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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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Cryotherapy: A Layman’s Attempt to Understand the Science

Whole Body Cryotherapy
NOTE: I get a lot of emails asking me whether treatment X is evidence-based or a scam. This one was different. Zachary Hoffman had done his homework and had already answered the question for himself (at least, as well as it could be answered with the existing published evidence). I asked him to write up his findings as a guest post for SBM. This is a great example of how a layman can figure things out for himself using little more than google-fu and critical thinking skills. I hope it will be an inspiration to others who may not have thought they were qualified to do what we do on SBM.


Recently a friend alerted me to something called “Whole-Body Cryotherapy” which has been making the rounds on Facebook and is being promoted by many athletes and celebrities. I had only heard of cryotherapy in the context of freezing off a wart, but I was about to find out there was so much more. She explained that subjecting your entire body to extreme cold (-200˚F!) for a few minutes a day was a virtual panacea, with weight-loss, tissue repair, and beauty treatments as the target market. My limited background in biology hadn’t quite prepared me for understanding why subjecting oneself to cold air could possibly help treat any illness.

For instance, up here in Boston, I ride my bike all winter long, and on a particularly cold day, after a 5 degree ride, no one has commented that I seem particularly trim, or that my face is looking unusually beautiful. Unfortunately, a few days ago while riding my bike, I took a spill and mushed my hand pretty good. However, the cold winter air hasn’t done much to alleviate that pain or stop my right hand from being twice the size of the left. In any case, it seemed to me that I’d have to give this a closer look before I made any comments.

A quick search on Google led me to a website, Cryohealthcare, Inc. The website is aesthetically pleasing and has plenty of information about how this treatment can transform your life. To top it off, there are lots of endorsements from professional teams and athletes. It appears that for about $65 a pop you can subject yourself to unfathomably low temperatures and enjoy a whole-body tingle when you step out (when I was younger I used to jump in the snow and then get into a hot tub, so I get the appeal). A quick scroll down and we see indications for injury recovery, pain mitigation, and athletic performance, among others, followed nicely by the FDA quack Miranda warning. (more…)

Posted in: Health Fraud, Medical devices

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Ethical Failures

 

M

Me, ten minutes after the end of this post.  EXTREME!

 

It is summer vacation for me in Eastern Oregon at Sunriver. Unbelievable geology, fantastic hikes, great biking, wonderful golf, delicious beer and good food. The thesaurus fails me for superlatives. It is hard to get too riled up about all things SCAM to produce a blog entry when I could be doing one or all of the above. I really don’t want to do this. Sadly, David keeps threatening me with the video he has of me touting the benefits of Integrative Medicine with its holistic approach to health care, and I just can’t have that published on the ‘net. So some brief speculation to fill the time between golf and a pint of IPA overlooking the Sisters.

Ethics, and the purpose of SBM

Steve started this blog in 2008 in part because he realized that evidence-based medicine was inadequate for the task of evaluating pseudo-medicines. He coined the term ‘science-based medicine’ with the realization that for fantastical therapies like acupuncture or homeopathy, all the potential biases and flaws in the evidence from clinical studies could result in pseudo-medicines appearing effective when at heart they are all Oakland California.

I do not suppose there could be science-based ethics. One person’s ethical certainty is another’s belly laugh. I remember a grand rounds on human cloning years ago and they had, among others, a priest discussing the ethics of human cloning, and I thought at the time there would be few speakers with less legitimacy. And really, I can see no harm in cloning an army of zombie super soldiers, especially if they were under my control.

Still, one of the issues I remain amazed at is how many clinical trials testing pseudo-medicines are approved by institutional review boards (IRB). (more…)

Posted in: Clinical Trials, Ethics

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Nevada’s new quack protection law

Nevada state seal

Practicing a licensed health care profession, such as medicine, without a license used to be a felony in Nevada. Not any more. As of July 1, quacks and charlatans are free to ply their trades unencumbered by the threat that they might have to answer to the regulatory authorities for their misdeeds, as long as they follow a few simple rules.

