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The evolving story of the harms of anti-inflammatory drugs

Advil (ibuprofen)

Owing to summer vacation, today’s post updates a 2011 post and a 2013 post with some new information.

Anti-inflammatory drugs are among the most well-loved products in the modern medicine cabinet. They can provide good pain control, reduce inflammation, and eliminate fever. We give non-steroidal anti-inflammatory drugs (NSAIDs) in infancy, continuing through childhood and then adulthood for the aches and pains of modern living. It’s the later stages of life where NSAIDs are used most frequently, usually in the treatment of joint disease like osteoarthritis, which eventually affects pretty much everyone. Over 17 million Americans use NSAIDs on a daily basis, and this number will grow as the population ages. While they’re widely used, they also have a long list of side effects. Not only can they cause stomach ulcers and bleeding by damaging the lining of the gastrointestinal tract, cardiovascular risks are also significant.

It was the arrival (and withdrawal) of the drugs Bextra (valdecoxib) and Vioxx (rofecoxib) that led to a much better understanding of the potential for these drugs to increase the risks of heart attacks and strokes. And it’s now well-documented that these effects are not limited to the “COX-2″ drugs – almost all NSAIDs, including the old standbys we have used for years, raise the risk of heart attacks and strokes. (more…)

Posted in: Clinical Trials, Politics and Regulation, Science and the Media

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Galvanic Skin Response Pseudoscience

How_Zyto_works

Selling snake oil is all about marketing, which means that a good snake oil product needs to have a great angle or a hook. Popular snake oil hooks include being “natural,” the product of ancient wisdom, or “holistic.”

Perhaps my favorite snake oil marketing ploy, however, is claiming the product represents the latest cutting-edge technology. This invariably leads to humorous sciencey technobabble. There are also recurrent themes to this technobabble, which often involve “energy,” vibrations and frequencies, or scientific concepts poorly understood by the public, such as magnetism and (of course) quantum effects. Historically, even radioactivity was marketed as a cure-all.

One category of technical pseudoscientific snake oil measures some physiological property of the body and then claims that this measurement can be used for diagnosis and determining optimal treatment. For example, machines might measure brain waves, heart rate variability, thermal energy or (the subject of today’s article) the galvanic skin response.

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Posted in: Medical devices

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“Hands On Learning Solutions”: Untested Solutions for Problems That May Not Even Exist

Get started...for as little as $14,000!

Get started…for as little as $14,000!

Hands On Learning Solutions, a business in Gig Harbor, Washington, evaluates and treats children for learning disabilities and claims to identify the underlying causes and help eliminate the symptoms. Much of what they do is questionable, and at least one of their methods is clearly bogus. Their program is reminiscent of the Brain Balance program that I wrote about in 2010. I’ll describe one child’s encounter with Hands On Learning Solutions and let you decide for yourself whether it sounds like a legitimate, helpful service.

Billy (not his real name) is an 11-year-old boy who is in the fifth grade at a Catholic school. He didn’t learn to talk until age 3, but he got speech therapy and is currently doing well in school, with a GPA of 86%. On his last report card, the section on “Successful Learner” rated him above average on working cooperatively with others, and satisfactory in all other categories, such as organizational skills, using time well, listening attentively, following directions, and completing work on time. His mother took him to Hands On Learning Solutions on the recommendation of a friend. On the intake questionnaire she expressed concerns about his written/oral expression, organization, study skills, attention focus, and motivation/behavior. She did not check the boxes for concerns about reading, spelling, comprehension, letter reversals, graphomotor skills, math, memory, poor grades, or slow work. (more…)

Posted in: Diagnostic tests & procedures, Neuroscience/Mental Health

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Should physicians and managed care organizations offer homeopathy?

Homeopathy is water

Anyone who reads Science-Based Medicine on even a semi-regular basis will know our collective opinion of homeopathy. Basically, at its core, homeopathy is pure quackery.

