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Sky Maul

The worst part of flying is the take off and landing. Not that I am nervous about those parts of the trip, it is that I am all electronic. Once I have to turn off my electronic devices, all I am left with is my own thoughts or what is in the seat pocket in front of me. Since there is nothing to be gained from quiet introspection, I am stuck with either the in-flight magazine or SkyMall. I usually choose the latter. SkyMall, for those of you who do not fly, is a collection of catalogs bound in one volume. I have occasionally purchased products found in SkyMall and thumb through it with mild interest.

This time one product caught my eye, the Aculife home acupuncture/acupressure device. I had never noticed the ‘health’-related products in SkyMall before, usually looking for electronic gadgets that I really do not need. I was curious. How many other products besides Aculife are in the catalogue? According to the interwebs, about 100,000,000 Americans fly every year and well over half a billion people world wide. A lot of people can potentially look at SkyMall, including the occasional skeptic.

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Posted in: Acupuncture, Science and Medicine

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CAM and the Law Part 3: Malpractice

It is with some trepidation I venture into the next subject in this series — malpractice law. This is a touchy subject for healthcare providers, for obvious reasons. Regardless of the flaws in the system, however, malpractice law is one of the mechanisms put in place by government to regulate the practice of medicine. Like the other such mechanisms touched on so far, licensure and scope of practice law, malpractice laws apply to alternative medicine practices in ways that are broadly similar, but sometimes subtly and significantly different, from how they apply to scientific medicine. 

So far, alternative practitioners are sued for malpractice relatively infrequently compared with physicians, presumably because they represent a much smaller fraction of the care provided, they tend to be utilized by those with an ideological bias in favor of their approaches, and they are not viewed as nearly as rich a target for litigation. But this may change if the political and cultural winds blow in the direction of greater utilization of alternative medical approaches. 

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Posted in: Legal, Politics and Regulation

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SBM 1000th Post

I have the pleasure of announcing that this is the 1000th post of Science-Based Medicine. The first post introducing the blog was on January 1st 2008 – almost three years ago. We have published steadily since then, and this post marks number 1000.

I would like to take this time to thank the many regular contributors and editors who have added to the success of SBM, as well as the regular readers and commenters. I would especially like to thank David Gorski, the managing editor, who has done much of the day-to-day management of SBM and is largely responsible for its growth.

We have plans to continue to build SBM into a better and better resource for science in medicine. We are just getting started, so stay tuned.

Posted in: Announcements

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Cloned Beef

The controversy over the human consumption of meat and dairy products from cloned cows continues. The UK Advisory Committee on Novel Foods and Processes, after reviewing the evidence, concluded that there was no substantial difference between meat and dairy from cloned cows compared to conventional cows. However, food products from cloned animals and their offspring remain banned in Europe.

Use of offspring of cloned cows, sheep and pigs are legal in the US, South America, and Asia. Australia is likely to follow suit in a year or two. The European Union (EU) has an effective ban at the moment, but the policy is under review. The UK is also negotiating with the EU regarding the use of clones.

There is not much of a theoretical reason to suspect that cloned animals would present a health risk. The primary concern is that something unanticipated might have occurred during the cloning process, causing the animal to be genetically or developmentally abnormal. However, if the cloning process works properly this should not happen. Further, if mutations do occur, but the animal lives, it is likely that any changes do not represent a risk to humans who consume the meat or dairy from such clones.

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Posted in: Nutrition

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Resident’s Working Hours: Should We Let Sleeping Docs Lie?

The Accreditation Council for Graduate Medical Education (ACGME) has released proposed new standards to limit working hours for medical residents. Bus drivers are allowed to drive for 10 hours and then are required to have 8 hours off duty. Airline pilots can be scheduled for up to 16 hours on duty — being at work, ready to fly — and up to eight hours of actual flight time in a 24-hour period, with a minimum of eight hours for rest between shifts. Physicians in residency training work 80 hours or more a week (compared to 75 hours a month for airline pilots) and are regularly on duty for more than 24 hours at a time. If adequate rest is an important safety measure for drivers and pilots, isn’t it important for doctors too?

