An Alternative to Appendectomy: Antibiotics

An appendix, mid-appendectomy.

An appendix, mid-appendectomy.

My title doesn’t refer to alternative medicine, it refers to an alternative within medicine: treating appendicitis with antibiotics instead of surgery. You may be surprised to learn that patients with appendicitis don’t always automatically need an appendectomy. A recent randomized controlled trial in Finland compared surgery to medical treatment.

History of appendicitis treatment

There is an excellent, detailed history of appendicitis available online, complete with anecdotes illustrating its importance. The appendix was not mentioned in early anatomical studies, probably because they were done on animals that didn’t have an appendix. The organ was first described in 1521. The existence of appendicitis (called “typhlitis” until 1886) was gradually recognized during the 19th century, and by the end of that century surgical removal of the appendix had become the standard treatment. Walter Reed, the yellow fever researcher for whom the Army hospital was named, died of a ruptured appendix. King Edward VII’s coronation was delayed while he underwent a life-saving appendectomy.

Appendectomy predated antibiotics, and it was believed that appendicitis would invariably progress to perforation. Once antibiotics were available, doctors experimented with treating appendicitis with them instead of with surgery, starting as early as 1956. The published trials had limitations, so the new study was done to try to get a more definitive answer to the question of whether the antibiotic approach was as effective as the surgical approach.


Posted in: Clinical Trials, Pharmaceuticals, Surgical Procedures

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“Aborted fetal tissue” and vaccines: Combining pseudoscience and religion to demonize vaccines

Yes, there are antivaccinationists who actually believe this.

Yes, there are antivaccinationists who actually believe this.

As hard as it is to believe after seven and a half years of existence and nearly 2,400 posts on SBM, every so often, something reminds me that we here at SBM haven’t discussed a topic that should be discussed. So it was a couple of weeks ago, when I saw a familiar name in a news story that wasn’t about vaccines. You might recall a news story last month when a shadowy group with ties to radical antiabortion groups, the Center for Medical Progress, led by a man named David Daleiden, ran a highly questionable “sting” operation (complete with fake IDs) to “prove” that Planned Parenthood was selling aborted fetuses for medical research.

While reading news stories about Daleiden and CMP, I came across a familiar name, a name that many of us who discuss antivaccine misinformation are familiar with. I’m referring to Theresa Deisher, founder of the Sound Choice Pharmaceutical Institute. It turns out that Deisher helped to prepare Daleiden for his role as a biomedical representative that he assumed in order to deceive representatives of Planned Parenthood. She taught him how to talk the talk and walk the walk, so to speak, so that he was convincing as a representative of a biomedical research firm.

I can hear you asking: So what? What do Daleiden and CMP have to do with vaccines? It’s not CMP per se, but Deisher who is relevant. The reason that Deisher is so relevant to Science-Based Medicine (SBM) is because she is one of the foremost promoters of a particularly pernicious form of antivaccine misinformation that tries desperately to create a religious basis to oppose vaccines with antivaccine activism. It is a form of misinformation designed to deceive those who believe abortion is a moral wrong into thinking that vaccines, too, are a moral wrong because some of the viruses used to make specific vaccines are grown during the manufacturing process in cell lines derived from human fetuses decades ago. But Deisher goes one huge step beyond just guilt by association for vaccines. She is, as the news story cited above notes, the foremost promoter of a related and equally pernicious form of antivaccine information that claims that DNA from the fetal cell lines used to grow vaccine strains of viruses is a cause of autism. The truly depressing thing about Deisher is that she is, in fact, a real scientist (or at least was).

