Matt Ridley’s not-so-mythical “myth” of basic science

Matt Ridley: Specious arguments against government research funding.

Matt Ridley: Specious arguments against government research funding.

I’m a clinician, but I’m actually also a translational scientist. It’s not uncommon for those of us in medicine involved in some combination of basic and clinical research to argue about exactly what that means. The idea is translational science is supposed to be the process of “translating” basic science discoveries in the laboratory into medicine, be it in the form of drugs, treatments, surgical procedures, laboratory tests, diagnostic tests, or anything else that physicians use to diagnose and treat human disease. Trying to straddle the two worlds, to turn discoveries in basic science into usable medicine, is more difficult than it sounds. Many are the examples of promising discoveries that appeared as though they should have led to useful medical treatments or tests, but, for whatever reason, didn’t work when attempted in humans.

Of course, if there’s one thing that the NIH and other funding agencies have been emphasizing, it’s been “translational research,” or, as I like to call it, translation über alles. Here’s the problem. If you don’t have basic science discoveries to translate, then translational science becomes problematic, virtually impossible even. Translational research depends upon a pipeline of basic science discoveries to form the basis for translational scientists to use as the starting point for developing new treatments and tests. Indeed, like many others who appreciate this, I’ve been concerned that in recent years, particularly with tight budgets, the NIH has been overemphasizing translational research at the expense of basic research.

Posted in: History, Politics and Regulation, Science and Medicine

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Everything you always wanted to know about fermented foods 

Delicious homemade Kimchi (fermented cabbage). It's alive!

Delicious homemade Kimchi (fermented cabbage). It’s alive! Click for a closer look.

Fermented foods, such as sauerkraut and kombucha, have become popular for health reasons. I have made my own sauerkraut in the past and have recently made the tasty, fermented Korean side dish, kimchi. I did it not only for the taste but also for the hope that the bacteria responsible for the fermentation of the cabbage — lactic acid bacteria (LAB) — would contribute to the diversity of my gut microbiota.

As a research scientist in the field of bacterial pathogenesis, this made sense to me. Now that I have started blogging about health and fitness and have been writing more in depth articles about health related topics, I started wondering what research has been done on the health benefits of fermented foods. Can the bacteria in fermented foods even survive the harsh conditions of the human gastrointestinal (GI) tract, particularly the stomach?

I was amazed to learn that the fermentation of food has been used by humans for thousands of years as a way to preserve foods, and that the health benefits go beyond their microorganisms (don’t worry, citations are provided below). The fermentation process enhances the nutritional quality of food by contributing beneficial compounds such as vitamins, and by increasing the bioavailability of minerals. Probiotics, including those found in kimchi, have a range of positive effects on health, including the improvement of various intestinal inflammatory conditions, positive impacts on the immune system and even weight loss, and can alter the composition of the gut microbiome.

However, these effects mostly depend on whether the bacteria actually make it in sufficient numbers to the colon. And let me tell you, the journey to the colon is one harsh and dangerous ride!


Posted in: Herbs & Supplements, Nutrition, Science and Medicine

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The elusive “potential” of integrative medicine

The Integrative Medicine Wheel

The Integrative Medicine Wheel


UPDATE: Dr. Katz has responded to this post in his usual venue, The Huffington Post.

Alternative medicine was all about “potential” from the get go:

In 1991, the Senate Appropriations Committee responsible for funding the National Institutes of Health (NIH) declared itself “not satisfied that the conventional medical community as symbolized at the NIH has fully explored the potential that exists in unconventional medical practices.”

Thus, the Committee, led by chair Sen. Tom Harkin, directed the NIH to create an advisory panel that would “fully test the most promising unconventional medical practices.”

The advisory panel became the Office of Alternative Medicine, which became the National Center for Complementary and Alternative Medicine, which became the National Center for Complementary and Integrative Medicine, its current iteration.