This new law, passed overwhelmingly in the Legislature and signed by the Governor, is yet another success of the “health care freedom” movement. It was shepherded through the legislative process by Alexis Miller, a lobbyist for the Sunshine Health Freedom Foundation (Sunshine), which is affiliated with the National Health Freedom Coalition. It’s Director of Law and Public Policy, Diane Miller, also spoke in favor of the bill. We’ll get back to these groups and their comrades in arms in a moment.

First, let’s take a look at what the new law does. A person who provides “wellness services” is protected from prosecution as long has he doesn’t practice medicine, podiatry, chiropractic, homeopathy (homeopaths are licensed in Nevada) or another licensed profession. Some forbidden services are listed in the law, including surgery, setting fractures, prescribing or administering x-rays or prescription drugs, or providing mental health services in the exclusive domain of psychiatrists and psychologists. Of course, while there is certainly danger in untrained persons doing any of these things, they aren’t generally on your average quack’s list of services, nor are they likely interested in them in the first place. (more…)

Posted in: Energy Medicine, Health Fraud, Herbs & Supplements, Legal, Politics and Regulation, Vaccines

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University of Toronto Coddles Quackery

homeopathy landau

The ongoing saga of quackademic medicine continues. The University of Toronto School of Public Health has been caught teaching utter nonsense to its students. Even worse, when called out on this dereliction of their academic responsibility, they defended it. Unfortunately, it is all too clear how something like this can happen.

The department was teaching an alternative medicine course at U of T’s Scarborough campus. The course was taught by Beth Landau-Halpern who is a homeopath Scott has discussed before, and who also happens to be the wife of the dean of that campus (it’s hard to imagine this was not a factor). Landau-Halpern should never, in my opinion, be anywhere near the classroom of a legitimate university.

The fact that she is a homeopath is enough to disqualify her to teach any health topic. On her website she boldly claims that “homeopathy works,” even though the evidence shows that homeopathic potions are indistinguishable from placebo. She also specializes in treating children with ADHD and autism. She advertises her training as a CEASE practitioner – CEASE stands for:

Complete Elimination of Autistic Spectrum Expression. Step by step all causative factors (vaccines, regular medication, environmental toxic exposures, effects of illness, etc.) are detoxified with the homeopathically prepared, that is diluted and potentized substances that caused the autism.

It is clear she is operating under a non-scientific narrative, which is typical of practitioners of alternative medicine.

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Posted in: Medical Academia

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Update on Cholesterol and Statins

The statin hypothesis is that statins reduce cardiac risk more than can be explained by the reduction in LDL cholesterol. That hypothesis has been overturned by a new study.

The statin hypothesis is that statins reduce cardiac risk more than can be explained by the reduction in LDL cholesterol. That hypothesis has been overturned by a new study.

 

The consensus of mainstream medicine is that a high blood level of LDL cholesterol is a major risk factor for cardiovascular disease and that lowering high levels can help with prevention and treatment. Statins have been proven effective for lowering cholesterol levels and for decreasing cardiovascular and all-cause mortality. I recently wrote about the new guidelines for statin therapy.

Currently half of American men between the ages of 65 and 74 are taking statins, and 71 percent of adults with heart disease and 54 percent of adults with high cholesterol take a cholesterol-lowering drug.

There is still a fringe group of a few maverick “cholesterol skeptics” who think lowering cholesterol is useless or counterproductive, but the evidence shows they are wrong.