In any event, it occurred to me that, although I’ve mentioned Deisher briefly before in the context of the Disneyland measles outbreak, I’ve never deconstructed her antivaccine misinformation in detail here. Yet, her work is often cited by antivaccine activists to persuade those whose religion tells them abortion is morally wrong that they shouldn’t vaccinate their children by adding to the false claim that somehow “fetal parts” are used in the making of vaccines the even more false claim that fetal DNA somehow gets into the brain, recombines with the DNA in neurons, and causes autism. She’s also just released what appears to be a new paper claiming to show how fetal DNA causes autism. The confluence of her name coming up in stories about CMP and Planned Parenthood and her release of this new “paper” makes this a perfect time to write about Deisher.

Posted in: Basic Science, Critical Thinking, Religion, Vaccines

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The Woo Boat, or: How far Andrew Wakefield has fallen

Sadly, this is not the crew of the Woo Boat, which is not the Love Boat. It would be awesome if that were the case, but it's not. I wonder if they'll be letting the astrologist navigate. The trip might end up being longer than expected.

Sadly, this is not the crew of the Woo Boat, which is not the Love Boat. It would be awesome if that were the case, but it’s not. I wonder if they’ll be letting the astrologist navigate. The trip might end up being longer than expected. Oh, and I couldn’t resist crossposting this from another blog because this is so damned hilarious.

File this one under the category: You can’t make stuff like this up. (At least, I can’t.)

Let’s say you’re a diehard all-conspiracy conspiracy theorist and alternative medicine believer (a not uncommon combination). You love Alex Jones and Mike Adams and agree with their rants that there is a New World Order trying to suppress your rights. You strongly believe that vaccines not only cause autism, sudden infant death syndrome, a shaken baby-like syndrome, autoimmune diseases, premature ovarian failure, and even outright death, but are a depopulation plot hatched by Bill Gates and the Illuminati who support his agenda. Heck, you even believe that black helicopters are keeping an eye on those who have discovered this plot. To you, genetically modified organisms (GMOs) are part of the same plot, pure poison and pure evil. And, of course, you just know that there is a cure for cancer—nay, cures for all diseases—out there but those evil pharmaceutical companies are keeping them from the people, the better to bolster their profits, just as they are preventing Brave Maverick Doctors like Andrew Wakefield, Mark Geier, and Sherri Tenpenny from telling the world the truth about vaccines. Heck, you just know that these same nefarious forces are even going so far as to kill vaccine “skeptic” heroes like Jeff Bradstreet (and, of course, make it look like a suicide) and holistic “pioneers” like Nicholas Gonzalez (and make it look like a heart attack).

And you like cruises.

So where do you go when you want to go on a cruise? Normal cruises are filled with people who just want to have a good time and tend to roll their eyes when you regale them with your ideas about how there is a shadowy conspiracy out there that is promoting toxic pharmaceuticals and vaccines and preventing natural cures from being used by the people, while simultaneously promoting GMOs to make people sick so that they think they need more of those pharmaceuticals and vaccines and more pliable so that their New World Order agenda faces less opposition. By the time you get to how they’re also using chemtrails as another means of control, AIDS is not caused by HIV, and Ebola can be cured with homeopathy, in other words, by the time you’ve been on the cruise a couple of days, you’ll find yourself basically shunned, eating alone at dinner, and drinking alone at the bar. When you sit down at a table, everyone suddenly finds a reason to be elsewhere.

Fear not! There is now a cruise for you. See the Conspira-Sea Cruise next January, embarking in Los Angeles and taking you on a cruise through the Mexican Riviera:

Posted in: Science and Medicine

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New Study on Homeopathic Cough Syrup for Children Reveals a Lack of Effectiveness and Ethics


Just say no to homeopathic cough syrup! Actually, avoid all cough syrups.

