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Holding the supplement industry to account: Can we learn from tobacco regulation?

When it comes to supplements, you can't trust what's on the label

When it comes to supplements, you can’t trust what’s on the label

The idea that “natural” products are safe and effective has been so effectively marketed to us that many don’t recognize it as a fallacy. Much of the supplement industry is built around an appeal to nature. Supplements are described as natural, gentle, and “holistic”. Medicine, especially prescription drugs, is the opposite. They’re “chemicals”. They’re risky and dangerous – just look at that list of side effects! Supplements are packaged beautifully, have impressive claims, and are for sale at Whole Foods. Drugs are hazardous: They may come in a plain vial, with warning labels, detailed information sheets, and cautious statements about their effectiveness. Is it any wonder that many consumers, when faced with health concerns or medical issues, instinctively think of supplements as a safer alternative? Purveyors of supplements and alternative medicine have leveraged this fallacy so effectively that it’s even guided the regulations that allow their sale. Regrettably, the result is a marketplace that puts consumers’ interests last. The supplement industry has completely stacked the odds against the consumer, challenging their ability to make informed decisions about their health. Most supplements on the market have never been properly tested for safety or effectiveness. And those that have been tested have largely been shown to be ineffective – or in the case of products like vitamins, often unnecessary. And while there are undoubtedly some ethical companies out there, the industry is regularly revealed to resemble a wretched hive of scum and villainy. Despite this, the industry has gone from success to success – in terms of sales, at least. In 1994 supplement sales were about $4 billion in the US. It’s now a $37 billion industry that is remains only lightly regulated – or largely unregulated. With recent action taken against fraudulent products, there are more questions than ever about how to force the supplement industry to make consumer protection a priority. A new paper in Drug Testing and Analysis makes a provocative suggestion: Local and state governments already regulate another hazardous product: tobacco. Can lessons learned from the tobacco wars improve the safety of supplements? (more…)

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CRISPR and the Ethics of Gene Editing

CRISPR-conf

If you have not heard of CRISPR yet, you should have. This is a truly transformative technology that allows for cheap and easy gene editing. It makes a powerful technology easily accessible.

Powerful biological technology, like stem cells to give another example, always seem to provoke profound hope and fear. The ability to manipulate human biology comes with it the hope of treating horrible and currently untreatable diseases. At the same time such technology provokes fear that it will be abused, or that it will violate the sanctity of what it means to be human.

As the public debate over stem cells seems to be fading into the background a bit (like IVF before it), debates over CRISPR and gene editing are likely to come to the forefront.

What is CRISPR?

(more…)

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Is Addiction a Disease? Yes and No

Yes, it's a disease

Yes, it’s a disease

No, it's a habit

No, it’s a habit


Addiction is a puzzling phenomenon. Why do addicts persist in self-destructive behavior even after it has lost them their jobs, their family, their health, and their self-respect? Do they have any control over their behavior? If so, why don’t they control it? If not, why not? Two recent books shed light on these questions: The Biology of Desire: Why Addiction Is Not a Disease, by Marc Lewis, and The Thirteenth Step: Addiction in the Age of Brain Science, by Markus Heilig.

Lewis is a neuroscientist and former addict; Heilig is a physician and addiction researcher. Lewis is convinced that addiction is not a disease, but a habit created by the neural circuitry of desire in the course of its normal functioning. Heilig is convinced that addiction is a chronic disease like diabetes that can’t be cured but that must be managed by lifelong treatment.

While they disagree about whether addiction is a disease, they actually agree about almost everything else. They agree that we should reject the stigma of addiction as a kind of moral failing. They reject the hypotheses that addiction is a matter of choice or self-medication. They think current diagnostic labels are inadequate. They both try to integrate two levels of information: the case histories of addicts and the scientific knowledge from research. They are both skeptical of AA and of conventional rehab programs. They both support evidence-based treatments. They both think addicts are not all alike and that individual addicts will respond better to individualized approaches. (more…)

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How not to debate a “pro-vaxer”

When people debating against vaccines win, children lose.

When people debating against vaccines win, children lose.

