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The DC as PCP? Drug Wars Resume

Coming soon, to a chiropractor's office near you?

Coming soon, to a chiropractor’s office near you?

Chiropractors are once again engaged in intra-fraternal warfare over the chiropractic scope of practice, a saga we’ve chronicled before on SBM. (See the references at end of this post.) Every time it looks like the warring factions have buried their differences, they come rising to the surface like zombies.

The International Chiropractors Association (ICA), representing the “straight” faction, wants chiropractic to continue as a drugless profession. They are happy to detect and correct subluxations, thereby removing “nerve interference” and “allowing the body to heal itself” in the tradition of Daniel David Palmer. But the American Chiropractic Association (ACA) has bigger fish to fry.

This time, the ICA is upset that the ACA House of Delegates up and decided to establish a “College of Pharmacology and Toxicology,” which would operate under the auspices of the ACA Council on Diagnosis and Internal Disorders. The ACA’s announcement of the “College” is rather vague on details:

The purpose of the College is to further educate the chiropractic profession on clinical matters related to the widespread use of both prescription and over-the-counter medications and nutritional supplements.

I e-mailed the ACA several days ago asking for more information but have yet to receive a reply.

The ICA sees this move as yet another attempt by:

forces at work within some organizations actively promoting incorporating drugs into the chiropractic scope of practice.

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Posted in: Chiropractic, Herbs & Supplements, Humor, Legal, Nutrition, Pharmaceuticals, Politics and Regulation

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Making One’s Own Reality – Food Babe Edition

Vani Hari, aka the "Food Babe".

Vani Hari, the “Food Babe”.

The default mode of human activity is to construct our own internal model of reality based upon our desires, biases, flawed perceptions, memories, and reasoning, and received narratives from the culture in which we live. That model of reality is then reinforced by confirmation bias and jealously defended.

But we also have the capacity to transcend this pathway of least resistance. Philosophy is the discipline of thinking carefully and systematically about ideas to see if they at least are internally consistent. Science is the discipline of systematically and carefully comparing our internal models of reality against objective reality, and then changing those models to suit the evidence.

Everyone engages in a combination of bias, superstition, logic, and evidence-based reason to varying degrees – the question is, to what degree? The goal of science-based medicine is to increase the proportion of science and reason in the mix with respect to the practice of medicine and public health.

There are many forces at work in society, however, that explicitly oppose the role of science because, in my opinion, they find it inconvenient to their internal model of reality or whatever narrative they are selling.

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Posted in: Science and Medicine

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A brief bit of shameless self-promotion…The Prince of Wales edition

PrinceCharles-590x350

In an effort to expand the Gorski empire almost to the level of the Crislip empire and to try to make it to somewhere within two or three orders of magnitude of the Novella empire, I’ve published an article on Slate.com about Prince Charles’ visit to our fine country entitled “Prince of Pseudoscience“. Consider this the mandatory shameless self-promotion that all SBM bloggers take advantage of from time to time to publicize their activities elsewhere.

Enjoy! (I hope.)

I’m told that Dana Ullman has made an appearance in the comments. I might have to head on over after work tonight…

Posted in: Announcements, Homeopathy, Politics and Regulation, Science and the Media

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Shred360: The Weight Loss Product with the Stupidest Hype Ever

There was a half-page ad in my local paper, thinly disguised as a “Special Report” by a Health and Fitness Editor, for a new fat-melting pill that “could put diet industry out of business by 2016.” I have seen a lot of ridiculous ads for weight loss products, but this one takes the cake. It’s arguably even worse than the one that proclaimed “we couldn’t say it in print if it wasn’t true” and then proceeded to say things in print that weren’t true.

It’s called Shred360. Here are some of the claims:

  • It shook up the fitness industry because it DOUBLES your fat-burning potential.
  • It allows anyone to LOSE INTENSE AMOUNTS OF FAT without grueling workouts or tasteless diet foods.
  • It breaks your fat cells apart and disintegrates them, even while you sleep.
  • Speeds your metabolism by 43%.
  • It vaporizes fat without effort.
  • Its proprietary blend of 16 potent ingredients is scientifically proven.
  • Burns stored fat through thermogenesis and lipolysis.
  • Increases energy and mental clarity almost immediately – guaranteed.
  • Fools your body into feeling full: the ultimate appetite suppressant.
  • Unconditionally guaranteed to make every surplus bit of your unwanted fat disappear effortlessly.
  • Analysts think it will put Jenny Craig and Weight Watchers out of business by 2018 (which doesn’t even make sense if it has already put the entire diet industry out of business by 2016).
  • You can eat like a normal person, skip the gym, and lose the fat you want while you sleep.
  • Produced under highly controlled environmental conditions in small batches, so supplies are very limited.
  • Free samples available for 100 customers – don’t wait to call.
A screenshot from the Shred360 product website. Lots of claims!

A screenshot from the Shred360 product website. Lots of claims!

