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Bad News and Good News from Down Under: Science-Based Medicine in Australia

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The bad news: in a disturbing attempt to woo customers, some Australian pharmacists are offering in-store consultations with naturopaths. The good news: Australian skeptics and supporters of science have had a lot of recent successes in combatting quackery.

Non-Doc in a Box

In an article in the Australian magazine The Skeptic, Loretta Marron reports on naturopaths in pharmacies. You can read it here. Pharmacy customers who want natural treatment alternatives are referred by pharmacy staff to an in-house naturopathy clinic. The cost, $90 for a one-hour consultation, is often covered by insurance. You can even get a Loyalty Card to make your fifth consultation free. They claim to “correct underlying causative factors,” advise about stress, diet, how to promote your vitality and immune system, etc. And they help you make informed decisions about your health (informed by their brand of misinformation).

They offer disproven diagnostic methods like iridology, live blood analysis, and bio-energetic screening with bogus machines that they claim can detect everything from vitamin deficiencies and parasites to “spinal energy” and “vaccination disturbance.” Marron doesn’t describe the treatments they recommend, but we can assume they are offering the usual naturopathic remedies, including homeopathy, in lieu of the pharmaceuticals that are the reason for the pharmacy’s existence. (more…)

Posted in: Naturopathy, Science and the Media

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Do doctors pay attention to negative randomized clinical trials?

vertebroplasty

We at the Science-Based Medicine blog believe that all medicine, regardless of where it comes from, should be held to a single science-based standard with regards to efficacy, effectiveness, and safety. We tend to focus primarily on “complementary and alternative medicine” (CAM), now more commonly known as “integrative medicine,” because (1) we believe it to be undermining the scientific basis of medicine and allowing outright quackery (or, as I like to refer to it, quackademic medicine) to infiltrate medical academia, which is fast becoming medical quackademia and (2) because when it comes to the other threats to the scientific basis of medicine as it is practiced today, such as pharma influence and various medical dogmatism, there are a whole host of active critics better equipped and more energetic than we are who can do the job (usually) better. That is why, whenever I hear advocates of CAM/”integrative medicine” attack us for not spending enough time on various corruptions of clinical trial processes or the perfidy of big pharma, I tend to gently tell them in my characteristically diplomatic manner that that’s what I like to call the “Why don’t you blog about what I think is important and interesting instead of what you think is important and interesting?” criticism, then I refer them to our posts on John Ioannidis, overdiagnosis and overtreatment, the shortcomings of mammography, or any number of other posts we at SBM have done through the years pointing out where current medical practice falls short. Indeed, it never fails to amuse me to point out how angry an eminent radiologist became at me for my posts criticizing him for his misleading attacks on certain studies that question the value of screening mammography.

In particular, though, I like to point out a post I did on vertebroplasty as a treatment for vertebral compression fractures (VCFs) due to osteoporosis. Basically, I discussed then recent evidence showing how vertebroplasty for such fractures is, basically, placebo medicine, no better than acupuncture. Indeed, I likened the state of evidence regarding vertebroplasty to that of acupuncture, in which small, pilot studies appear to be positive, but then the follow-up rigorous randomized clinical trials fail to find a benefit greater than that of placebo. It turns out that a rather telling study regarding vertebroplasty was published earlier this year that I somehow missed that addresses a problem we have in “conventional” medicine.
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Posted in: Clinical Trials, Medical devices

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Announcement: “Integrative oncology” – Really the best of both worlds?

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One of our goals here at SBM is to do more than just blog about the issues of science and pseudoscience in medicine that are our raison d’être. We also want to publish our science-based critiques in the peer-reviewed medical literature. Our first crack at this was an article by Steve Novella and myself published last month in Trends In Molecular Medicine entitled “Clinical trials of integrative medicine: testing whether magic works?” Even better, thanks to a press release and how the editors made the article free to all, it garnered more social media attention than any article previously published in TMM, and the editor has informed me that it “shot straight to the top of TMM’s ‘Most read’ article list and I anticipate it staying there for quite some time.” For this, Steve and I thank you, our readers, and those of you who spread the news. We’re hoping that this success garners more offers to write review and commentary articles for the peer-reviewed literature about topics near and dear to us.