I don’t care if it’s repetitive to say this yet again because it can’t be emphasized enough times that homeopathy is The One Quackery To Rule Them All. OK, there are others that compete for that title, such as reiki and other magical “energy therapies” like therapeutic touch, both of which, unfortunately, can be found in many academic medical centers where the faculty really should know better. Any “medicine” whose very precepts break multiple laws of physics and chemistry, laws that would have to be proven not just wrong but spectacularly wrong for homeopathy to work, deserves only ridicule.

The “laws” of homeopathy

Think of it this way. There are two “laws” of homeopathy, neither of which has any basis in reality. First, there is the law that states “like cures like” and asserts that, to relieve a symptom, you need to use a substance that causes that same symptom in healthy adults. There is, of course, no evidence that this is a general principle of medicine. For instance, we don’t generally treat fever by administering something that causes fever or treat vomiting with something that causes vomiting. The second law, however, is the one that’s completely ridiculous. Basically, it’s the law of infinitesimals. This law states that a homeopathic remedy is made stronger with dilution, specifically serial dilutions with vigorous shaking between each dilution step to “potentize” the remedy. That’s ridiculous enough, but homeopaths, never satisfied with the merely ridiculous have to turn the ridiculous up to 11 and beyond by using this principle to assert that dilutions far beyond the point where there is likely even to be a single molecule of the original remedy left are effective and become more so with more dilution. For instance, a 30C dilution is 30 one hundred-fold dilutions (C=100, get it?), or a 1060 dilution. Avogadro’s number is only on the order of 6 x 1023, or more than 1036-fold less than the dilution. The simple mathematics of homeopathy just doesn’t work, although this doesn’t stop homeopaths from coming up with some truly spectacular flights of pseudoscience (like the “memory of water”) to try to “explain” how it can work.
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Posted in: Homeopathy

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GcMAF and the life and death of an autism quack

Bradstreet

[Editor’s note: This is an extra bonus post that has appeared elsewhere. This week’s post will appear in several hours.]

A mysterious apparent suicide and conspiracy theories

Three weeks ago, those of us who combat the antivaccine movement noted the then-very recent death of an autism quack and antivaccinationist (but I repeat myself) who’s been big in the “autism biomed” movement for a long time and was a regular fixture at autism quackfests like Autism ONE for many years. I’m referring, of course, to Jeff Bradstreet, whose body was found in a river on June 19, dead from a gunshot wound to the chest that appeared to have been self-inflicted. It didn’t take long (less than a week) for the antivaccine movement to start speculating about conspiracies in which Bradstreet had been “bumped off” by big pharma, as represented by comments like these:

  • “It’s obvious that he was deliberately killed off because he spoke out against federal deceit, CDC, etc and was a life-saver for many like myself.”
  • “He did NOT kill himself! He was murdered for who he was speaking against, what he knew, and what he was doing about it. He was brilliant kind compassionate doctor with amazing abilities to heal. He was taken. Stopped. Silenced.”
  • “If this does not stink to high heaven I don’t know what does. A fisherman finds his body with a gunshot wound that appears to be a self inflicted. Just how the hell would they know that. Amazingly they happen to find the gun in the river. Wow that is some amazing detective work.”
  • “What a tragic loss of a beloved doctor. I pray the authorities get to the bottom of this story…it seems highly unlikely that a Christian man would shoot himself in thy chest and conveniently fall into a river.”

You get the idea. Meanwhile, others insinuated the existence of, basically, pharma hit squads. Not long afterward, Bradstreet’s family started a GoFundMe page to “find the truth.”

Let me just say one thing. I understand, to some extent, what the Bradstreet family is going through. My family has not escaped without having had one of its members commit suicide. Although it was someone I wasn’t particularly close to, he was very close to family members I am close to. So I understand better than most the pain they are going through. They do have my sympathy. I’ve been there.

