Forgive the departure from my usual verbosity. I’m on my way to a meeting, and I don’t have the time. Today I’ll report disturbing content found in health care bills that are competing for passage in Washington. Thanks to Linda Rosa for keeping our attention on language in one of the Senate bills: “S.1679 – Affordable Health Choices Act,” sponsored by (guess who?) Senator Tom Harkin (D-IA). According to Linda, Harkin and supporters will attempt to merge his bill with Baucus’s. Here are some of the choice passages in Harkin’s 800+ page bill (emphasis added):
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.
…(4) ensure that the health team established by the entity includes an interdisciplinary, interprofessional team of health care providers, as determined by the Secretary; such team may include medical specialists, nurses, nutritionists, dieticians, social workers, behavioral and mental health providers (including substance use disorder prevention and treatment providers), doctors of chiropractic, licensed complementary and alternative medicine practitioners, and physicians’ assistants;
…(c) Requirements for Health Teams- A health team established pursuant to a grant under subsection (a) shall–
(1) establish contractual agreements with primary care providers to provide support services;
(2) support patient-centered medical homes, defined as mode of care that includes–
(A) personal physicians;
(B) whole person orientation;
…(F) provide coordination of the appropriate use of complementary and alternative (CAM) services to those who request such services;
…(H) provide local access to the continuum of health care services in the most appropriate setting, including access to individuals that implement the care plans of patients and coordinate care, such as integrative health care practitioners; (more…)
Some of our more astute readers may have noticed that we are paying influenza slightly more attention than other topics of late. That’s because this situation is new, rapidly changing, and covers more areas of science and medicine than one can easily count. It’s also a subject about which the general public and media are keenly interested. This is an outstanding learning and teaching opportunity for us as a professional community. Unfortunately, it is also fertile ground for confusion, fear, and misinformation, and a playground for those who would exploit such things.
Mercola.com is a horrible chimera of tabloid journalism, late-night infomercials, and amateur pre-scientific medicine, and is the primary web presence of Joseph Mercola. Unfortunately, it is also one of the more popular alternative medicine sites on the web and as such is uncommonly efficient at spreading misinformation. I am not a fan, and have addressed his dross in the past.
Joseph Mercola has recently posted an excerpt from an individual he evidently holds in high regard, Bill Sardi. Bill published “18 reasons why you should not vaccinate your children against the flu this season.” Mercola chose his nine favorites (one would assume the nine best reasons), and re-posted it on Mercola.com. There are so many mistakes, so much misinformation in so little space, it’s almost a work of art. You know, like that crappy art that you might expect to find on the wall at an hourly motel. Without further delay, let’s examine Mercola and Sardi’s nine best reasons for you not to vaccinate your children against influenza this season: (more…)
Dr. Jay Gordon is a pediatrician to a particular subculture of pseudoscientific celebrities, such as Jenny McCarthy. He lends his MD cred to this community. He also appears, in my opinion, to be a shameless self-promoter – one of those pop professionals (Dr. Oz, Dr. Phil) who has sold his soul for some easy celebrity.
Regardless of his motivations, he has been spouting arrogant nonsense about vaccines for years, essentially arguing that his clinical gut feeling and anecdotal experience trump the actual science. This is exactly the wrong approach to science-based medicine.
In a recent open letter on his website, he adds to the anti-vax chorus advising not to get the H1N1 (swine flu) vaccine. It’s almost as if this crowd wants to maximize the morbidity and suffering from this somewhat preventable disease. I know this is not literally true, but their ideologically motivated and confused actions will have the same effect.
On 10/08/09, the NIH and Science through press releases announced the following remarkable information: Consortium of Researchers Discover Retroviral Link to Chronic Fatigue Syndrome (CFS.) From Science on line:
Scientists have discovered a potential retroviral link to chronic fatigue syndrome, known as CFS, a debilitating disease that affects millions of people in the United States. Researchers from the Whittemore Peterson Institute (WPI), located at the University of Nevada, Reno, the National Cancer Institute (NCI), part of the National Institutes of Health, and the Cleveland Clinic, report this finding online Oct. 8, 2009, issue of Science.