To say that the relationship that antivaccine activists have with science and fact is a tenuous, twisted one is a major understatement. Despite mountains of science that says otherwise, antivaccinationists still cling to the three core tenets of their faith, namely that (1) vaccines are ineffective (or at least nowhere near as effective as health officials claim; (2) vaccines are dangerous, causing autism, autoimmune disease, neurodevelopmental disorders, diabetes, sudden infant death syndrome, and a syndrome that is misdiagnosed as shaken baby syndrome; and, of course, (3) the Truth (capital-T, of course!) is being covered up by a nefarious combination of big pharma, the medical profession, and the government (in the US, primarily the Centers for Disease Control and Prevention, which works with pediatricians to produce the recommended schedule of vaccines). Because vaccine rejectors don’t have science on their side, they have to resort strategies common to science denialists like those who reject the scientific consensus about evolution or human-caused global climate change. These fallacious strategies include (but are not limited to) selective citation of evidence (i.e., cherry picking), misrepresentation and logical fallacies, impossible expectations about what science can deliver (e.g., vaccine denialists expecting 100% efficacy and 100% safety from vaccines or cancer quacks expecting 100% cure rates and no side effects from chemotherapy); fake experts (e.g., Andrew Wakefield); and, of course, conspiracy theories. Add to that appeals to personal freedom and “health choiceüber alles and painting any form of vaccine mandate as incipient totalitarianism, with those rejecting vaccines taking on the role of the Jews in Hitler’s Germany, and you have a pretty good idea of the sorts of arguments antivaccine activists resort to.

Not surprisingly, even the most diehard antivaccine advocate can get frustrated. After all, it must be very frustrating to have one’s posterior handed to one in arguments on the science of vaccines time and time again. Of course, for that purpose, like most science denialists, antivaccine activists have the Internet. In particular, they’ve taken full advantage of Facebook, and, more recently, Twitter. One such online gathering place is the public group known as Vaccine Resistance Movement (VRM). I encourage pro-science advocates to peruse this group, just to see that when I refer to people being anti-vaccine, there is no doubt that that is what they are. It was there that I found a rather telling document posted, for the benefit of antivaccine advocates everywhere.
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No, Purell Does Not Breed Super-Anything

Pictured:  Mechanism of pumpy doom, or savior to us all?  Neither!

Pictured: Superbug spawner, or savior to us all? Neither!

Recently, I was sitting in a meeting and reached for the dispenser of Purell hand sanitizer sitting on the conference room table. A colleague of mine gave a small, rueful shake of her head to the person on her other side. Apparently I had erred. I asked what was the matter, and got a brief answer to the effect of “because superbugs.” We exchanged nothing more about it; the interaction was over before the alcohol had dried from my hands.

I wouldn’t have thought anything of such an interaction with anyone else, but my colleague is a PhD student in immunology, six years older and more schooled than I, doing her doctoral research in a lab run by a physician-scientist — a specialist in infectious disease, no less. A touch ironic.

And so I noticed a need for some mythbusting: alcohol-based hand sanitizers do not breed resistant bacteria. (more…)

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Announcing: Video Lecture Course on Science-Based Medicine

A couple of years ago, the James Randi Educational Foundation commissioned me to develop a series of 10 video lectures on Science-Based Medicine. After a lot of work and many vicissitudes, it has finally gone live on YouTube. http://web.randi.org/educational-modules.html The lecture titles are:

  1. Science-Based Medicine vs. Evidence-Based Medicine
  2. What Is CAM?
  3. Chiropractic
  4. Acupuncture
  5. Homeopathy
  6. Naturopathy and Herbal Medicine
  7. Energy Medicine
  8. Miscellaneous “Alternatives”
  9. Pitfalls in Research
  10. Science-Based Medicine in the Media and Politics

The series is accompanied by a Course Guide that can be downloaded as a pdf.

 

 

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SCAM Cell Therapies

Surprisingly, the best youth is in the chump.

Pictured: Stem cells.  Surprisingly, the best youth is in the chump.

Injecting animal cells into humans for therapeutic reasons has a long history. The most infamous was John Brinkley who injected goat testicles into 16,000 men in the 1920s and 30s to treat impotence. Harriet wrote a review of Charlatan: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam, which covers the topic. I wonder who would get the title today. Chopra…Gesundheit.