This effort to unlock the “potential” of unconventional (renamed alternative, renamed complementary and alternative, renamed integrative) medicine forced an uncomfortable alliance between science and pseudoscience from the beginning. Advocates like Harkin, and his two quackery-promoting constituents, Berkeley Bedell (colostrum and something called “714-X,” derived from camphor) and Frank Wiewel (immuno-augmenative therapy for cancer), were all for “fully testing” until they realized what “fully testing” meant to a scientist: double-blind, placebo controlled trials. It was thus that the true believers discovered the value of special pleading: they “favored quick field studies that would validate alternative treatments.”

Taxpayer monies flowed into legitimate medical and scientific research institutions to conduct alternative medicine research: the Maryland School of Medicine, Harvard Medical School, University of California at Davis, and the Texas Health Science Center, among others, received funds for the study of antineoplastons, cartilage products, magnets, mind-body control, and even Bedell and Wiewel’s beloved “714-X” and immuno-augmentative therapy. (more…)

Posted in: Clinical Trials, Medical Academia, Public Health

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Whole Body Cryotherapy


Last week a Hawaiian woman living in Las Vegas, Chelsea Ake, was found dead in a cryotherapy chamber where she works. Apparently she was using the chamber unsupervised and accidentally locked herself in or passed out, and was found 10 hours later. Her death, of course, is tragic and we have nothing but sympathy for her and her family.

The event, however, was the first time many people heard of whole body cryotherapy (WBC) and prompted many questions. Three months ago Zachary Hoffman published a guest post on SBM about cryotherapy, showing that the science is just not there. He focused mainly on using ice packs to treat sprains and sports injuries (which is surprisingly not evidence-based, but also perhaps not unreasonable), I am going to focus on using WBC for general health.

What is whole body cryotherapy?

As is often the case, perfectly legitimate or perhaps preliminary medical procedures are hijacked by entrepreneurs and hyped into a bogus “spa” therapy, snake oil, or medical device. Preliminary evidence or legitimate uses are then used to justify the pseudoscientific extrapolations. Stem cells are a legitimate area of medical research, but I would not go to a stem cell clinic in China to treat your ALS.


Posted in: Science and Medicine

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Immunity: More Than Just Antibodies and Vaccines

immunitySince I graduated from medical school, new scientific developments in immunology have been occurring at a prodigious rate. I knew I could use a refresher course, and serendipity dropped one in my mailbox in the form of a review copy of the new book Immunity, by William E. Paul, MD, chief of the Laboratory of Immunology at the National Institute of Allergy and Infectious Diseases of the National Institutes of Health and a major player in many of the scientific discoveries he describes. It was just what I needed. It brought me up to date, and it left me in awe of the amazing things our bodies do to keep us alive.

We are bombarded with claims that something will “boost the immune system” but the people who say that have no understanding of how the immune system really works. We have anti-vaxxers who still deny the effectiveness of vaccines and the existence of herd immunity, and who imagine all kinds of hypothetical harms from vaccines, but who have little understanding of how vaccines actually work. This book itself could serve as a sort of vaccine to immunize readers against scientifically ignorant arguments. (more…)

Posted in: Basic Science, Book & movie reviews, Vaccines

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Antivaccinationists and the Nation of Islam protest in front of the CDC, but don’t you dare call them “antivaccine”

Flyer for "CDC Truth" Rally. Apparently a bunch of antivaccine activists showed up in Atlanta on Saturday to annoy CDC employees and try to use the manufactured "scandal" of the so-called "CDC whistleblower" to attack vaccines. Same as it ever was.

Flyer for “CDC Truth” Rally. Apparently a bunch of antivaccine activists showed up in Atlanta on Saturday to annoy CDC employees and try to use the manufactured “scandal” of the so-called “CDC whistleblower” to attack vaccines. Same as it ever was.

If there’s one thing that’s guaranteed to anger most antivaccine activists, it’s a skeptic calling them “antivaccine.” The reason, of course, is that (1) many of them actually believe they are “not antivaccine” but rather “pro-vaccine safety,” even though their words and actions proclaim otherwise and (2) they crave legitimacy. They want desperately to be taken seriously by the government and scientific community. The problem is that, again, by their very words and actions they make it almost impossible for anyone who knows anything about vaccines to take them seriously, except as a threat to public health. They have no one but themselves to blame, as a critical perusal of Age of Autism, The Thinking Moms’ Revolution, VacTruth (and VaxTruth), or any number of antivaccine websites and blogs will indicated to anyone of a scientific bent who has the intestinal fortitude to plunge down any or all of those rabbit holes of magical thinking and pseudoscience.