Now, I’m happy to announce another commentary in the peer-reviewed literature. It’s an article I wrote for Nature Reviews Cancer that just appeared online yesterday entitled “Integrative oncology: Really the best of both worlds?” I must say, I’m quite proud of this one, and it is a big deal, hopefully to more people than just me. If you look up the impact factor for NRC, you’ll see it’s around 35, which is between The Lancet and JAMA.
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Posted in: Announcements, Cancer

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Rationalizing the Ridiculous

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Pictured: Cutting-edge medicine

I remain flummoxed. How do physicians and health care systems, trained in all the sciences that lie at the heart of medicine, justify the use of pseudo-medical interventions with no basis in reality? Rationalization. Making excuses:

a defense mechanism in which controversial behaviors or feelings are justified and explained in a seemingly rational or logical manner to avoid the true explanation, and are made consciously tolerable – or even admirable and superior – by plausible means.

Rationalization of the ridiculous comes in many forms. It has been said that it is a mark of a first rate intelligence to able to hold two contradictory ideas in the mind at the same time and still retain the ability to function. Clever as it is, I suspect the opposite is true. (more…)

Posted in: Acupuncture, Naturopathy, Science and Medicine

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Missouri tackles primary care shortage with “assistant physicians”

Medical school clinical training

Medical school clinical training

A new law in Missouri will allow medical school graduates who have not completed a residency to practice in underserved areas. They will be able to call themselves “doctor” but will be licensed as “assistant physicians” with significant limitations on their practice. (The first link is to Senate Bill 716, the bill that was passed and signed by the governor. It covers several subjects, so you will need to skip to page 8 to find the portion we’re discussing.)

The Missouri State Medical Association supports the new law and helped draft the original bill. It is designed to address the state’s critical need for primary care physicians – 40% of Missouri’s population lives in underserved areas but only 25% of the state’s physicians practice there, according to a 2009 survey. Underserved areas have high poverty rates, high infant mortality, large senior populations and fewer primary care physicians per capita. (more…)

Posted in: Chiropractic, Legal, Naturopathy, Politics and Regulation, Science and Medicine

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Privileged Antivaxxers

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The Hollywood Reporter recently published what is mostly an exposé on privileged Hollywood parents who have elected to delay, limit, or avoid altogether immunizing their children. The most common headline coming out of this article is that some LA communities have vaccination rates at third-world levels, such as South Sudan. The issues raises many questions pertinent to the promotion of science-based medicine – what leads an otherwise well-educated individual with financial security to make decisions that actually put their own children (and others) at risk?

Some background

We have often observed at SBM that the anti-vaccine movement is likely to experience a serious backlash once epidemics of vaccine-preventable diseases start to emerge. I think we are seeing the beginning of this prediction coming true. Vaccines are partly the victim of their own success. The diseases they prevent, such as polio, measles, whooping cough, and others, are now uncommon. Modern parents have the privilege of not fearing these diseases because the vaccination program has reduced them to sporadic cases. Therefore, when pseudoscientists or ideologues stoke fears against vaccines, the fear of the diseases they prevent is not there as a balancing force.

That may be changing, however. The CDC reports:

During 2012, 48,277 cases of pertussis were reported to CDC, including 20 pertussis-related deaths. This was the most reported cases since 1955. The majority of deaths occurred among infants younger than 3 months of age.

From January 1-August 16, 2014, 17,325 cases of pertussis have been reported to CDC by 50 states and Washington, D.C.; this represents a 30% increase compared with the same time period in 2013.

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Posted in: Vaccines

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The Human Mold: Another Example of Self-Deception

This cover picture is scientifically inaccurate. See explanation below.

This cover picture is scientifically inaccurate. See explanation below.

José Jarimba believes that our bodies are physically molded into an asymmetric form by our mothers’ sleeping positions during pregnancy, that this has lifelong adverse impacts on health, and that shoe inserts can eliminate pain and other health problems by realigning the body. This is a silly untested hypothesis by a single individual. As such, it would be too minor to merit mention on SBM; but it is worth analyzing as a teaching opportunity. Jarimba attempts to bypass the scientific process; he provides a prime example of self-deception, confirmation bias, scientific ignorance, and the “Unpersuadables” I recently wrote about.