“We now have evidence that a retrovirus named XMRV is frequently present in the blood of patients with CFS. This discovery could be a major step in the discovery of vital treatment options for millions of patients,” said Judy Mikovits, Ph.D., director of research for WPI and leader of the team that discovered this association. Researchers cautioned however, that this finding shows there is an association between XMRV and CFS but does not prove that XMRV causes CFS.
I know we have been focusing on the vaccine issue extensively, but this is crunch time and the anti-vaccine forces are relentless. We are now facing a regular seasonal flu spiked with the H1N1 pandemic. Our best weapon against morbidity and mortality caused by the flu is information, and yet the public is being barraged with misinformation designed to encourage poor choices and thereby result in maximal morbidity and mortality.
I confess I was never impressed with FDR’s famous quip, “All we have to fear is fear itself,” – I think there is plenty else to fear. But his sentiment is very appropriate to the current situation – fear mongering around the seasonal flu and H1N1 vaccines is what we have most to fear.
And of course, as is almost always the case, accurate information is complex and requires a nuanced understanding. This creates uncertainty, which is easy to exploit to manufacture unreasonable fear.
The anti-vaccine fear mongers are playing every card in the deck. They are arguing (falsely) that H1N1 is not severe enough to warrant getting the vaccine, that the vaccine does not work anyway, and that there are unacceptable or unknown risks to the vaccine. In the most extreme cases, bizarre conspiracy theories are brought to bear, but I will not discuss these here as anyone compelled by such fantasies is likely beyond the reach of any information I could provide.
A reader sent me an interesting post from her own blog. It’s well-written, compelling, and betrays an exceptional intelligence. It’s also completely wrong.
The piece is called, “Bias, Racism, and Alternative Medicine”, an intriguing title. The first part tries to establish that “Western medicine” in one of many ways of understanding health and disease. She starts with some personal anecdotes—always interesting, rarely generalizable:
While receiving Western biomedical treatment for ADD, the side effects of my therapy convinced me that western medication alone would not provide a solution to my problems.
One of the author’s fundamental misunderstandings is that the failure of a particular treatment to make her feel better does not invalidate all of medical science, and more important, it does not validate “other ways of thinking”. Still, I can understand how this happens. Personal experience is powerful; unfortunately, it is also misleading. I like this writer. She seems very kind. She goes on to describe her enlightenment further, but this is where a pleasant anecdote goes terribly wrong: (more…)
We would all like to live longer. The most promising longevity research indicates that severe calorie restriction might extend life span, but such a diet is difficult to follow. Resveratrol, a phytochemical found in red wine, has been evaluated as a possible way out of the dilemma. When given to obese mice on a high calorie diet, it produced a number of changes associated with improved health, such as increased insulin sensitivity, and it increased survival. Perhaps by taking resveratrol you could eat as much as you want and get fat without suffering the usual consequences. Perhaps you could get the longevity benefits of severe calorie restriction without restricting calories.
In addition to fat mice, resveratrol also extends the life of Saccharomyces cerevisiae, Caenorhabditis elegans and Drosophila melanogaster (yeast, nematodes, and fruit flies). But a study in non-obese mice found no increase in survival (although it did find several signs of improved health). Besides the anti-aging claims, there is also some evidence from in vitro and animal studies that it might have cardiovascular effects and anti-cancer effects. (more…)
It’s tempting to think that the practice of medicine should be simple and intuitive. Unlike other sciences, we all have access to the basic materials—ourselves. We feel that because we are intimately familiar with our bodies, we know a lot about how they work. Unfortunately, it’s a little more complicated than that. The biochemical processes walking around in this sack of meat are pretty complicated. Learning these processes is important, but in medicine, it’s not enough. If we have a hypothesis that some change in biochemistry will affect some disease, we must test this in groups of real people in well-designed clinical trials. Or, we can use the Huffington Post method and just make it all up.