On the pages of SBM we frequently discuss homeopathy, and rightfully so considering its position as one of the most pervasive yet dumbest forms of alternative medicine. Just yesterday our own Scott Gavura, who is neither pervasive nor dumb, wrote an excellent review of some recent improvements in the regulation of these ridiculous remedies in Canada, and I encourage readers to check that out. Sadly, despite numerous high profile setbacks for the practice, including a thorough trouncing by the Australian National Health and Medical Research Council in March, proponents of what is essentially the belief in sympathetic magic continue to clutter the pubmeds and interwebs with worthless studies. (more…)

Posted in: Ethics, Homeopathy, Science and Medicine

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A homeopathic win for consumers

Homeopathy – not medicine

Do you believe in magic? It might surprise you to learn that some people believe sugar pills have healing properties. This belief system, called homeopathy, is a multi-billion dollar industry worldwide, and it’s growing. While there is no convincing evidence to demonstrate that homeopathic treatments are more effective than a placebo, many consumers and even some health professionals accept homeopathy as a legitimate health treatment, and its providers as legitimate health professionals. Responding to the perceived consumer demand for these products, government regulators have had a difficult decision to make: They could ignore homeopathy as a health practice, treating it like we might think of astrology: firmly outside of medicine. Or they could choose some form of regulation, targeting the providers (homeopaths) or the product (homeopathy), possibly with the goal of managing its use, or perhaps limiting harms to consumers. The risk of regulating nonsense, as has been described before, is the perceived legitimacy that recognition and regulation implies. Regrettably, regulation in many countries has had that exact effect. What’s worse, regulation often seems to have prioritized the commercial interests of homeopaths over the public interest, leaving consumers with little understanding that homeopathy lacks scientific credibility as a health practice. Consequently, homeopathy has attracted regular criticism from SBM’s bloggers, science and health journalists, and other science advocates over the years. It appears this advocacy is finally having an effect. Regular readers will recall several posts over the past few weeks, describing the possibility of new regulation of homeopathy by the US Food and Drug Administration (FDA). And just recently, Health Canada announced two important changes to its homeopathy regulation, which may signal a new direction. Are we witnessing the beginning of more sensible regulation of this prescientific practice? (more…)

Posted in: Homeopathy, Politics and Regulation, Science and Medicine, Vaccines

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We Should Abandon the Concept of “Alternative Medicine”

FALSE-DICHOTOMY-copyIn a recent editorial for the New York Times, Aaron E. Carroll argues, “Labels Like ‘Alternative Medicine’ Don’t Matter. The Science Does.” I agree with this headline thesis, but the details of his argument ironically show the harm that the so-called CAM (complementary and alternative medicine) movement has done.

Carroll starts out well, essentially pointing out that the division between “conventional” and “alternative” medicine, and the division between “Western” and “Eastern” medicine are false dichotomies. Despite this strong start, he muddles his way through the rest of his editorial.

The primary error he commits is to swing from a false dichotomy to a false equivalency, essentially saying that there is no difference between conventional and alternative practice or practitioners. In order to support this contention, however, he has to distort the facts beyond recognition.

In other words, Carroll commits the less-well-known false continuum logical fallacy. Let me explain.

The real differences between SBM and CAM


Posted in: Science and Medicine

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Monkeys, Myths, and Molecules: A Chemist Separates Fact from Fiction


“Dr. Joe” (from the title of his radio show) has done it again. He keeps putting out books faster than I can take them in; this one is titled Monkeys, Myths, and Molecules. It is packed with pithy analyses of health-related subjects that should be of particular interest to SBM readers.

Dr. Joe is Joseph Schwarcz, a chemistry professor and science popularizer based at McGill University. I’ve reviewed two of his many previous books before, Is that a Fact? here on SBM and The Right Chemistry over at, as well as his free online chemistry lectures, “Food for Thought“, over at As usual, this new book is a compendium of short (four-page) articles on a variety of subjects, written in a humorous, accessible style, and larded with intriguing trivia like where to see the largest illuminated advertising sign in the world.