Another thing that I’ve come to understand over the more than a decade that I’ve been doing this is that there is a profound tension between what I like to call the two wings of the antivaccine movement. Basically, as is the case in most political or ideological movements, antivaccine activists gravitate towards one of two views. The first (and most prominent view) tends to be the pragmatic view. These are the antivaccinationists who deny vociferously that they are “antivaccine” and instead portray themselves as “pro-safe vaccine.” They want to appear reasonable and are willing to take partial victories on an incremental path towards achieving their ends. Then there are the “loud and proud” antivaccine activists. They don’t eschew or hide from the term “antivaccine.” They embrace it and proudly proclaim that they believe that vaccines are irredeemably toxic, that they don’t protect against disease, that big pharma is a criminal syndicate intent on poisoning their children and turning them autistic, and that the CDC is complicit in the whole plot. Of course, like all ideological movements, there is not a dichotomy; rather, there is a continuous spectrum between the two. Also, in this case, the two groups differ more on tactics than actual beliefs. As I’ve found many times, push a “reasonable” antivaccinationist, one who proclaims herself “not antivaccine” but “pro-vaccine safety,” and it’s usually not hard to get them to say things indistinguishable from the hard core antivaccinationists. They’ll basically cling to their self-perception as “pro-safe vaccine, while making the same evidence-free claims that vaccines cause autism, sudden infant death syndrome (SIDS), autoimmune diseases, diabetes, and all the other conditions on which antivaccinationists blame vaccines.

Posted in: Politics and Regulation, Public Health, Religion, Vaccines

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The Time a Pulitzer Prize Winning Journalist Got Manipulated by a Chiropractor


You have WiFi allergy, chronic Lyme, multiple chemical sensitivity, and menopause!

Katherine Ellison won a Pulitzer Prize in 1985, not for science journalism but for coverage of the monetary mayhem perpetrated by Ferdinand and Imelda Marcos on the people of the Philippines. I was nine at the time and have little recollection of the impact of her work, but I will assume that it was meaningful in light of the award. And she went on to win numerous additional accolades for her writing on politics, economics, and human rights.

Her most recent work, “Chiropractic Care Grows, and Gains Acceptance“, will likely not be considered for any journalism awards. The article, published on the New York Times Health and Wellness blog, reveals a terribly flawed understanding of chiropractic practice and philosophy and a preternatural ability to interpret fleecing at the hands of an obvious quack as a positive experience. She displays few if any signs of an ability to think critically when it comes to medicine and gives no indication of having done more than cursory research on the subject of chiropractic.

Sometimes the apple does fall far from the tree

The inspiration for Ellison’s article was a trip to the chiropractor after having injured her tail bone during a spin class. She does this despite having grown up with a surgeon father who apparently did not think highly of “alternative healers,” particularly chiropractors. Right off the bat she brings up the history of the AMA’s stance on the chiropractic profession:

Of course, this was in the 1960s, when the American Medical Association was still waging war on the profession via its Committee on Quackery, which labeled chiropractors as an “unscientific cult.”


The A.M.A.’s Committee on Quackery is long defunct, having gone out of existence after a lawsuit by chiropractors led to a 1987 federal district judge’s ruling that the medical association had tried to destroy the chiropractic profession.

Well, not exactly. The AMA absolutely was vehemently opposed to chiropractic and its practitioners and, as Dr. Harriet Hall describes, they are far from beyond reproach in the methods they used. In fact, I think you would be hard pressed to find anyone that would defend their tactics today. But the Committee on Quackery actually disbanded in 1974, two years prior to the filing of the infamous Wilk v. AMA antitrust lawsuit and at a time when all 50 states were licensing chiropractors. Louisiana, as backwards as my home state can be when it comes to science and medicine, was the last to give in that same year.