When I was an intern and resident, my hours were a little better than some. Instead of every other night, I was on call every third night. I had to work from about 7 AM one day to 5 PM the following day (34 consecutive hours). I stayed in the hospital: there was a call room with a bed, but if we got to lie down it was never for very long. When I got off duty, my sleep-deprived body demanded that I go home and crash. It was only every third day when I worked “only” a 10 hour shift, that I could devote an evening to all the other activities of my life like laundry, grocery shopping, and trying to read medical journals. One memorable weekend I worked from Saturday morning to Monday evening and only got to lie down for about 20 minutes. I don’t think I made any fatigue-induced mistakes that hurt patients, but by Monday afternoon I was groping my way through brain fog and running on fumes. (more…)

Posted in: Politics and Regulation

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Science-based medicine and improving patient safety and quality of care

The last couple of weeks, I feel as though I may have been slumming a bit. After all, comparatively speaking it’s not that difficult to take on claims that homeopathy benefits fibromyalgia or Oprah Winfrey promoting faith healing quackery. Don’t get me wrong. Taking on such topics is important (otherwise I wouldn’t do it). For one thing, some quackery is so harmful and egregiously anti-science that it needs to be discussed. For another thing, they serve as examples of how even the most obvious quackery can seem plausible. All it takes are the cognitive quirks to which all humans are prone plus a bit of ignorance about what constitutes good scientific evidence to support the efficacy of a given therapy for a given condition.

So let’s move on to something a little more challenging.

Of all the attacks on science-based medicine (SBM), one of the favorite attacks made by its opponents is the claim that SBM is dangerous, that it kills or harms far more people than it helps. An excellent example of this occurred when quackery promoter Joseph Mercola teamed up with fellow quackery promoter Gary Null to write a widely cited article entitled Death by Medicine. Using the famous Institute of Medicine article that estimated deaths from medical errors to be on the order of 50,000 to 100,000 per year, Mercola and Null wove a scary story meant to imply that conventional medicine does far more harm than good. Of course, as our very own Harriet Hall pointed out, they concentrated solely on the harm, which makes it difficult to determine whether the harms truly outweigh the benefits. As Peter Lipson puts it, such arguments are intentionally designed to take our fears and exaggerate them out of all perspective. The idea behind the fallacious arguments used by the likes of Mercola and Null is that, because “conventional” medicine has problems and needs to improve its safety record, the quackery they promote must be a viable alternative to SBM. Yes, that is basically what their arguments boil down to.

The fallacious manner in which advocates for quackery such as Joe Mercola, Mike Adams, and Gary Null use and abuse any shortcoming of SBM that they can find (and, when they can’t find any, make some up) notwithstanding, there is a problem in SBM. Indeed, over the last 10 years or so since the IOM report, reducing the toll due to medical errors has — finally — become an incredibly important issue in medicine. Indeed, I myself have become involved in a state-wide quality improvement initiative in breast cancer as our site’s project director. As a result, I’m being forced to learn more about the nitty-gritty of quality improvement than I had ever thought I would. Combine this with a study published just before the Thanksgiving holiday in the New England Journal of Medicine, and I’m learning that improving care is incredibly difficult. The issues involved are many and tend to involve systems rather than individuals, which is why the solutions often bump up against the individualistic culture to which physicians belong. Moreover, such efforts, like comparative effectiveness research (CER), tend to earn less prestige than scientific research because, like CER, quality improvement initiatives do not in general look for new information and scientific understanding but rather at how we apply what we already know.
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Posted in: Clinical Trials, Quality Improvement, Science and Medicine

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What’s with the new cough and cold products?

One of my earliest lessons as a pharmacist working in the “real world” was that customers didn’t always act the way I expected. Parents of sick children frequently fell into this category — and the typical vignette went like this for me:

  1. Parent has determined that their child is sick, and needs some sort of over-the-counter medicine.
  2. Parent asks pharmacist for advice selecting a product from the dozens on the shelves.
  3. Pharmacist uses the opportunity to provide science-based advice, and assures parent that no drug therapy is necessary.
  4. Parent directly questions the validity of this advice, and may ask about the merits of a specific product they have already identified.
  5. Pharmacist explains efficacy and risk of the product, and provides general non-drug symptom management suggestions.
  6. Parent thanks pharmacist, selects product despite advice, and walks to the front of the store to pay.

In many ways, a pharmacy purchase mirrors the patient-physician interaction that ends with a prescription being written — it’s what feels like the logical end to the consultation, and without it, feels incomplete. It’s something that I’m observing more and more frequently when advising parents about cough and cold products for children.