Much of alternative medicine originated with a “lone genius” who had an epiphany, thought he had discovered something no one had ever noticed before, extrapolated from a single observation to construct an elaborate theory that promised to explain all or most human ills, and began treating patients without any attempt to test his hypotheses using the scientific method. Some of them were uneducated laymen, others were scientifically trained medical doctors who should have known better. I wrote about one of them here, Dr. Batmanghelid, inventor of the Water Cure, who attributed a great variety of illnesses to dehydration after he thought he had cured a prisoner’s peptic ulcer disease by giving him a glass of water. Similar paths were followed by many others. Hahnemann invented homeopathy after he thought a malaria remedy gave him symptoms of malaria. Palmer invented chiropractic after he thought he had restored a man’s hearing by repositioning an out-of-place bone in his back. Nogier invented ear acupuncture after he imagined that the external ear looked sort of like a fetus. Shapiro invented EMDR after she noticed during a walk in a park that moving her eyes seemed to reduce the stress of disturbing memories. Bach invented Bach flower remedies after a walk in the country revealed his intuitive psychic connection to various plants. Jose Jarimba follows in their footsteps. (more…)

Posted in: Critical Thinking, Obstetrics & gynecology

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Only two months until Skepticon

I don’t recall if I’ve mentioned this before, but I will be speaking at Skepticon in November. (Holy crap, that’s just over two months away. I’d better get my talk ready. It’ll be about the central dogma of alternative medicine. Or some such medically-related topic.) In any case, now’s crunch time, the time of year when Skepticon’s fundraising needs to go into high gear, given that the bills are coming due for the conference.

So give. Give until it hurts. Or buy swag. Or both. And if you’re planning on going, register now instead of later. You’ll be glad you did.

Posted in: Announcements, Science and Medicine

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Medicine past, present, and future: Star Trek versus Dr. Kildare and The Knick

mccoyvs20thcen

I’ve been a big Star Trek fan ever since I first discovered reruns of the original Star Trek episodes in the 1970s, having been too young (but not by much!) to have caught the show during its original 1966-1969 run. True, my interest waxed and waned through the years—for instance, I loved Star Trek: The Next Generation, while Star Trek: Enterprise and Star Trek: Voyager pretty much left me cold—but even now I still find myself liking the rebooted movie series. In the original series, my favorite characters tended to alternate between Spock, the Vulcan first officer and science officer on the Enterprise, and Dr. Leonard “Bones” McCoy, the ship’s chief medical officer. I sometimes wonder if my love of these two characters had anything to do with my becoming a doctor and researcher myself. It probably did.

One aspect of all the Trek shows that always interested me was its portrayal of medicine in the 23rd and 24th centuries. After all, what doctor wouldn’t like to have a device like the tricorder that he could wave over the patient and come up with an instant diagnosis and course of treatment? Who knew, of course, that nearly 50 years after the first Trek episode first aired, we would have technology that makes the communicators on the original series (TOS, for those Trek non-fans) look primitive and large by comparison and that we’d be well on the way to developing devices that can do some of what tricorders did on the show. Throughout all the shows and movies, the medical technology of a few hundred years in the future is portrayed as vastly superior to what we have now, with 20th century medicine at times denigrated by “Bones” McCoy and other Star Fleet medical personnel as barbaric quackery.

A confluence of events and media led me to want to explore a couple of questions. First, which procedures that we consider state-of-the-art science-based medicine will be considered “barbaric” 50 or 100 years from now? Second, is the contempt expressed for the medicine of the past (e.g., by “Bones” McCoy) justified? These are questions that I’ll explore a bit with the help of the Star Trek universe, a recent new cable television drama series, and a couple of articles that appeared on medical sites as a result of the premier of that series.
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Posted in: Cancer, History, Science and the Media, Surgical Procedures

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Fluoride: Still Not Poisoning Your Precious Bodily Fluids!

We dentists are an evil group of sociopaths. When we’re not trying to kill you or give you chronic diseases such as multiple sclerosis with our toxic mercury saturated fillings, we are advocating for the placement of rat poison/industrial waste (i.e. fluoride) in your water supply by our governmental overlords. What is up with us?

i-stopped-using-flouride-and-you-should-too

The problem is, we’re failing miserably. Even after more than 150 years of placing silver amalgam restorations in our patients, thereby saving untold numbers of teeth, reducing pain and suffering, and improving chewing ability for millions upon millions of people, there is still no evidence worth a damn that shows any correlation or causative effects for any known disease or condition. And with fluoride, after adjusting fluoride levels in municipal water supplies throughout the U.S. and in many places world wide for over sixty years, after adding fluoride to toothpastes and mouthwashes, and giving fluoride treatments to patients in our offices, the only nefarious result we have obtained is the significant reduction of dental decay with its concomitant savings of billions of health care dollars and untold pain and suffering for our patients. Man, we can’t do anything right.

Now, with the help of the American Academy of Pediatrics (AAP), there’s a new strategy.

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Posted in: Dentistry, Public Health, Science and Medicine

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