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Leaky Bowel

Pictured: Something you might need if you actually had a leaky gut.  Click to embiggen.  Weirdo.

Pictured: Something you might need if you actually had a leaky gut. Click to embiggen. Weirdo.

We are at a disadvantage. We have to rely on reality to validate the practice of medicine. Anatomy, physiology, pharmacology, chemistry, the basic sciences that made up the first two years of medical school education and a huge chunk of pre-med. And we have to rely on the truth, as slippery a concept as that can be. I can’t just make up a disease or a therapy.

It would be so much easier to not have to worry about reality in deciding on a disease and treatment for people with symptoms.

I came across “Healthy Life: Leaky Gut Syndrome” in my feeds. I am always attracted to exclamation marks! They must mean something important! Or surprising to the author!

It’s called “leaky gut syndrome” and patients say it can wreak havoc on everyday life, but some doctors say there’s no such thing!

Some doctors. Must be that pesky 10% percent or so of obstructionist doctors who don’t recommend Tylenol or Advil. (more…)

Posted in: Herbs & Supplements, Naturopathy, Nutrition, Science and Medicine

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Dubious MTHFR genetic mutation testing

Naturopathic catnip for patients.

Naturopathic catnip for patients.

Naturopaths, along with some chiropractors, acupuncturists and a few “integrative” physicians, are advising patients that they should be tested for MTHFR genetic mutations. Typically, the naturopath will start with the pitch that “conventional” medical doctors are ignoring your genes as a possible source of your health problems. (And it is mostly naturopaths who are doing this – just Google “naturopath MTHFR genetic mutation” and see what comes up.) NDs know better, of course – it could be a MTHFR genetic mutation causing your maladies.

Just what is the MTHFR gene? Allow me to introduce some actual scientific information here. According to Genetics Home Reference, a service of the National Library of Medicine,

the MTHFR gene provides instructions for making an enzyme that plays a role in processing amino acids, the building blocks of proteins. This particular enzyme is important for a chemical reaction involving forms of the vitamin folate (also called vitamin B9), a reaction required for the multistep process that converts the amino acid homocysteine to another amino acid, methionine. The body uses methionine to make proteins and other important compounds.

Back to pseudoscience. Next comes the scare tactic: telling you how a MTHFR mutation might affect your health: anxiousness, adrenal fatigue, brain fog, cervical dysplasia, increased risk of many cancers (including breast and prostate), low thyroid, leaky gut, high blood pressure, heart attacks, stroke, Alzheimer’s disease, diabetes, and miscarriages. (more…)

Posted in: Chiropractic, Diagnostic tests & procedures, Health Fraud, Herbs & Supplements, Naturopathy, Nutrition, Obstetrics & gynecology, Vaccines

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Lawsuit Update

The First Amendment of the United States of America, guaranteeing freedom of speech

The First Amendment of the United States of America, guaranteeing freedom of speech

For those of you following the defamation lawsuit against me by Dr. Edward Tobinick, there has been a significant and positive update. For quick background, Dr. Tobinick filed a suit against me personally, the Society for Science-Based Medicine, Yale University and SGU Productions for an article I wrote here critical of his claims that perispinal etanercept can treat a variety of neurological conditions. All the defendants but me have since been removed from the case.

There are three plaintiffs in the case; Dr. Tobinick himself, his California corporation, and his Florida LLC. Last year I filed a motion to strike some of the claims as they apply to the California corporation under that state’s anti-SLAPP statute. The update is that last week the judge in the case ruled in my favor on this motion. These are public documents, so you can read the entire decision here. It concludes:

For the foregoing reasons, it is hereby ORDERED AND ADJUDGED that Steven Novella’s Special Motion to Strike (Anti-SLAPP Motion) [DE 93] is GRANTED. Tobinick M.D.’s claims for unfair competition under 28 U.S.C. § 1338(b) (Count II), trade libel (Count III), and libel per se (Count IV) are STRICKEN from the Amended Complaint.

(more…)

Posted in: Announcements, Legal

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Green Tea: Panacea or Poison?

320px-Genmaicha_tea_brewed_and_unbrewed

In the news: a woman in Fort Wayne, Indiana is suing the Arbonne International company in Allen Superior Court, claiming that its product contained toxic levels of green tea extracts, causing her to develop acute liver failure.