If you read this book, you will:

  • Learn that Mozart only had seven teeth when he died.
  • Learn what was the first synthetic drug ever given to a human, and who administered it.
  • Learn that Popeye really ate spinach for the vitamin A, not for the iron, and how myths about myths about spinach (no, that’s not a typo) led to ever-increasing misinformation.
  • Hear the story of American military experts in WWII who had the bright idea of turning bats into weapons by attaching small incendiary devices to them. In an experiment hilariously gone wrong, the flaming bats set fire to a general’s car. (Remember that saying about military intelligence?)
  • Learn the role of coprolites (fossilized animal poop) in the development of modern agriculture.
  • Learn why Greek yogurt is not friendly to the environment.

Dr. Joe is a packrat for tidbits like these. I wonder where he finds them all. He seems to have a bottomless supply. (more…)

Posted in: Book & movie reviews

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The 21st Century Cures Act: The (Somewhat) Good, The (Mostly) Bad, and The (Very) Ugly

The 21st Century Cures Act: Unnecessary and misguided.

The 21st Century Cures Act: Unnecessary and misguided.

The approval of new drugs and medical devices is a process fraught with scientific, political, and ethical landmines. Inherent in any such process is an unavoidable conflict between rigorous science and safety on the one side, which tend to slow the process down by requiring large randomized clinical trials that can take years, versus forces that demand faster approval. For example, patients suffering from deadly diseases demand faster approval of drugs that might give them the hope of surviving their disease, or at least of surviving considerably longer. This is a powerful force for reform, as evidenced by HIV/AIDS activism in the 1980s and 1990s that led to the development of fast-track approval mechanisms for drugs for life-threatening conditions, a change whose effects have been mixed. It’s also a powerful force potentially for ill, as I’ve documented in my posts about the understandable but misguided “right-to-try” movement. After all, what politician can say no to a constituency representing desperately ill people who only want a shot at survival? It’s not all desperate patients, however. Also wanting more rapid drug approval are powerful business interests in the form of the pharmaceutical and medical device industries, for whom the time and expense of prolonged clinical trials eat into profits and make some drugs not worth developing from a business standpoint.

In 1962, after Frances O. Kelsey, MD, PhD (who died on Friday at the age of 101) successfully prevented the approval of the drug thalidomide in the US, a drug found to cause serious birth defects, Congress passed the Kefauver-Harris Drug Amendments to the Federal Food, Drug, and Cosmetic Act. These amendments required that drug companies not just show safety before their drugs could be FDA-approved, as had been the case prior to the amendments, but also to provide substantial evidence of effectiveness for the product’s intended use. That evidence had to be in the form of adequate and well-controlled clinical trials, which at the time was considered a revolutionary requirement. (Believe it or not, no requirement for high quality clinical trials existed before 1962.) This led to the current system of phase I, II, III, and IV clinical trials in force in the United States today. The amendments also included a requirement for informed consent of study subjects and codified good manufacturing processes, as well as the requirement that adverse events be reported. This has been, with some tweaking over the years, the law of the land regarding how the FDA approves drugs for specific indications

Medicine is a lot more complex now than it was in the 1960s however, and there has been a growing sentiment that the system is, if not broken, at least functioning in a way that is behind the times, a manner that was acceptable and appropriate 40 years ago but is no longer so in this era of genomics, precision medicine (formerly known as “personalized medicine”), and targeted therapies. The new drug approval process, which can take up to a decade and cost a billion dollars, it is argued, is too rigid, cumbersome, and slow for the 21st century. (Why it wasn’t too rigid, cumbersome, and slow in the 20th century, no one seems to say. I guess that “21st century” sounds way cooler.)

Into this ongoing controversy have marched Rep. Fred Upton (R-Mich.) and Rep. Diana DeGette (D-Colo.), who have sponsored a bill passed by the House of Representatives in a rare display of bipartisanship in July. The bill, H.R.6, is entitled the “21st Century Cures Act“. Given how it passed the House by a vote of 344-77, one would think that it should glide through the Senate easily. Certainly, its sponsors and supporters have mounted a mighty PR effort. That might not be the case, given that in the Senate a single senator can hold up or even kill a bill through a filibuster, and to shut down a filibuster or prevent a threatened filibuster requires 60 votes. Be that as it may, I’m not so much interested in the politics of this bill, which, if it survives the Senate, will almost certainly be significantly amended, but rather what the bill does.

