically modified organisms (GMOs) and found them to be completely safe, there remains a public controversy on this topic. In fact a Pew Poll found that while 88% of AAAS scientists believe that GMOs are safe for human consumption, only 37% of the public do – a 51% gap, the largest in the survey.

This gap is largely due to an aggressive anti-GMO propaganda campaign by certain environmental groups and the organic food industry, a competitor which stands to profit from anti-GMO sentiments. There is also a certain amount of generic discomfort with a new and complex technology involving our food.

Because of all this, the National Academy of Sciences put together an expert committee to systematically review all the evidence regarding this new technology. Their thorough 407 page report is now available.

They pulled together experts with diverse backgrounds, and also took public comment and solicited input from a wide range of interests. They decided specifically not to rely on any previous review, but to conduct their own review of the primary literature. (more…)

Posted in: Public Health

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Hormone Replacement Therapy for Menopausal Symptoms: Setting the Record Straight

HRT
Whether you call them hot flashes or “power surges,” the symptoms of menopause can be very distressing. They were routinely treated with hormone replacement therapy (HRT) until the Women’s Health Initiative study in 2002 persuaded many patients and doctors to abandon that treatment. The results of that study were misunderstood by some and questioned by others, and there continues to be confusion about what the evidence shows and how menopausal symptoms should be treated. We have learned much more about this subject since 2002. HRT is still the most effective treatment and can be used safely under the new treatment guidelines.

The history of hormone replacement therapy

In the second half of the 20th century, there was much enthusiasm about estrogen. Mimicking the estrogen levels of a young woman was seen as a way to remain young and healthy. Doctors recognized that there were risks, but they seemed minor. There were studies showing that HRT protected women from the increased risk of heart disease after menopause. Few if any doctors prescribed it solely to prevent heart disease, but cardiovascular protection and osteoporosis prevention were seen as added benefits that served to tip the balance towards a decision to prescribe it for menopausal symptoms.

Then the Women’s Health Initiative study (WHI) dropped a bomb. It found that HRT didn’t protect women from cardiovascular disease after all. It showed that HRT did more harm than good. The number of prescriptions dropped by as much as 80%. Many women turned to alternative treatments that had not been studied anywhere near as extensively as HRT. (more…)

Posted in: Obstetrics & gynecology, Pharmaceuticals

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Nobody licenses quacks in my state! HB 4531 and the licensing of naturopaths in Michigan

Just as nobody steps on a church in Peter Venkman's Manhattan, nobody licenses quacks in my state...I hope.

Just as no giant marshmallow man steps on a church in Peter Venkman’s Manhattan, nobody licenses quacks in my state…I hope.

Over the years, I’ve taken care of women with locally advanced breast cancer so advanced that it’s eroded through the skin, forming huge, nasty ulcers filled with stinky dead cancer tissue that’s outgrown its blood supply, leaving the patient in chronic pain. If the patient is fortunate, her cancer has not metastasized beyond her axillary lymph nodes (the lymph nodes under her arm), and her life might still be saved by a combination of chemotherapy, radical surgery, and radiation. If the patient is not fortunate, either the cancer has metastasized and she is doomed or hasn’t metastasized yet, but it’s invaded into the chest wall and the nerves in her axilla (the structures under the arm), making it impossible to remove surgically but not likely to kill her any time soon. In the latter case, chronic pain, infection, and blood loss is what the patient will look forward to until the cancer either metastasizes or invades a vital structure. Fortunately, I’ve only seen a handfull of these patients over the last 20 years. Fortunately, the number of such patients I’ve seen and taken care of has been small.

I fear that, before long, I’m going to bee seeing a lot more of them. Leave it to Jann Bellamy to wake me up to that possibility.