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Posted in: Clinical Trials

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The war in California over nonmedical exemptions to school vaccine mandates, part 2

The war in California over nonmedical exemptions to school vaccine mandates, part 2

Last week, in the run-up to the 4th of July holiday weekend, something happened that I truly never expected to see. SB 277 became law in the state of California when Governor Jerry Brown signed it. In a nutshell, beginning with the 2016-17 school year, the new law eliminates nonmedical exemptions to school vaccine mandates. When last I wrote about SB 277 for this blog three weeks ago, I explained why I thought it was unlikely that SB 277 would ever become law, so that California could join West Virginia and Mississippi as the only states that do not permit religious or personal belief exemptions to school vaccine mandates. Basically, it was because California is not Mississippi or West Virginia. It’s a hotbed of antivaccine activism. Although statewide vaccination rates are high, there are a number of areas where antivaccine and vaccine-averse parents have led to low vaccine uptake with resultant outbreaks of vaccine-preventable diseases. Most recently, a large outbreak centered at Disneyland served as the catalyst that made it politically possible for a bill like SB 277 even to be seriously considered by the California legislature. Even so, given that California is home to a number of antivaccine celebrities such as Rob Schneider, Alicia Silverstone, Bill Maher, Charlie Sheen, Mayim Bialik, and Jim Carrey, antivaccine pediatricians such as “Dr. Jay” Gordon and “Dr. Bob” Sears, and many of the activists at the antivaccine crank blogs Age of Autism and The Thinking Moms’ Revolution, I was not optimistic.

I was mistaken in my pessimism, and I’m happy about that. I’m grateful to all those who didn’t see passing this law as an impossible task, such as Senators Richard Pan and Ben Allen, and who worked tirelessly to see it through, as some of our regular readers did. I was also pleasantly surprised that Governor Jerry Brown didn’t betray California children by watering down the bill with a signing statement, as he did three years ago when an earlier bill (AB 2109) was passed to make it more difficult for parents to obtain personal belief exemptions to school vaccine mandates.

So since SB 277 is law in California, what now?
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Posted in: Politics and Regulation, Public Health, Religion, Vaccines

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Cochrane Review on Community Water Fluoridation

Fluoridated water: Panacea or poison?  Probably neither.

Fluoridated water: Panacea or poison? Probably neither.

One of the overriding themes of the Science Based Medicine blog is to use rigorous science when evaluating any health claim – be it medical, dental, dietary, fitness, or any other assertion put forth with the intention of improving one’s health. Once the scientific evidence is evaluated as to efficacy, there are other criteria which must be taken into consideration, such as ease of administration, costs, possible adverse effects, and so on. Benefits have to be carefully weighed against risks to properly determine any appropriate course of action. For example, if a new pill is developed which is significantly better at , say, managing hypertension than existing medications, but it kills 10% of patients taking it, it obviously would not be the drug of choice. Conversely, if a proposed treatment, say homeopathy, is touted as being 100% safe with no side effects, but has absolutely zero benefits, it too would not be a recommended treatment. It’s a complicated and often ambiguous algorithm, and is imperfect due to the impossibility of attempting to quantify non-quantifiable values and qualities. (more…)

Posted in: Dentistry, Science and Medicine

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This stimulant can kill, yet you can legally buy it online. Why?

Caffeine Powder

This stimulant drug is highly toxic and perfectly legal.

If there’s one thing that unites all countries and cultures, it’s our love of caffeine. Whether it’s coffee, tea or other foods, caffeine is the most widely consumed drug in the world — more than alcohol, and more than tobacco: 90% of adults worldwide consume caffeine daily. At doses found in food and beverages, the effects are predictable and the side effects are slight. But natural or not, caffeine is a drug; isolate the pure substance, and the risks change. It would be difficult for most people to drink 16 cups of coffee in a row, but that’s the equivalent of just one teaspoon of caffeine powder. If that doesn’t hospitalize you, a tablespoon of the powder will probably kill you. Yet despite the risks, there are no restrictions on the sale of caffeine powder. You can buy a 1kg bag for $35, which provides the caffeine of about 5,000 cups of coffee. Caffeine powder is freely available to buy because regulators treat it differently – not because of its inherent properties, but because it’s “natural” and sold as a dietary supplement rather than a drug. This is a regulatory double-standard that harms consumers. It’s leaving a body count. And it needs to change: (more…)

Posted in: Herbs & Supplements, Politics and Regulation, Public Health

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