I had thought this therapy was consigned to the sharps container of history. Of course not. No SCAM ever fades away.

As part of my ID reading I came across the headline “Q Fever Outbreak Among Travelers to Germany Who Received Live Cell Therapy — United States and Canada, 2014.”

It surpasses the classic “Notes from the Field: Campylobacter jejuni Infections Associated with Sheep Castration — Wyoming, 2011” for foolishness, where:

…men reported having used their teeth to castrate some of the lambs.

Really. A most curious way to acquire Campylobacter. But at least the castrators were doing practical, albeit eeewwwwwwww, work. And there is an alternative to teeth, including the Burdizzo Emasculatone, which is:

an elegant little tool especially suited to crushing the spermatic cords of a variety of male mammals. It really helps to make a neat job of what would otherwise be an unpleasantly messy endeavor, and the Burdizzo achieves the goal of bloodless castration admirably.

But I digress and leave to the commenters to make completely inappropriate remarks. Only the SCAM universe can be odder than infectious diseases. (more…)

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Brian Clement claims Hippocrates treatments “reverse” multiple sclerosis

Brian Clement

Brian Clement

American charlatan Brian Clement made another trip to Canada recently and was caught on audiotape claiming multiple sclerosis could be “reversed” at the Hippocrates Health Institute (HHI), where he serves as Director. This is yet another in a series of his misrepresentations about the effectiveness of the quack treatments offered at HHI. Indeed, Clement calls to mind the old joke about inveterate liars:

Q: Know how can you tell this guy is lying?

A: His lips are moving.

Once again, the Canadian Broadcasting Corporation (CBC), which has done an outstanding job exposing Clement and his mendacity, caught him in this particular fabrication. (The American media, by contrast, has largely ignored the story, even to the point of printing credulous puff pieces about Clement.) According to the CBC, it:

obtained a recording of a lecture Clement gave in September in Montreal where he said, “Last week, we had somebody at the institute that reversed multiple sclerosis.”

He went on to claim that many other people who visited his Florida spa, the Hippocrates Health Institute, saw similar results.

“A nurse that came to us two years ago was crippled, had braces on. By the time she left Hippocrates, she reversed the multiple sclerosis.

“And mainstream medicine, they think it’s remarkable. I’ve seen lots and lots of people over the years did that.”

(more…)

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Exercise and Memory

exercise-brainThere is no escaping the evidence that regular moderate exercise is associated with a host of medical benefits. Among those benefits are perhaps improved memory and cognition, and questionably a decreased risk of developing dementia.

The latest study to show this correlation involved younger and older adults who wore a step-monitor. The number of steps they took during the study interval was then correlated with their performance on neuropsychological testing. The researchers found that for the older adults, but not younger adults, more physical activity correlated with better overall cognitive performance, but especially for face-name recognition.

This is a small study, with 60 subjects total. Also, the study is correlational only. It is possible that healthier older adults are both more physically active and cognitively nimble, because of underlying biological fitness. More cognitively active older adults may also be more physically active – the lines of cause and effect are plausible in multiple ways. (more…)

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American Academy of Family Physicians Home Study Course Recommends Non-Science-Based Treatments

aafp

Strong medicine…along with a little nonsense

Since passing my board exams in family practice in 1979 I have relied heavily on the American Academy of Family Physicians for continuing medical education via the American Family Physician and the AAFP home study programs. The AAFP prides itself on its evidence-based approach to medicine. In general, it delivers. But the recent FP Essentials Number 432 on “Chronic Pain Management” fell short. It recommended treating chronic pain with acupuncture, chiropractic, touch therapy, and S-adenosyl methionine (SAM-e), presenting them in a way that misled readers into thinking that the recommendations were based on good scientific evidence. They were not.

With 6,500 peer reviewed journals and over two million papers published every year, it is easy to find a study to support pretty much any point of view. John Ioannidis taught us that most published research findings are false, with preliminary studies frequently being overturned by larger, better follow-up studies. When evaluating the evidence for a treatment, it is not enough to find one or two positive studies. It is essential to also look for negative studies and for systematic analyses that weigh all the published evidence, and to put all the available evidence into perspective. The authors failed to do that. (more…)

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