I’m referring, of course, to her post last week about yet another attempt by naturopaths to expand their scope of practice. Worse, this is happening in my state through Michigan House Bill 4531, which has been approved by the Michigan Committee on Health Policy and referred to the full House for consideration. Yes, of these patients I’ve seen with horrific neglected breast cancers, at least half of them had relied on naturopaths before they came to the attention of real oncologists and surgeons. The last time I wrote about naturopaths trying to expand their scope of practice in my state was in 2013 in the form of a bill that was not as broad as HB 4531, namely HB 4152. Fortunately, it went nowhere and, in contrast to HB 4531, didn’t even make it out of the Committee on Health Policy.

Although Jann has already ably discussed the bill and occasional Science-Based Medicine (SBM) contributor Peter Lipson has referred to naturopaths as fake doctors in white coats (which is true), as well as why naturopathy is unscientific and how he as a primary care internist not infrequently has to clean up the messes left when local naturopaths treat patients incompetently, this is my state, and I can’t help but chime in myself. What I will try to do is to predict what the potential consequences will be if HB 4531 passes and expands the scope of practice to be nearly as broad as that of MDs practicing primary care medicine. I will do that by looking at real world examples of naturopathic shenanigans and disasters both within our very own state, because these are the people with whom the reins of primary care will be shared if HB 4531 were to pass.
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Posted in: Homeopathy, Naturopathy, Politics and Regulation

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“Integrative” medicine versus “alternative” medicine

“Integrative” medicine versus “alternative” medicine

I’ve written a lot about the language issue with respect to alternative medicine. As I like to put it (at least in shortened form), first there was quackery. Quacks did not like that name at all, and thus was born alternative medicine. And the quacks did think it good—for a while. There was a problem, however. “Alternative” medicine implied (correctly, of course) that what was being discussed was not real medicine, and the quacks could not abide that. Thus was born “complementary and alternative medicine” (CAM).

And the quacks thought this very good indeed.

Unfortunately, it was not long before the problem with the term CAM became apparent. It had the word “complementary” in it. The implication of that word, of course, is that what they were doing was still somehow not real medicine. It was complementary to real medicine, the icing on the cake, if you will. Real medicine could do without it, and having that implication in the very name that their evolving specialty had taken on was offensive to the quacks.

So they changed it.
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Posted in: Basic Science, Critical Thinking, Science and the Media

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Vaginal Seeding. Ew. That’s nuts. Hmmm, interesting.

A breakdown of bacterial species from your skin's microbiome. As a favor to

A breakdown of bacterial species from your skin’s microbiome. As a favor to pregnant women expectant fathers teenage boys on the internet everyone, this is the image I went with. Click to macrolaarggen (Ikean for embiggen).

Sometimes a headline will cause me to run through a series of reactions in rapid sequence. For example “Mothers facing C-sections look to vaginal ‘seeding’ to boost their babies’ health”:

Early studies show that swabbing a mother’s vagina and transferring it to her baby’s mouth, eyes and skin may stimulate microbiome development similarly to babies born naturally – and protect it from health issues later in life

I mean ick.

But take a step back. Not really. I tend to think of people like “Pig Pen” in Charlie Brown, shedding skin and bacteria into the environment. If we were to really think about each other’s microbiome, we might not have intimate contact with our significant other. Or any other animal. I always point out, when someone lets their dog lick them, that they (the dog) had probably just licked its rear, AKA dog-ass seeding. And no, a dog’s mouth is not cleaner than a human’s, unless your dog brushes and flosses with greater frequency than you. (more…)

Posted in: Basic Science, Evolution, Faith Healing & Spirituality, Humor, Nutrition

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Legislative Alchemy: Michigan House Bill 4531 gives naturopaths a broad scope of practice

Legislative Alchemy

Legislative Alchemy

Michigan House Bill 4531, if passed, would give naturopaths one of the broadest scopes of practice in the U.S., essentially equaling that of a family practice MD or DO. The bill made it through all the necessary House committees and is now before the House for an initial vote determining whether it will proceed further in that body. If it passes there, it will move to the Senate and its committee process.