That being said, it appears that more information is coming out about what happened in the days leading to Bradstreet’s death. It’s even started to filter out to major media outlets, as in this story published yesterday in the Washington Post, “The mysterious death of a doctor who peddled autism ‘cures’ to thousands“:
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Posted in: Health Fraud, Vaccines

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Separating Fact from Fiction in the Newborn Nursery: Hepatitis B Vaccine for Newborns

hepbincidence

Hmm, what could have happened in the early 90s to explain the significant decrease in incidence of acute hepatitis B? Urkel?

For those of you new to Science-Based Medicine, I am a pediatric hospitalist and spend the majority of my time caring for newborns. It’s an extremely rewarding experience on most days. The babies are usually healthy, the parents are usually happy and appreciative, and I get to give a lot of good news. I also get to dispel a lot of myths and misconceptions regarding the care of infants, which as you can probably imagine, I take great pleasure in.

Parents ask a lot of questions, which I appreciate and encourage, but they also make a lot of claims about the care of children based on their prior experience, advice from well-meaning friends and family, or their evaluation of the online “literature.” Some of these claims I will challenge, nicely of course, when they are demonstrably wrong or increase the risk for a bad outcome. (“We read that babies should sleep inverted like a bat in order to increase blood flow to the brain.”) Some of these claims I acknowledge as an acceptable approach, even if I don’t agree with them myself, if there is low risk or a lack of available quality evidence to guide me. (“We burped our last baby every five minutes during feeds to prevent colic.”) Sometimes I even learn a thing or two from parents.
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Posted in: Science and Medicine

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It’s time for pharmacies to stop selling sugar pills

Some of these products contain no medicine at all.

Some of these products contain no medicine at all.

Retail pharmacies have a sugar pill problem. Homeopathic “remedies” may look like conventional medicine when they’re stocked on pharmacy shelves, like the photo above. But unlike conventional medicine, homeopathic products don’t contain any “medicine” at all. They are effectively sugar pills – placebos. Not surprisingly, there is convincing evidence to show that homeopathy is useless as a medical treatment, and fundamentally incompatible with a scientific understanding of medicine, biochemistry and even physics. Questions have been raised about the ethics of selling homeopathy in pharmacies to consumers who may not realize what they’re buying. This growing practice is attracting sharp criticism from other health professions. So why do pharmacies sell them? And what will it take for pharmacies to change? (more…)

Posted in: Ethics, Homeopathy, Politics and Regulation, Public Health

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False Balance for Homeopathy in the BMJ

homeopathy TThe BMJ is a prestigious medical journal, which just goes to show that prestigious journals can sometimes make awful decisions. They recently published a pro vs con article on homeopathy. Peter Fisher dragged out the current repertoire of pro-homeopathy tropes, while Edzard Ernst did a fine job of summarizing why homeopathy is nonsense.

I also think the article is an excellent example of the difference between evidence-based medicine and science-based medicine. While EBM is led by a misguided notion of “scientific equipoise” or fairness, SBM endeavors to use all scientific knowledge to make the best judgments we can about treatments.

An SBM approach to homeopathy leads only to scathing condemnation, because it is among the purest of pseudosciences. (more…)

Posted in: Homeopathy

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How To Listen to Chi

My Chi says my puppy is bad for me and I should get rid of it.  I'm keeping the puppy, and getting rid of my Chi instead.

My Chi says my puppy is bad for me and I should get rid of it. I’m keeping the puppy, and getting rid of my Chi instead.

You will need flat shoes and a bottle of vitamins, herbal formula, or prescription medicine.

Step 1: Hold the bottle with both hands, touching your chest

Step 2: Stand up straight and get your balance

Step 3: Close your eyes and feel what is happening to your body.

Results:

If your body moves forward or stays neutral – going side to side – then whatever you are holding near your chest is okay for you. Your Chi matches.

If your body moves backwards – whatever you are holding is not good for you. Your body is repelling it. Chi is saying it doesn’t want that.