Green tea accounts for 20% of tea consumption worldwide. It has become more and more popular because of its many reported health benefits; the consumption of green tea in the US has risen by 40% just since 2000. A less-processed form of tea, green tea contains higher levels of antioxidants and polyphenols than other teas. It was traditionally used to control bleeding, heal wounds, aid digestion, improve heart and mental health and regulate body temperature. More recently, research has suggested that it has many health benefits.

The evidence for health benefits

The University of Maryland Medical Center has a helpful webpage that summarizes all the relevant research and provides a long list of references. Green tea may reduce the risk of heart disease (but the FDA prohibits that claim on labels; they concluded there was no credible evidence to support it). Green tea lowers total cholesterol and raises HDL. Population studies suggest that it may help protect against several kinds of cancer, but the evidence is mixed: other studies suggest that it may actually increase the risk of some cancers, and it may interfere with cancer chemotherapy. It may help in inflammatory bowel disease, diabetes, liver disease, and weight loss. There is even preliminary evidence that it might prevent dental cavities, might be useful in arthritis, might help treat genital warts, and might even prevent symptoms of colds and flu. Studies show that drinking green tea is associated with reduced risk of dying from any cause. At first glance, it might sound like a panacea, but the evidence is still questionable. Much of it is from small, preliminary studies that have not been replicated or that contradict each other. (more…)

Posted in: Herbs & Supplements

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Mandatory breast density reporting legislation: The law outpaces science, and not in a good way

Over the years, our bloggers here at Science-Based Medicine have written time and time again about the intersection of law and science in medicine. Sometimes, we support a particular bill or law, such as laws to protect children against religion-inspired medical neglect; laws making it harder for manufacturers of homeopathic “medicines” to deceive the public; or California Bill AB 2109, a bill whose intent was to make it more difficult for parents to obtain nonmedical exemptions to vaccine mandates but whose implementation after being passed into law was profoundly sabotaged by Governor Jerry Brown. or, more recently, California SB 277, a bill currently wending its way through the California legislature that would eliminate nonmedical exemptions to school vaccine mandates and has, not surprisingly, engendered extreme resistance from the antivaccine crowd, including by Robert F. Kennedy, Jr. In the vast majority of cases we explain how the law lets us down when it comes to science in medicine, and, unfortunately, examples are many: Naturopathic licensing laws; supplement regulation (or, more appropriately, lack of regulation); misguided, deceptive, and patient-hostile “right-to-try” laws; state laws regulating medical practice that allow quackery to flourish unchecked; laws regulating pharmaceutical cost transparency that ask the wrong question.

The case I will discuss here is unusual in that it is a case of the law getting ahead of what the science says in a manner that will likely do little, if any, good for patients, cause a lot of confusion until the science is worked out better, and end up costing patients money for little or no benefit. I am referring to laws mandating the reporting of high-breast-density to women with dense breasts undergoing mammography. These laws are sweeping the country (albeit not as rapidly as “right-to-try” laws), with a total of 22 states having passed them as of today since Connecticut became the first to do so in 2009. The most recent of these laws went into effect in my own state of Michigan exactly one week ago:

Women with dense breast tissue — the sort that can hide potentially deadly tumors from routine mammograms — must be notified in writing and encouraged to consider additional tests under a new state law that is effective Monday.

While mammograms remain the gold standard for detecting breast tumors, they’re less reliable in almost half of women with dense breast tissue. Dense or fibrous tissue shows up as splotches of white on a mammogram — so do tumors.

That will likely surprise many of the millions of women who rely on mammography for catching the earliest signs of cancer, said Nancy Cappello. The Connecticut woman was shocked in 2004, when her gynecologist found a lump — advanced cancer that had already spread to her lymph nodes — just months after a mammogram deemed her cancer-free.