Most naturopathic licensing bills fail, even in those states where attempts are made year after year. Michigan is no exception. Both David Gorski (a Michigan resident) and I discussed the previous licensing attempts there. In the two states where naturopathic licensing or registration has succeeded in the last few years, they have been able to get only a much more limited scope of practice than the full primary care scope they desire. For example, in Colorado, there are severe limitations on naturopaths’ seeing pediatric patients. They must disclose they are not physicians, recommend to parents that their children have a relationship with a licensed pediatric practitioner, and give parents the CDC-recommended vaccination schedule. All this is to thwart their efforts to talk parents out of vaccinating their children by giving them “balanced” information that is actually full of anti-vaccination dog whistles.

In Maryland, where naturopaths are regulated by the Maryland Board of Physicians, they cannot call themselves physicians or claim to practice primary care. They must have a collaboration and consultation agreement with an MD or DO and attest to the Board that the ND will “refer patients to and consult with physicians and other health care providers.” NDs must also have patients sign a consent form stating that the ND’s practice is limited to the scope of practice allowed by law. They cannot deviate from what is termed “safe care of patients” whether or not actual injury to a patient is established.

If passed, HB 4531 would be a radical departure from that trend. This newfound success in moving the ball forward may be due to an influx of funds from Emerson Ecologics, a company that sells dietary supplements and homeopathic remedies to naturopaths for resale to their patients. The company also sells the sort of dubious diagnostic tests used by naturopaths in their practice. For example, they offer a test for “adrenal stress” (to discover, not just “adrenal fatigue,” but actual “exhaustion”) and a saliva test for hormone levels as an indicator of the need for “bio-identical hormones.” (Neither the test nor “bio-identical hormones,” which is actually a marketing, and not medical term, are recommended in evidence-based medical practice.) In March, Emerson Ecologics announced a “grant” to the Michigan Association of Naturopathic Physicians (MANP) of $10,000 to support the effort to obtain full licensure for naturopathic doctors in Michigan.
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Posted in: Legal, Naturopathy, Politics and Regulation

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A Harris Poll on “Alternative Medicine”

One can only imagine how annoyed Twain would have been had he known about opinion polls.

One can only imagine how annoyed Twain would have been had he known about opinion polls.

Mark Twain popularized the phrase, “There are three kinds of lies: lies, damned lies, and polls and surveys.” (He may have said “statistics” at the end, but I think this version works as well.)

A new Harris Poll on “alternative medicine” nicely demonstrates some of the problems with polls. The biggest problem is how you frame the questions. You can dramatically affect the results of the poll by exactly how a question is phrased, which other questions come before or after the question, and the overall context of the poll.

In essence a poll is a two-way form of communication. While it is meant to derive information from the subjects of the poll, those subjects are also receiving information from the poll itself. That is the very reason for “push polling” – which is the practice of disguising campaigning messages as a poll. (“On a scale from 1-5, how much are you bothered by the fact that candidate X is a misogynist?”). Yes, Prime Minister has an amusing example of this practice in action.

Interpreting the results of a poll is also not straightforward. You have to know how the subjects of the poll interpreted the questions, and what factors might affect their response. (more…)

Posted in: Commentary

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The “Incoherent Mess” That Is Homeopathy: Old and New Insights

jongh-paper-1stpage
Back in 1943 a Dutch physician, David Karel de Jongh, wrote a PhD dissertation on homeopathy. It was based on his experience working in a homeopathic hospital and on all the published information he could find, and was highly critical of homeopathy. It was an impressive opus, with over 200,000 words. It is way too long for the average reader to wade through; and since it is in Dutch, few of us could read it even if we wanted to. Jan Willem Nienhuys, secretary of the Dutch skeptics’ organization Skepsis, has done us a great favor by summarizing its contents and updating it with information about recent developments. He has kindly had his summary translated into English and published in full on the Skepsis website. He comments “Basically Dr. de Jongh’s conclusions were that homeopathy is an incoherent mess.”

We all should know by now how monumentally silly homeopathy is (“delusions about dilutions”). I had investigated the subject and knew enough about it to have written about it repeatedly, but there is much more that I didn’t know. Nienhuys’ article is full of surprising facts and fascinating details. (more…)

Posted in: Homeopathy

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