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Vaginal Seeding. Ew. That’s nuts. Hmmm, interesting.

A breakdown of bacterial species from your skin's microbiome. As a favor to

A breakdown of bacterial species from your skin’s microbiome. As a favor to pregnant women expectant fathers teenage boys on the internet everyone, this is the image I went with. Click to macrolaarggen (Ikean for embiggen).

Sometimes a headline will cause me to run through a series of reactions in rapid sequence. For example “Mothers facing C-sections look to vaginal ‘seeding’ to boost their babies’ health”:

Early studies show that swabbing a mother’s vagina and transferring it to her baby’s mouth, eyes and skin may stimulate microbiome development similarly to babies born naturally – and protect it from health issues later in life

I mean ick.

But take a step back. Not really. I tend to think of people like “Pig Pen” in Charlie Brown, shedding skin and bacteria into the environment. If we were to really think about each other’s microbiome, we might not have intimate contact with our significant other. Or any other animal. I always point out, when someone lets their dog lick them, that they (the dog) had probably just licked its rear, AKA dog-ass seeding. And no, a dog’s mouth is not cleaner than a human’s, unless your dog brushes and flosses with greater frequency than you. (more…)

Posted in: Basic Science, Evolution, Faith Healing & Spirituality, Humor, Nutrition

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Legislative Alchemy: Michigan House Bill 4531 gives naturopaths a broad scope of practice

Legislative Alchemy

Legislative Alchemy

Michigan House Bill 4531, if passed, would give naturopaths one of the broadest scopes of practice in the U.S., essentially equaling that of a family practice MD or DO. The bill made it through all the necessary House committees and is now before the House for an initial vote determining whether it will proceed further in that body. If it passes there, it will move to the Senate and its committee process.

Most naturopathic licensing bills fail, even in those states where attempts are made year after year. Michigan is no exception. Both David Gorski (a Michigan resident) and I discussed the previous licensing attempts there. In the two states where naturopathic licensing or registration has succeeded in the last few years, they have been able to get only a much more limited scope of practice than the full primary care scope they desire. For example, in Colorado, there are severe limitations on naturopaths’ seeing pediatric patients. They must disclose they are not physicians, recommend to parents that their children have a relationship with a licensed pediatric practitioner, and give parents the CDC-recommended vaccination schedule. All this is to thwart their efforts to talk parents out of vaccinating their children by giving them “balanced” information that is actually full of anti-vaccination dog whistles.

In Maryland, where naturopaths are regulated by the Maryland Board of Physicians, they cannot call themselves physicians or claim to practice primary care. They must have a collaboration and consultation agreement with an MD or DO and attest to the Board that the ND will “refer patients to and consult with physicians and other health care providers.” NDs must also have patients sign a consent form stating that the ND’s practice is limited to the scope of practice allowed by law. They cannot deviate from what is termed “safe care of patients” whether or not actual injury to a patient is established.

If passed, HB 4531 would be a radical departure from that trend. This newfound success in moving the ball forward may be due to an influx of funds from Emerson Ecologics, a company that sells dietary supplements and homeopathic remedies to naturopaths for resale to their patients. The company also sells the sort of dubious diagnostic tests used by naturopaths in their practice. For example, they offer a test for “adrenal stress” (to discover, not just “adrenal fatigue,” but actual “exhaustion”) and a saliva test for hormone levels as an indicator of the need for “bio-identical hormones.” (Neither the test nor “bio-identical hormones,” which is actually a marketing, and not medical term, are recommended in evidence-based medical practice.) In March, Emerson Ecologics announced a “grant” to the Michigan Association of Naturopathic Physicians (MANP) of $10,000 to support the effort to obtain full licensure for naturopathic doctors in Michigan.
(more…)

Posted in: Legal, Naturopathy, Politics and Regulation

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A Harris Poll on “Alternative Medicine”

One can only imagine how annoyed Twain would have been had he known about opinion polls.