You can do this test on just about anything – a bottle of wine, foods, clothing. It’s easy to test and see if these things bring positive or negative energy to your body.

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Posted in: Energy Medicine, Traditional Chinese Medicine

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The uncertainty surrounding mammography continues

Screening mammography

Mammography is a topic that, as a breast surgeon, I can’t get away from. It’s a tool that those of us who treat breast cancer patients have used for over 30 years to detect breast cancer earlier in asymptomatic women and thus decrease their risk of dying of breast cancer through early intervention. We have always known, however, that mammography is an imperfect tool. Oddly enough, its imperfections come from two different directions. On the one hand, in women with dense breasts its sensitivity can be maddeningly low, leading it to miss breast cancers camouflaged by the surrounding dense breast tissue. On the other hand, it can be “too good” in that it can diagnose cancers at a very early stage.

Early detection isn’t always better

While intuitively such early detection would seem to be an unalloyed Good Thing, it isn’t always. Although screening for early cancers appears to improve survival, the phenomenon of lead time bias can mean that detecting a disease early only appears to improve survival even if earlier treatment has no impact whatsoever on the progression of the disease. Teasing out a true improvement in treatment outcomes from lead time bias is not trivial. Part of the reason why early detection might not always lead to improvements in outcome is because of a phenomenon called overdiagnosis. Basically, overdiagnosis is the diagnosis of disease (in this case breast cancer but it is also an issue for other cancers) that would, if left untreated, never endanger the health or life of a patient, either because it never progresses or because it progresses so slowly that the patient will die of something else (old age, even) before the disease ever becomes symptomatic. Estimates of overdiagnosis due to mammography have been reported to be as high as one in five or even one in three. (Remember, the patients in these studies are not patients with a lump or other symptoms, but women whose cancer was detected only through mammography!) Part of the evidence for overdiagnosis includes a 16-fold increase in incidence since 1975 of a breast cancer precursor known as ductal carcinoma in situ, which is almost certainly not due to biology but to the introduction of mass screening programs in the 1980s.

As a result of studies published over the last few years, the efficacy of screening mammography in decreasing breast cancer mortality has been called into question. For instance, in 2012 a study in the New England Journal of Medicine (NEJM) by Archie Bleyer and H. Gilbert Welch found that, while there had been a doubling in the number of cases of early stage breast cancer in the 30 years since mass mammographic screening programs had been instituted, this increase wasn’t associated with a comparable decrease in diagnoses of late stage cancers, as one would expect if early detection was taking early stage cancers out of the “cancer pool” by preventing their progression. That’s not to say that Bleyer and Welch didn’t find that late stage cancer diagnoses decreased, only that they didn’t decrease nearly as much as the diagnosis of early stage cancers increased, and they estimated the rate of overdiagnosis to be 31%. These results are in marked contrast to the promotion of mammography sometimes used by advocacy groups. Last year, the 25 year followup for the Canadian National Breast Screening Study (CNBSS) was published. The CNBSS is a large, randomized clinical trial started in the 1980s to examine the effect of mammographic screening on mortality. The conclusion thus far? That screening with mammography is not associated with a decrease in mortality from breast cancer. Naturally, there was pushback by radiology groups, but their arguments were, in general, not convincing. In any case, mammographic screening resulted in decreases in breast cancer mortality in randomized studies, but those studies were done decades ago, and treatments have improved markedly since, leaving open the question of whether it was the mammographic screening or better adjuvant treatments that caused the decrease in mortality from breast cancer that we have observed over the last 20 years.

Given that it’s been a while since I’ve looked at the topic (other than a dissection of well-meaning but misguided mandatory breast density reporting laws a month ago), I thought now would be a good time to look at some newer evidence in light of the publication of a new study that’s producing familiar headlines, such as “Mammograms may not reduce breast cancer deaths“.

Here we go again.
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Posted in: Cancer, Public Health

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