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Posted in: Herbs & Supplements

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Medical marijuana as the new herbalism, part 3: A “cannabis cures cancer” testimonial

Medical marijuana as the new herbalism, part 3: A “cannabis cures cancer” testimonial

It’s been a while since I discussed medical marijuana, even though it’s a topic I’ve been meaning to come back to since I first dubbed medical marijuana to be the equivalent of herbalism and discussed how the potential of cannabinoids to treat cancer has been, thus far, unimpressive, with relatively modest antitumor effects. The reason I refer to medical marijuana as the “new herbalism” is because the arguments made in favor of medical marijuana are very much like arguments for herbalism, including arguments that using the natural plant is superior to using specific purified cannabinoids, appeals to how “natural” marijuana is, and claims of incredible effectiveness against all manner of diseases, including deadly diseases like cancer, based on anecdotes and testimonials. Now, as I pointed out before, not only am I not opposed to the legalization and regulation of marijuana for recreational use, even though I’ve never tried it myself, but I support it. What I do not support are claims for medical effects that are not backed up with good scientific evidence, and for medical marijuana most claims fall into that category. That’s why I tend to view medical marijuana as a backdoor way to get marijuana legalized. Personally I’d rather advocates of marijuana legalization drop the charade, argue for legalization, and stop with the medical nonsense.

The last time around, I discussed the evidence supporting claims that “cannabis cures cancer” and found them to be wanting based on science. I didn’t however, discuss the “cannabis cures cancer” testimonial machine that drives the claim that marijuana is useful for treating cancer; at least, I only touched on it by discussing briefly Rick Simpson, who claims that his hash oil cures approximately 70% of patients with terminal cancer and a published anecdote in which it was claimed that hemp oil was effective in treating acute lymphoblastic leukemia. (It wasn’t. At least, the evidence presented was not convincing.) Since then, I’ve wanted to revisit the topic of “cannabis cures cancer” testimonials, and, for whatever reason, now seems like a good time to do it.
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Posted in: Cancer, Herbs & Supplements

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ND Confession, Part 1: Clinical training inside and out

Editors’ note: With this guest post, we welcome Britt Marie Hermes to the SBM blog. Her new blog NaturopathicDiaries.com was mentioned by Jann Bellamy last week. Hermes is a former naturopath who came to doubt naturopathy. Through her contact with Jann, she has agreed to contribute occasional blog posts to us. Her insights into the pseudoscientific medical system of naturopathy, her reasons for becoming a naturopath, her reasons for leaving naturopathy, and, most importantly, her inside knowledge of naturopathy, will provide compelling reading. Here is the first of what, we hope, are multiple posts.


In 2011, I graduated from Bastyr University with a doctorate in naturopathic medicine. I passed the Naturopathic Physicians Licensing Examination (NPLEX) and landed a competitive, one-year residency in family medicine and pediatrics at an out-patient clinic in Seattle. When I completed my residency, I remained at this clinic for a brief time before moving to Arizona to practice until 2014.

During my time in Arizona, I realized that my profession had severely misled me. Naturopathic medicine is marketed as a “distinct form of primary health care.” This phrase is ubiquitous: it appears on the websites of naturopathic medical schools, on materials published by practicing naturopaths, and on lobbying documents to promote the unfettered licensure of naturopaths and to expand eligibility for federal loan repayment programs. Based on my educational and professional experience as an accomplished member of the naturopathic community, I can say that naturopathic medicine might be a distinct form of something, but it is not any form of primary health care. I am saddened to report that not only was I misled, but so were hundreds of legislators, thousands of students, and tens of thousands of patients.

Patient undergoing hydrotherapy treatment

Historical image of a patient undergoing hydrotherapy treatment. Image from the History of Medicine (NLM).

Given my journey through naturopathic medical school, I can provide strong evidence and testimony of the quality and quantity of training at Bastyr University. I base what follows on my academic transcript, course syllabi, course catalog, and the student clinician’s handbook in addition to my personal experiences. It should come as no surprise to readers of ScienceBasedMedicine.org that naturopathic training is not as the profession presents. I’ll say it anyway: naturopathic education is riddled with pseudoscience, debunked medical theories, and experimental medical practices.

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Posted in: Naturopathy, Politics and Regulation

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Evaluating milk and its substitutes

"Milk"

“Milk” at my local grocery store

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…)

Posted in: Nutrition

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Another Review Finds Homeopathy Worthless

homeopathy T

Just say “NO” to homeopathy. Available at skeptoid.com.

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…)

Posted in: Homeopathy

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Mind Over Matter: The Brain’s Way of Healing

The Brain's Way of HealingIn 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…)

Posted in: Book & movie reviews, Neuroscience/Mental Health

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Clinical trials of homeopathy versus “respect for science”

Trojan Rabbit

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.
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Posted in: Clinical Trials, Energy Medicine, Homeopathy

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