Posted in: Basic Science, Clinical Trials, Politics and Regulation

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Do You Believe in Magic? Oregon Does.

Pictured: OHP and HERB picking "evidence-based treatment options"

Pictured: OHP and HERB picking “evidence-based treatment options”

Do You Believe in Magic?

Do you believe in magic for a back pains fix

How the needles can free her, where ever it pricks

And it’s magic, if the chi is groovy

It makes you feel happy like an old-time movie

I’ll tell you about the magic, and it’ll free your soul

But it’s like trying to tell a CAM ’bout randomized control

If you believe in magic don’t bother to choose

Although subluxation is simply a ruse

Just go and get adjusted on the table

It won’t wipe off the pain no matter how hard you try

Your wallet is empty and you can’t seem to find

How you got there, so just blow your mind

If you believe in magic, come along with me

We’ll CAM until morning paid for by the OHP

And maybe, if the CAM is right

I’ll meet you tomorrow, sort of late at night

And we’ll go dancing, baby, then you’ll see

How the magic’s in the CAM and the CAM’s in me

Yeah, do you believe in magic

Yeah, believe in the magic of a back pains fix

Believe in the magic of CAM

Believe in the magic that can set you free

Oh, talking ’bout magic

Do you believe like I believe… Do you believe in magic

Do you believe like I believe… Do you believe, believer

Do you believe like I believe… Do you believe in magic

The Lovin’ Spoonful. Sort-of.

Maybe not my best lyrics.

More Oregon magic

It continues.

Oregon has a problem with prescription pain pills. Oregon leads the nation in the abuse of such drugs, federal statistics show, with Oregon’s rate of prescription drug abuse 39 percent higher than the national average. Go us.

Why that is, I do not know. As an Infectious Disease doctor I prescribe a narcotic about once a year. There are real problems with the treatment of chronic pain and while I am aware of the issues and the changes over the last 25 years, it does not impact my practice, so my knowledge of the issues is basic.

I am also well aware of the Oregon Health Plan (OHP). The OHP was intended to make health care more available to the working poor, while rationing benefits. They were fairly transparent that resources were fixed and not everything would be covered.

Given limited resources, part of the plan has always included a prioritization of treatments and diagnostics, paying for care that give the most bang for the buck. Not a perfect way to ration care and as is always the case, no good deed goes unpunished. (more…)

Posted in: Acupuncture, Chiropractic, Legal, Medical Academia, Naturopathy

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Society for Science-Based Medicine: Comment to FDA on homeopathic drug regulation


Author’s note: The FDA has asked for public comments on the regulation of homeopathic products. The Society for Science-Based Medicine’s Comment follows, modified for this format. The Comment is based in part on two previous posts, “How should the FDA regulate homeopathic remedies?” and “Homeopathic industry and its acolytes make poor showing before the FDA.” The comment period closes August 21, 2015.

Society for Science-Based Medicine

Comment: Homeopathic Product Regulation: Evaluating the Food and Drug Administration’s Regulatory Framework After a Quarter-Century

All homeopathic products on the U.S. market today, whether over-the-counter (OTC) or prescription, fall within the definition of “drug” in the Food, Drug & Cosmetic Act of 1938. The overwhelming scientific consensus is that homeopathy is highly implausible, unsupported by scientific evidence, ineffective in treating illness and, when relied upon instead of actual medicine, dangerous and even deadly. Yet the FDA has, without statutory authority, exempted homeopathic drugs from the regulatory scheme mandated by federal law. In accordance with its consumer protection mandate, the FDA should take immediate action to remedy this by requiring that all homeopathic drugs comply with the same statutes and regulations as all other OTC and prescription drugs. (more…)

Posted in: Announcements, Health Fraud, Homeopathy, Legal, Politics and Regulation

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