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Information Literacy and the Number Needed to Treat

NNTIncreasingly people are accessing healthcare information in order to make decisions for their own health. A 2010 Pew poll found that 80% of internet users will do so for health care information. This presents a huge potential benefit, but also a significant risk.

Information literacy

Daniel Levitin talks about the need for public information literacy, something we also discuss frequently here on SBM. If you are accessing the internet to inform your health care decisions, then you need to know how to determine the legitimacy and trustworthiness of the websites you are visiting. There is a big difference between NaturalNews (a crank site full of misinformation and conspiracy theories) and Nature News (an outlet for one of the most prestigious science journals in the world).

Even when you can discriminate between good and bad health information websites, the challenge remains to properly interpret the scientific information to which you now have access.


Posted in: Science and the Media

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Breast Milk Testing: Scaremongering, Not Science

New mothers, especially first-time mothers, tend to worry about whether they are doing what is best for their babies. A new service, Happy Vitals, will only add to those worries. We know that breast is best, but these folks make women question whether their breast milk is good enough. They say:

Happy Vitals provides families with the tools they need to monitor and improve the long-term health of their children. With our simple and easy-to-use tests, mothers can learn for the first time about the nutrient make-up of their breast milk, improve their diet and nutrition, and safeguard against exposure to heavy metals and other toxins that are harmful to a child’s growth and development.

After a crowdfunding/pre-sale campaign, they plan to start shipping kits this month. They offer various packages. For $149.95, they will analyze a sample of breast milk for four key nutrients: glucose, lactose, protein, and fat. For $559.95, they will also test for:

  • Four “indicators of immunity”: cortisol, IgA antibodies, IgG antibodies, IgM antibodies.
  • Eleven micronutrients: calcium, folate, iron, vitamin D, vitamin A, ferritin, magnesium, phosphorous, sodium, potassium, and vitamin B12.
  • Four heavy metal toxins: arsenic, lead, mercury, and cadmium (based on samples of infant’s hair and nails.)


Posted in: Diagnostic tests & procedures, Nutrition

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Authority versus science on integrative medicine

Should we respect David Katz's authority?

Should we respect David Katz’s authority?


David Katz doesn’t much like us here at Science-Based Medicine. In fairness, I can’t say that I much blame him. We have been very critical of his writings and talks over the years, dating back as far as Steve Novella’s deconstruction of one of Dr. Katz’s more infamous statements about using a “more fluid concept of evidence” to Kimball Atwood’s characterization of his tortured logic to my pointing out that his arguments frequently boil down to a false dichotomy of either abandoning science or abandoning patients.

Last week, Jann Bellamy did her usual great job discussing an unfortunate special supplement of the American Journal of Preventative Medicine (AJPM) entitled Integrative Medicine in Preventive Medicine Education. This supplement included articles summarizing the results of project called IMPriME (Integrative Medicine in Preventive Medicine Education), funded by the Health Resources and Services Administration (HRSA), to advance the inclusion of “integrative medicine” in Preventive Medicine residency programs. Not surprisingly, this project was led by Dr. Katz. Jann used this special issue as a jumping off point to show, quite correctly, how, when it comes to so-called “integrative medicine,” it is always about the “potential,” which has always been elusive and has never been realized. Unfortunately, the elusiveness of the amazing potential attributed to “integrative medicine” (formerly referred to as “complementary and alternative medicine” or “CAM”) has done almost nothing to dampen the ardor of its cheerleaders for “integrating” as much woo as they can into medicine, which is why a major journal would allow someone like David Katz to edit a special issue dedicated to articles discussing IMPriME’s findings.

Thanks to Jann’s post, it appears that Dr. Katz is most displeased with us again here at SBM. To express his displeasure, he has rattled off a little rant over at his usual non-academic hangout and quack-friendly Internet outlet, The Huffington Post. There, he castigates us with a post entitled Science and Medicine, Fools and Fanatics: The ‘Fluidity’ of Woo. Yes, right off the bat, it’s the same old strategy, to paint advocates of “integrative medicine” as the “reasonable” ones while those of us who object to integrating prescientific quackery into medicine are clearly the “fanatics” (or, if you prefer, the fools). In it, as usual, Dr. Katz lays down some real howlers in defense of his integration of woo with medicine.

Posted in: Basic Science, Critical Thinking, Medical Academia

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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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