(more…)

Posted in: Cancer, Politics and Regulation, Public Health

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Chiropractic Manipulation of the Neck Linked to Stroke in a 6-Year-Old Child…

neckjer

The risk of suffering a stroke when undergoing aggressive chiropractic manipulation of the neck is not a new concern. We’ve discussed it several times on the pages of Science-Based Medicine over the years, most recently in November of 2014 when Steven Novella covered the death by chiropractor of 30-year-old Jeremy Youngblood, whose fatal brain injury occurred while seeking treatment for a sore neck. For a nice review of cervical manipulation in general, the evidence against its inappropriate use, and an assessment of the literature on this subject, check out prior posts by Dr. Hall and chiropractor Samuel Homola.

I believe that my take on the issue is in line with my fellow SBM authors. There is no role for high velocity, low amplitude (HVLA) thrust-type maneuvers that cause sudden and intense rotation of the neck in any patient, for any reason. It is not effective for neck pain, headache or any other complaint, and it is a proven risk factor for injury to the vertebral arteries and subsequent stroke. Some patients are at higher risk, such as the elderly or those with atherosclerosis or connective tissue disorders, but this type of injury can occur at any age and even in a perfectly healthy individual. (more…)

Posted in: Chiropractic, Science and Medicine

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Medicine doesn’t come from the hardware store: Don’t drink turpentine

This is not a health food. Don't drink it.

This is not a health food. Don’t drink it.

I enjoy feedback from readers. Yes, there’s the regular hate mail accusing me of being a Big Pharma Shill. But there’s the occasional appreciative comment from someone that found a post helpful or informative. The most gratifying feedback is when someone tells me that something I wrote led to a more informed health decision. Often it’s because I was able to answer a question that they couldn’t find a science-based answer to. I’ve answered thousands of questions in my pharmacy career, and have only blogged a handful of them (so far). One of my most fascinating experiences was a stint working evenings in a pharmacy that happened to have a large “natural” health focus. It’s there I began to scrutinize alternative medicine more closely, because it was virtually all the store sold. Homeopathy, ear candles, copper bracelets and salt lamps were all for sale. If it was unproven, proven ineffective, or defied some law of physics or chemistry, this pharmacy probably sold it. But the customers loved these products. I was dumbfounded. Some would buy dozens of supplements, costing hundreds dollars per month, on the advice of their naturopath, treating some vague or non-specific complaints. Others swore by homeopathic remedies, for themselves and their pets. It was common to meet people who were treating conditions that either didn’t exist, or hadn’t been properly diagnosed, like naturopath-diagnosed “food intolerances” or “hormone imbalances”. There were also the occasional “pH balancing” advocates that insisted I was misguided and uneducated for reassuring them that their body’s pH was just fine, despite what their urine test strips were telling them. (more…)

Posted in: Herbs & Supplements, Naturopathy, Science and Medicine

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Remembering Wallace Sampson

Wally Sampson, MD March 29, 1930 – May 25, 2015

Wally Sampson, MD
March 29, 1930 – May 25, 2015

I’m sad to report that Dr. Wallace (Wally) Sampson, one of the original authors at Science-Based Medicine, passed away on May 25th at the age of 85. Wally was a valued member of the SBM community, a mentor to many of us, and a tireless crusader against health fraud and pseudoscience in medicine. He carried the banner of defending science and reason within medicine for a generation, and his is one of the giant shoulders on which SBM currently rests. His contributions to this website can be found here.

Wally was fighting against health fraud back when it was still called health fraud, rather than “alternative medicine” or whatever the latest marketing term they have adopted is. I would often go to him for perspective on the long range trends in our struggle to promote science in medicine. He had put in the decades of service necessary to have such perspective.

I personally owe Wally a great deal for my own career battling medical pseudoscience. Wally was keen to identify and nurture new people interested in promoting science in medicine. As a much younger skeptic, prior to social media, when I was only running a new and obscure local skeptic group, Wally invited me to speak at conferences, and eventually to be one of the assistant editors for The Scientific Review of Alternative Medicine, a print journal of which he was the first editor (available online here). Such nurturing was not common in my experience. He gave me the experience and platform upon which I eventually built Science-Based Medicine.