Posted in: Science and Medicine, Science and the Media

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Naturopathy vs. Science: Diabetes Edition

Diabetes Mellitus
Does naturopathy offer something special or uniquely effective for the treatment of diabetes? Naturopaths are alternative medicine practitioners who claim to provide primary care, like medical doctors. Among naturopaths and their supporters, it’s regularly claimed that naturopathy offers something that “conventional” medicine does not: Naturopaths are described as “doctors plus”, using unconventional approaches to coax the body to “heal itself” with methods that are claimed to be safer and more effective than conventional drugs and medical interventions. The superiority of naturopathy over conventional medicine is an argument that showed up in the comments to my last post, when I pointed out that this year’s Nobel Prize in Physiology or Medicine failed to validate either naturopathy or herbalism. Here’s one example:

Someone diagnosed with pre-Type 2 diabetes could visit a Naturopathic Doctor and stop the disease in its tracks. The doctor would recommended a simple diet change to a high-fat, low-carb, zero refined sugar diet, maybe some supplements, and exercise. Bye, bye, Type 2 diabetes. The same person could visit an MD, and before you know it would be taking insulin and Metformin (and other horrible drugs) for the rest of his or her life. An added bonus with the insulin is weight gain. Notice that the diabetes commercials feature overweight actors and actresses? Yes, there are natural cures. Is this is a site promoting good health, or is it a front for the pharmaceutical companies?

You can follow the comment thread for the discussion that followed. The same commenter continued in Mark Crislip’s post on Friday about the difference between naturopathy and conventional medicine:

Allopath – you will be taking insulin, Metformin and other drugs for the rest of your life. Your diabetes will be managed, but there will be a slow deterioration in the quality of your life.

Naturopath – we can reverse this with a change in your diet, along with exercise.

Naturopath wins.

Now this individual never claimed to be a naturopath – but testimonials like these are not surprising. I’ve written several posts in the past about the claims made by naturopaths, and how they stack up against the scientific evidence. Naturopaths offer an array of disparate health practices like homeopathy, acupuncture and herbalism that are linked by the (now discarded) belief in vitalism – the idea we have a “life force”. From this philosophy can sometimes emerge sensible health advice, but not because naturopaths are following the evidence. As long as a treatment is viewed as being congruent with the naturopathic belief system, it’s acceptably “naturopathic”. In past posts I’ve looked at the naturopathic perspectives on fake diseases, infertility, autism, prenatal vitamins, vaccinations, allergies, and even scientific facts themselves. Britt Hermes is a former naturopath and has written extensively about naturopathy from the perspective of an insider, and her evaluation is scathing: There are no naturopathic standards of care, naturopathic training is much different than what naturopaths purport, and the accreditation of naturopathic schools is questionable. Now, diabetes is a widely prevalent chronic disease. It causes a huge burden of illness on society. And while we have a fair understanding of its causes and how to treat it, there are still far too many people suffering from complications of the disease. Diabetes already requires care from multiple medical professionals, including physicians, nurses, dietitians, and pharmacists. Should naturopathy be included? Is there any evidence that demonstrates that naturopathy can “stop” diabetes? And how does advice from a naturopath differ from “conventional” medical advice? (more…)

Posted in: Naturopathy, Science and Medicine

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The American Cancer Society’s new mammography guidelines: Déjà vu all over again

The American Cancer Society’s new mammography guidelines: <em>Déjà vu</em> all over again

One of the things that feels the weirdest about having done the same job, having been in the same specialty, for a longer and longer time is that you frequently feel, as the late, great Yogi Berra would have put it, déjà vu all over again. This is particularly true in science and medicine, where the same issues come up again and again and again, often with the same arguments on either side. Sometimes the same players are even involved. So it is with mammography recommendations. Indeed, I’m feeling déjà vu all over again right now, as I read headlines like “Women advised to get mammograms later, less often“, “American Cancer Society, in a Shift, Recommends Fewer Mammograms“, and “ACS: Breast cancer screening should begin at age 45“. What provoked these headlines was a major revision in the American Cancer Society’s recommendation for mammographic screening for breast cancer in women at average risk of the disease. In a seeming replay from 2009, when the United States Preventative Services Taskforce (USPSTF) sent shockwaves through the breast cancer world by recommending that most women not start mammography until age 50 and then only to have it done every two years instead of every year, the American Cancer Society (ACS) has now just similarly ratcheted back its recommendations for screening mammography, just not as much as the USPSTF did. The new recommendations were communicated in a special communication published by JAMA on Tuesday.