The latest abomination is an article on diabetes, by Kathy Freston. Bad information on diabetes is particularly dangerous. The longer diabetes goes untreated, the higher the likelihood of complications. When reading medical writing it’s important to evaluate the source. The author of this article wrote a book called, The Quantum Wellness Cleanse which pretty much says it all. But is it really fair to judge someone on a crappy book title?
Well, yes, but more important is the crappy interview she conducts with Dr. Neal Barnard. I have no way of knowing with absolute certainty whether Barnard is as dangerous a fool as he sounds, but I suspect so. He and Freston promulgate a dangerously over-simplified view of diabetes. (more…)
EDITOR’S NOTE: Dr. Gorski is currently in Chicago attending the American College of Surgeons Clinical Congress. As a result, he has not prepared a post for this week (although he doesn’t feel too guilty about missing this week, given that he did write two rather hefty posts last week, one on the cancer quackery known as the German New Medicine and the other on a rather dubious monkey study being promoted by the anti-vaccine movement). Fortunately, we have Ben Kavoussi to fill in with a post on some of the more exaggerated claims of advocates of nutritional interventions for various diseases and conditions. Enjoy!
- A centipede was happy quite,
- Until a frog in fun
- Said, “Pray, which leg comes after which?”
- This raised her mind to such a pitch,
- She lay distracted in the ditch
- Considering how to run.
Just like complementary and alternative medicine (CAM), nutritionism — meaning the unexamined assumption that food is only a conveyor of the substances it contains 1,2 — has evolved independently of science and medicine since the 1970s, and has caused so much wondering and confusion about food and diet that many Americans have become unable to eat properly. Today, there isn’t a popular magazine that doesn’t have a “health and nutrition” section that — often with the backing of very little science — promises many health benefits of a nutrient or warns against the harms of another; and then provides a list of foods that contain it. The same publication might time and again write the exact opposite, further adding to the already-prevalent nutritional confusion. Nutritionism is thus an ideology sourced by popular beliefs, academic reveries, and the food and dietary supplements industry, where food is simply seen as a mean to achieve a specific health goal. In its latest form, however, coupled with genomics and biomedical informatics, and called “nutrigenomics” or “nutritional genomics,” nutritionism takes academic reveries to such an extent that it could be accurately described as “science fiction.” The Center of Excellence for Nutritional Genomics at UC Davis writes indeed (in bold) on its website that:
“The promise of nutritional genomics is personalized medicine and health based upon an understanding of our nutritional needs, nutritional and health status, and our genotype. Nutrigenomics will also have impacts on society — from medicine to agricultural and dietary practices to social and public policies — and its applications are likely to exceed that of even the human genome project. Chronic diseases (and some types of cancer) may be preventable, or at least delayed, by balanced, sensible diets. Knowledge gained from comparing diet/gene interactions in different populations may provide information needed to address the larger problem of global malnutrition and disease.”
I guess I will be spending the rest the flu season writing about the nonsense that is promulgated about the flu vaccine and the disease. One of the more common laments about the flu vaccine is that it doesn’t work: I got the flu vaccine and still got the flu. Well maybe. Maybe not. It takes a few weeks to get protection, so the flu could have developed before the antibody response to the vaccine. The vaccine does not protect to the numerous other viral infections that circulate each winter, so perhaps you had an adenovirus but thought it was the flu. Then there is the evidence. Some readers of the blog are worried that the literature does not support the use of the vaccine.
“My research for good studies on the efficasy (sic) of seasonal flu vaccines so far has left me wondering if I’ve somehow missed the good research. Tom Jefferson of the Cochrane Institute says that Most studies are of poor methodological quality and the impact of confounders is high. I agree. Please would you refer me to some of the best studies on the efficasy (sic) of seasonal flu vaccines. After a critical appraisal of the best studies you know of I’d like to submit the same for publication in the interest of science.”
Why some readers think I am a research librarian, I do not know. It is not an uncommon request. As an aside, I have a full time job and a family to raise. Don’t be asking me to do your grunt work. It’s called Pubmed. Use it.
But the topic for this post concerns the efficacy of the flu vaccine. I am limiting myself to the use of the vaccine in adults.