One can only imagine how annoyed Twain would have been had he known about opinion polls.

Mark Twain popularized the phrase, “There are three kinds of lies: lies, damned lies, and polls and surveys.” (He may have said “statistics” at the end, but I think this version works as well.)

A new Harris Poll on “alternative medicine” nicely demonstrates some of the problems with polls. The biggest problem is how you frame the questions. You can dramatically affect the results of the poll by exactly how a question is phrased, which other questions come before or after the question, and the overall context of the poll.

In essence a poll is a two-way form of communication. While it is meant to derive information from the subjects of the poll, those subjects are also receiving information from the poll itself. That is the very reason for “push polling” – which is the practice of disguising campaigning messages as a poll. (“On a scale from 1-5, how much are you bothered by the fact that candidate X is a misogynist?”). Yes, Prime Minister has an amusing example of this practice in action.

Interpreting the results of a poll is also not straightforward. You have to know how the subjects of the poll interpreted the questions, and what factors might affect their response. (more…)

Posted in: Commentary

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The “Incoherent Mess” That Is Homeopathy: Old and New Insights

jongh-paper-1stpage
Back in 1943 a Dutch physician, David Karel de Jongh, wrote a PhD dissertation on homeopathy. It was based on his experience working in a homeopathic hospital and on all the published information he could find, and was highly critical of homeopathy. It was an impressive opus, with over 200,000 words. It is way too long for the average reader to wade through; and since it is in Dutch, few of us could read it even if we wanted to. Jan Willem Nienhuys, secretary of the Dutch skeptics’ organization Skepsis, has done us a great favor by summarizing its contents and updating it with information about recent developments. He has kindly had his summary translated into English and published in full on the Skepsis website. He comments “Basically Dr. de Jongh’s conclusions were that homeopathy is an incoherent mess.”

We all should know by now how monumentally silly homeopathy is (“delusions about dilutions”). I had investigated the subject and knew enough about it to have written about it repeatedly, but there is much more that I didn’t know. Nienhuys’ article is full of surprising facts and fascinating details. (more…)

Posted in: Homeopathy

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Are medical errors really the third most common cause of death in the U.S.?

NOTE: Anyone who has seen several derogatory articles about me on the web and is curious about what the real story is, please read this and this.

Dr. Martin Makary claims that medical errors are now the third leading cause of death in the US. Is he correct?

Dr. Martin Makary claims that medical errors are now the third leading cause of death in the US. Is he correct?

It is an unquestioned belief among believers in alternative medicine and even just among many people who do not trust conventional medicine that conventional medicine kills. Not only does exaggerating the number of people who die due to medical complications or errors fit in with the world view of people like Mike Adams and Joe Mercola, but it’s good for business. After all, if conventional medicine is as dangerous as claimed, then alternative medicine starts looking better in comparison.

In contrast, real physicians and real medical scientists are very much interested in making medicine safer and more efficacious. One way we work to achieve that end is by using science to learn more about disease and develop new treatments that are as efficacious or more so than existing treatments with fewer adverse reactions (clinical equipoise). Another strategy is to use what we know to develop quality metrics against which we measure our practice. Indeed, I am heavily involved in just such an effort for breast cancer patients. Then, of course, we try to estimate how frequent medical errors are and how often they cause harm or even death. All of these efforts are very difficult, of course, but perhaps the most difficult of all is the last one. Estimates of medical errors depend very much on how medical errors are defined, and whether a given death can be attributed to a medical error depends very much on how it is determined whether a death was preventable and whether a given medical error led to that death.
(more…)

Posted in: Politics and Regulation, Public Health, Quality Improvement, Science and Medicine

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Join Us at NECSS 2016. One Week To Go

A day of Science-Based Medicine, a weekend of science and skepticism

NECSS, the NorthEast Conference on Science and Skepticism, is this spring.

Included in the program will be a full day of Science-Based Medicine.