What changed regarding mammography recommendations

Before we get to the issues, how, specifically, did the ACS change its mammography recommendations? Before this change, the ACS basically recommended the same thing that most other American professional societies dealing with breast cancer did: yearly mammography starting at age 40 for the rest of a woman’s life. The new guidelines now recommend that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years and continuing annually until age 54. From age 55 and older, the ACS recommends that women transition to every two years. (More details below.) As I Tweeted when I saw these recommendations, basically it appears that the ACS has more or less split the difference between the old recommendations and the USPSTF recommendations.

So why is the ACS changing its recommendations? And what does this say about the science and our values regarding cancer screening? If you’ve been reading this blog, you know that over the last several years there has been a steady drip, drip, drip of studies that range from highlighting the downside of widespread mammographic screening to downright questioning the value of mammography. That’s why I’ve been discussing rethinking screening for breast cancer since at least 2008. Basically, you can go back and read my old posts and, if you have a lot of time and are enough of a glutton for punishment to read them all, watch the evolution of my thinking about breast cancer screening over the last seven years.

Back in the day, I used to fully support breast cancer screening beginning at age 40 and proceeding yearly throughout. As I examined more and more of the evidence, I became less enthusiastic about screening so intensely and started to believe that starting at 40 was too young for most women. Indeed, I was probably the only breast cancer doctor at my cancer center in 2009 who supported the USPSTF recommendations when they were announced, which led to some—shall we say?—interesting discussions about what should be said to the press and what a press release our cancer center wanted to release ASAP should actually say. I also got myself into a little…trouble…for criticizing colleagues in radiology—not from my institution, I hasten to add!—for some rather blatant turf protection. Let’s just say that a prominent radiologist, one who’s achieved far more renown in his field than I ever have in mine, was most displeased with some of my commentary and let me know about it. I found this displeasure odd, given that I am most definitely not a nihilist with respect to mammography screening (and, make no mistake, there are quite a few of those out there these days). I’m just a lot more balanced and aware of its limitations than I used to be. On the other hand, I did call him out for some of his more obnoxious comments that implied that those who question mammography are cackling gleefully at the thought of more women dying of breast cancer. Interestingly, I don’t seem to get asked to contribute to such press releases that much anymore, but in fairness neither do most of the other breast cancer clinicians I work with; so I probably can’t blame it on my previous outspokenness.

What brought me to this point is an increasing understanding of the concepts of overdiagnosis and lead time bias, coupled with a string of studies that show more modest benefits (and, in one case, no benefit) from screening mammography. To be honest, the attack dog reaction by some mammography supporters to some of these negative studies also set my skeptical antennae a’twitchin’ as well.

Posted in: Cancer, Public Health

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Are Placebos Getting Stronger?

placebo1A new study looked at clinical trials for neuropathic pain over the last 23 years and found that the response of subjects in the placebo group has been increasing over time, but only in the United States. The cause of this increase is unknown, and has provoked a fascinating discussion about the nature of placebos and their role in medical research.

What is the placebo effect?

We have discussed the placebo response at length here at SBM because the concept is critical to understanding clinical science, and it is largely misunderstood. Most often it is presented as a mind-over-matter response to the expectation of benefit. Proponents of worthless treatments often hype the placebo response as if it can have real healing power, when the evidence shows it does not.

In reality, there are a large number of placebo effects and the phenomenon is quite complex. In clinical trials “the placebo effect” is whatever happens in the placebo group of the study, the group receiving an inactive treatment. This is not one effect, however, but a complex combination of many effects.


Posted in: Clinical Trials

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