(more…)

Posted in: Announcements, Health Fraud

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The Rosedale Diet: Here We Go Again

The Rosedale Diet

Ron Rosedale, MD has devised a “powerful program based on the new science of leptin.” “Finally — the ultimate diet for fast, safe weight loss, lifelong health, and longer life…” He suggests it will prevent or improve high blood pressure, diabetes, heart disease, osteoporosis, arthritis, and a host of other ills. He repeats the CAM canard that “doctors only treat symptoms” and claims that his diet corrects the underlying cause of obesity, premature aging, and many diseases. That underlying cause is hormone (leptin) dysfunction. His is essentially just another low carb diet, only with more fat and less protein than other versions. His recommendations are ridiculously elaborate and are not supported by good evidence. His diet extrapolates from basic science, is based on speculative hypotheses, and has never been tested to see whether it works and is safe, much less whether it is superior to other diets.

If this sounds vaguely familiar, it should. He is doing what so many proponents of fad diets have done in the past, and he does it poorly. His book is a puerile effort compared to Gary TaubesGood Calories, Bad Calories; Taubes at least marshaled an impressive mass of scientific data, presented a cogent argument, and ultimately acknowledged that more studies would be needed to test his recommendations. (more…)

Posted in: Book & movie reviews, Herbs & Supplements, Nutrition

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Let food be thy medicine and medicine be thy food? The obsessive worship of “medicinal foods”

Let food be thy medicine and medicine be thy food? The obsessive worship of “medicinal foods”

Let food be thy medicine and medicine be thy food.

– attributed to Hippocrates

Who said anything about medicine? Let’s eat!

– attributed to one of Hippocrates forgotten (and skeptical) students

 

Who hasn’t seen or heard Hippocrates’ famous quote about letting food be your medicine and your medicine your food? If you have Facebook friends who are the least bit into “natural” medicine or living, you’ve almost certainly come across it in your feed, and if you’re a skeptic who pays the least bit of attention to what’s going on in the quackosphere you will almost certainly have seen it plastered on a picture as a meme, either using a picture of Hippocrates or pictures of plates of green, leafy vegetables, or both. I like to view the fetishization of “food as medicine,” to cite Hippocrates, as one of the best examples out there of the logical fallacy known as the appeal to antiquity; in other words, the claim that if something is ancient and still around it must be correct (or at least there must be something to it worth considering).

Of course, just because an idea is old doesn’t mean it’s good, any more than just because Hippocrates said it means it must be true. Hippocrates was an important figure in the history of medicine because he was among the earliest to assert that diseases were caused by natural processes rather than the gods and because of his emphasis on the careful observation and documentation of patient history and physical findings, which led to the discovery of physical signs associated with diseases of specific organs. However, let’s not also forget that Hippocrates and his followers also believed in humoral theory, the idea that all disease results from an imbalance of the “four humors.” It’s also amusing to note that this quote by Hippocrates is thought to be a misquote, as it is nowhere to be found in the more than 60 texts known as The Hippocratic Corpus (Corpus Hippocraticum).

As Diana Cardenes argues:

But Hippocratic doctors clearly saw a difference between food and medicines. In fact, food was considered as a material that could be assimilated after digestion (e.g. the air was also food) and converted into the substance of the body. For example, food was converted into the different parts of the body such as muscles, nerves, etc. By contrast, the concept of medicines at the time was a product which was able to change the body’s own nature (in terms of humor quality or quantity) but not be converted into the body’s own substance. Thus a food wasn’t considered a medicine. A possible root of the food-medicine confusion is the following cryptic phrase found in the work On Aliment: “In food excellent medication, in food bad medication, bad and good relatively”.3 This text is nowadays attributed to the Hellenistic period, but was considered to be Hippocratic in Antiquity by Galenus in particular.

Now, it is certainly true that Hippocrates and his followers used diet to treat many illnesses, it’s not really clear what sort of success they had. However, this ancient idea that virtually all disease could be treated with diet, however much or little it was embraced by Hippocrates, has become an idée fixe in alternative medicine, so much so that it leads its proponents twist new science (like epigenetics) to try to fit it into a framework where diet rules all, often coupled with the idea that doctors don’t understand or care about nutrition and it’s big pharma that’s preventing the acceptance of dietary interventions. That thinking also permeates popular culture, fitting in very nicely with an equally ancient phenomenon, the moralization of food choices (discussed ably by Dr. Jones a month ago).
(more…)

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