The NECSS will be held May 12th–15th, 2015, in New York City at the Fashion Institute of Technology.

Full Conference schedule here.

Description: NECSS welcomes over 400 attendees to New York City for a celebration of science and critical thinking. Through individual presentations, panel discussions, and performances, attendees are informed and inspired by leading scientists, educators, activists, and performers – each bringing their own perspective and passion to the goal of fostering a more rational world.

The SBM schedule (subject to change) at NECSS

9:30-9:40 10 minutes Welcome
9:40-10:15 35 minutes Functional Medicine is Dysfunctional Harriet Hall
10:15-10:50 35 minutes Science-Based Dentistry: Where the Truth Meets the Tooth Grant Ritchey

10:50-11:00 10 minutes Break

11:00-12:10 70 minutes Natural Disaster: Dietary Supplements Scott Gavura & Jann Bellamy

12:10-1:40 90 minutes Lunch

1:40-2:15 35 minutes Kids & CAM: Playing Make-Believe with Children’s Health John Snyder
2:15-2:50 35 minutes Chronic Lyme: When Life Hands You Lemons Saul Hymes
2:50-3:25 35 minutes Your Baby’s Spine Will Be Just Fine Without Chiropractic Adjustment Clay Jones

3:25-3:40 15 minutes Break

3:40-4:45 65 minutes Debate: Should Physicians “Fire” Anti-Vaccination Patients? John Snyder, Saul Hymes, Clay Jones
4:45-5:20 35 minutes Bayesian Statistics Steve Novella
5:20-6:05 45 minutes Ask Us Anything: Audience & Twitter Q & A All Speakers
6:05-6:15 10 minutes Closing

Registration is open.

See you there.

Posted in: Announcements

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The Crack Heard Round the World

Chiropractor Ian Rossborough mid-rationalization

Chiropractor Ian Rossborough shown here mid-rationalization

In January, Melbourne chiropractor Ian Rossborough uploaded a video to YouTube of himself treating a 4-day-old premature infant. The video, one of many that can be found on his “Chiropractic Excellence” channel, is for educational purposes only, intended to teach the world about the miraculous benefits of chiropractic care for a wide variety of conditions. Although the cynical among us may proclaim that his videos are just more examples of chiropractic practice building shenanigans, Rossborough claims that he simply wants to “enable natural healthy living, without resorting to drugs or surgery.”

Australian physicians respond

Well, there are apparently a lot of angry and cynical Australians, particularly journalists and physicians. In late April, the video, which features Rossborough manipulating the newborn’s thoracic spine hard enough to cause a loud cracking sound and a cry of pain went viral after it was featured in a story on Australian Broadcasting Corporation Radio National. Rossborough, and the treatment of children by chiropractors, has since come under intense scrutiny.

According to the Australian press, “doctors have declared war on chiropractors” in response to the realization that newborns and young infants are undergoing unnecessary spinal manipulation for problems such as colic, acid reflux, and excessive crying as well as for nebulous benefits like boosting the immune system and improved growth and development. The Royal Australian College of General Practitioners, the largest medical college in Australia with a membership of over 30,000 rural and urban primary care physicians, has even requested that members refrain from referring patients to chiropractors. They want the federal government and private insurers to stop paying for nonsense such as infant chiropractic.

Frank Jones MD, president of the RACGP, has made the media rounds, describing infant and toddler adjustments as “seemingly almost cruel” and lacking any supporting evidence. He has also called for the Chiropractic Board of Australia to shape up in order to have any chance of being accepted as a legitimate scientific discipline. Jones thinks that chiropractors like Rossborough and his ilk don’t know what they are doing and are putting patients at risk. He reminds the public that a physician’s job is to advocate for patients and to try to reduce exposure to practices where the risk far exceeds any potential benefit. I like this guy.

(more…)

Posted in: Chiropractic, Science and Medicine

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Is there a naturopathic standard of care?