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Posted in: Homeopathy, Legal, Science and Medicine

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Be thankful: No anti-vaccine propaganda at the movies this weekend

It’s Thanksgiving Day here in the U.S., and, despite the crappy economy, there are still things to be thankful for. For instance, skeptical activism can still be effective. On Sunday Skepchick Elyse put out the call to Skepchick readers to complain to movie theaters that were reportedly going to be airing a public service announcement from the anti-vaccine group SafeMinds? (Actually, “public service announcement” is a misnomer; it should be called a public disservice announcement.) The entire PSA was a truly disgusting and deceptive bit of misinformation. In response, Elyse urged Skepchic readers to flood the relevant theaters with complaints about showing an anti-vaccine advertisement prior to its movies.

Now here’s what we can be thankful for: It worked. At least with AMC Theaters. Last night the anti-vaccine propaganda blog Age of Autism, which had been teaming up with SafeMinds to raise money to show these ads during the Thanksgiving holiday weekend admitted as much.

At least for now:

SafeMinds was notified late yesterday afternoon that AMC Theaters has decided to block the SafeMinds Public Service Announcement (PSA) on influenza vaccines with mercury. The PSA alerts parents and pregnant women of the presence of mercury in most influenza vaccines and the ample availability of mercury-free alternatives. The CDC has declined to give a preference for the mercury-free versions, so it is important that the public is aware of its options. AMC’s advertising representative had reviewed and approved the PSA to run in AMC cinemas over the Thanksgiving weekend. A small group of vocal vaccine proponents dismissive of mercury concerns learned of the PSA and bombarded the AMC website, leading to the company’s decision to prevent its release. SafeMinds thanks its supporters who viewed the PSA and contributed to its efforts to educate the public to avoid unnecessary mercury exposure. Mercury in all forms is dangerous, especially to the developing fetus and infants, as referenced on the PSA website www.safemindsflu.org. SafeMinds will continue its mission to educate the public on this important healthcare topic.

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Posted in: Public Health, Science and the Media, Vaccines

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Bill Clinton’s Diet

Bill Clinton loved hamburgers from McDonald’s. He used to eat a typical American high calorie, high fat, meat-based diet. No more. He had a heart attack and a quadruple bypass in 2004. Recurrent blockages required placement of two stents in February 2010. This got his attention and he went on a strict new diet, losing 24 pounds to get back down to what he weighed in high school.

He is now a vegan.

I live on beans, legumes, vegetables, fruit. I drink a protein supplement every morning — no dairy, I drink almond milk mixed in with fruit and a protein powder so I get the protein for the day when I start the day up.

I did all this research, and I saw that 82 percent of the people since 1986 who have gone on a plant-based, no dairy, no meat of any kind, no chicken, no turkey — I eat very little fish, once in a while I’ll have a little fish — if you can do it, 82 percent of people have begun to heal themselves.

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Posted in: Nutrition

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How low can Oprah Winfrey go? Promoting faith healer John of God to the masses

Several of the bloggers on Science-Based Medicine have been — shall we say? — rather critical of Oprah Winfrey. The reason, of course, is quite obvious. Oprah is so famous that if you mention her first name nearly everyone will know exactly of whom you speak. For the last quarter century, her daytime TV talk show has been a ratings juggernaut, leading to the building of a media behemoth and making Oprah one of the richest and most famous women in the world. Unfortunately, part of Oprah’s equation for success has involved the promotion of quackery and New Age woo, so much so that last year I lamented about the Oprah-fication of medicine, which scored me a writing gig in the Toronto Star. Whether it be promoting bio-identical hormones, The Secret (complete with a testimonial from someone who used The Secret to persuade herself not to pursue conventional therapy for breast cancer), Suzanne Somers, the highly dubious medicine promoted by Dr. Christiane Northrup, or foisting reiki aficionado Dr. Mehmet Oz or anti-vaccine “mother warrior” Jenny McCarthy onto a breathless public, arguably no one is a more powerful force for the promotion of pseudoscience in America, if not the world. Truly, the ending of Oprah’s TV show in the spring is a very good thing indeed for science and rationality. Or it would be, were it not for the fact that the reason Oprah is wrapping up her show after a quarter of a century is to start up her own cable channel, so that we can have Oprah-branded and -inspired programming 24/7.

The mind boggles.

Still, my dislike for how Oprah promotes New Age mysticism and pseudoscience on a distressingly regular basis aside, I actually did think there were limits to how low she would go. I actually thought there were limits to how egregiously vile a quackery Oprah would endorse. The operative word, of course, is “did,” which now needs to be struck off after last Wednesday, which is when Oprah did an entire show entitled Do You Believe in Miracles? (Guess what answer was implicitly, if not explicitly, endorsed.) Featured prominently in that episode were several segments on the faith healer John of God.
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Posted in: Energy Medicine, Health Fraud, Religion, Science and the Media

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