Stephans
Public outcry over the death of Ezekiel Stephan, the 19-month-old Alberta toddler who died of bacterial meningitis in 2012, continues to grow following last’s weeks court decision, which found both of his parents guilty of failing to provide the necessaries of life. David and Collet Stephan failed to seek appropriate medical care for their obviously-ill child, instead relying on a variety of vitamins, supplements, and remedies from the family’s own home business, Truehope Nutritional Support. While sentencing will not take place until later this year, David Stephan hasn’t hesitated to lash out with an open letter to the jury that suggests he remains unrepentant for the series of decisions that led to the death of his son:

I only wish that you could’ve seen how you were being played by the Crown’s deception, drama and trickery that not only led to our key witnesses being muzzled, but has also now led to a dangerous precedent being set in Canada.

The precedent referred by Stephan seems to his perceived “right” to prioritize his beliefs in what is demonstrable pseudoscience and quackery over the “right” for his child to receive appropriate medical care. Ezekiel had never seen a physician. He had received no vaccinations, including vaccination against Haemophilus influenza type b (Hib), a vaccine which protects against bacterial meningitis. And as he lay dying, the parents chose to use an Echinacea tincture recommended by a naturopath, Tracey Tannis, who never even examined Ezekiel. Given the involvement of Tannis in this tragedy, there are renewed questions about naturopathy in Canada, whether naturopaths are capable of self-regulation, and the standard of care they provide. (more…)

Posted in: Naturopathy, Science and Medicine

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Overprescribing Antibiotics

Phial of penicillin from 1946, marking the advent of the now-closing "antibiotic era".

Phial of penicillin from 1946, marking the advent of the now-closing “antibiotic era”. Image from the Wellcome Trust via the Wikimedia Commons.

Recently I had a cutaneous abscess which was treated (quite painfully) with incision and drainage. My doctor told me that antibiotics were not strictly necessary, but I could have them if I wanted. The idea of any treatment that could resolve the abscess more quickly was appealing, but I did not want to contribute to the unnecessary use of antibiotics so I declined.

The use of antibiotics in cutaneous abscess is not straightforward, as there are indications – signs of systemic infection, failure to resolve quickly with just I&D, or in immunocompromised patients. Antibiotics may also reduce the risk of recurrence. These are, after all, bacterial infections.

If I were not very familiar with the issue of antibiotic overuse and emerging resistance I probably would have caved and accepted the antibiotics, and I suspect most patients do. Many patients probably request antibiotics or at least ask about them. I declined, and everything turned out fine. (more…)

Posted in: Guidelines, Public Health

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Sharks Get Cancer, Mole Rats Don’t: Clues to Understanding Cancer

sharks
We think of cancer as caused by mutations. Mutations are necessary, but not sufficient, to cause cancer. New research indicates that it’s the body’s response to mutant cells that determines whether cancer will develop. James S. Welsh, MD, a radiation oncologist and researcher, has written a book on the immunology of cancer, Sharks Get Cancer, Mole Rats Don’t: How Animals Could Hold the Key to Unlocking Cancer Immunity in Humans. In it, he pieces together clues from animals, pregnancy, Ebola virus, infections, organ transplantation, parasites, and human cancer patients, weaving a web of insights that point to a better understanding of cancer biology and treatment.

Sharks do get cancer

Shark with cancer

Shark with cancer

The first book claiming that sharks don’t get cancer came out in 1992. It persuaded so many people to take shark cartilage that the world market exceeded $30 million and shark populations decreased by as much as 80%. Sharks do get cancer, as you can see in this picture.

Ironically, sharks can even get cancer of the cartilage! And of course shark cartilage supplements don’t prevent cancer in humans. Welsh explains how that myth got started. It was magical thinking based on extrapolation from a legitimate scientific study on angiogenesis where tumor growth in lab animals was suppressed by placing rabbit cartilage next to the tumors.
(more…)

Posted in: Basic Science, Cancer

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