This war taking place in our nation's medical schools and academic medical centers. Orac at Respectful Insolence has been tracking this trend, as have those of us writing at Science-Based Medicine. It is a war between those who feel that medicine should continue to be based on science and those who want to integrate faith-based practices. The model for this war is not that of pedagogical disputes or funding scuffles. More than anything else, it resembles a religious war.
Archive for: March, 2009
Pope Benedict, the former head of the same Church body that ran the Inquisition, has done it again. He just committed an act which is morally equivalent to involuntary sodomy, and did it to an entire continent.
Africa, the epicenter of the AIDS pandemic, sometimes seems to have not all that much going for it---AIDS drugs are expensive, some leaders have been idiots, but there have been some bright lights, such as Botswana's comprehensive HIV prevention program.
So when some German dude walks in and tells everyone that condoms are wrong and may make the problem worse, one might consider using a rather loaded word to describe this behavior. What would that word be?
Genocide. mass murder Aw, Hell, I don't even know anymore. Maybe I'll go with negligent homicide on a continental scale.
To discourage the use of the most effective HIV prevention technique among Africans, a group of people who are dying of AIDS by the millions, is morally indefensible. He should be ashamed.
But of course, he has no shame (it kinda goes with infallibility).
Yes, yes, I realize that "papal infallibility" is not an unlimited concept.
Yes, I realize that "genocide" may be a bit over the top, but the point is this: When Mbeke fell for AIDS denialism, tens of thousands died. When the Pope lies about condoms, basically encouraging unsafe sex, thousands or more may die as a direct result of his words and actions. This is not OK. It is not a rant against the Catholic Church, but against the actions of a man whose position makes him uniquely able to help or harm millions.
The best way to prevent sexually transmitted infections is the proper use of condoms. That being said, it's not the only way to prevent STI's. Abstinence is one way, but it involves an amputation of sorts---the removal of a critical human behavior. Another amputation (of sorts) that prevents STIs is circumcision. Male circumcision has been found in several good studies to reduce the rate of HIV transmission, and now a study out of Uganda shows a significant decrease in rates of genital herpes infections (HSV-2), human papilloma virus (HPV) infection (the strains that cause penile, cervical, and anal cancer), but no decrease in syphilis infection.
This study complements the our knowledge on the benefits of circumcision to prevent disease. The authors emphasize that circumcision alone is not sufficient, but may be a useful adjunct to prevent serious STIs. In fact, STI's tend to travel together, and ulcerative diseases such as herpes increase transmission of HIV.
Whatever you think of its political reporting, no other mainstream media outlet can bring the stupid like the Huffington Post, especially with regards to medical reporting. Its most famous contributors include antivaccinationists like David Kirby and Robert Kennedy, Jr., and kumbaya therapy wackaloon Deepak Chopra.
Now they bring us an article by some dude I've never heard of with a title that should have him laughed out of any legitimate scientific institution: "The Science of Distant Healing". This is one stupid article.
First of all, who the hell is this guy? According to his bio:
Dr. Srini Pillay is an internationally recognized executive coach, public speaker, psychiatrist, and brain imaging researcher who is focused on the fields of personal and organizational transformation. His aim is to help people and corporations achieve their dreams by drawing on his expertise that addresses the intersections of coaching, biology, psychology and spirituality.
Srini has also been a "brain-imaging researcher" for the past fifteen years. He has had numerous publications and has been nationally funded.
That's interesting. A well-published brain-imaging researcher?
Hmmm...he has four publications indexed by PubMed, all of them on fMRI, a very limited technique shot through with horrid experimental designs, fantastic leaps of faith, and religious-like zeal from its supporters. We have had a number of discussions here lately about what a scientist is---he ain't it.
Googling him isn't that much more helpful---I get hits from HuffPo, and not much else. I did manage to verify that he is, in fact, a licensed psychiatrist.
So what about his article? It's drivel. First, he goes on and on about a study while failing to cite it. Finally, after being berated by his commenters, he named the citation: Dean Radin PhD et al. Compassionate Intention As a Therapeutic Intervention by Partners of Cancer Patients: Effects of Distant Intention on the Patients' Autonomic Nervous System, EXPLORE: The Journal of Science and Healing. Volume 4, Issue 4, July 2008, Pages 235-243.
It should be enough to say that the study looked at galvanic skin response as a surrogate measure of "distance healing intention (DHI)". What is "DHI"? According to the study:
To avoid unnecessary religious connotations, the descriptive phrase distant healing intention (DHI) is sometimes used in the scientific and medical literature
And why should we fail to laugh them out of the room?
Science is beginning to reconcile with the concept of "spooky action at a distance" within fundamental physics, but so far the idea that nonlocal effects might also exist in living systems, and be pragmatically useful in some way, evokes as much contempt as it does serious interest.
While our physicist friends weep, let the rest of us remember that once you are working above the sub-atomic level, "spooky action at a distance" is irrelevant, but hey, there's no woo like quantum woo (and if you want to learn more, go see what a real physicist has to say).
Let me sum it up for you: HuffPo prints a piece by a supposed expert with inflated credentials who cites an article from an unknown pseudoscientific journal; the said article bases its hypotheses on a near-criminal misuse of physics to explain prayer, and uses measurements from glorified Scientology E-meters as their main outcome.
As long as HuffPo continues to host fake health writers, I will always have something to blog about.
The current insanity at JAMA has been well reported elsewhere (also see these links: here, here, here, and here). I'll give you a thumbnail sketch. A professor from a small university wrote to JAMA (the Journal of the American Medical Association) to let them know that an author of an antidepressant study appeared to have an undisclosed conflict of interest (COI). When he didn't hear back from JAMA he wrote to a more prestigious journal, the British Journal of Medicine (BMJ) who published his letter. This caused the editors at JAMA to completely lose their shit, threatening the letter writer, calling his dean, insulting him with juvenile taunts ("you're a nothing and a nobody") and banning him from publishing in JAMA (irony alert---he had his letter published in a much better journal, BMJ).
The links above will lead you to most of the prurient details, but I'd like to look at one of the most idiotic results of this incident.
JAMA has always been a second tier journal (after the New England Journal of Medicine, Annals of Internal Medicine, the Lancet, BMJ) and JAMA has never liked this position. Despite their second-tier status (or perhaps because of it), the editors of JAMA seem to think they have some sort of superpowers, powers that allow them to reach out a punch some one in the nose publicly and then claim to be the aggrieved party. Rather than stepping back from the fray to find a way to dig themselves out of this particular cesspit, they have continued to dig furiously, compounding every error, and showing a stunning lack of competence and yes, frank stupidity.
The worst of the arrogant stupidity is to be found in an editorial in JAMA, apparently the official response to the situation.
This editorial would be amusing if it didn't make me wonder which institution the editors had escaped from. Let's examine it briefly (all emphasis mine):
As a result of these recent events we are making the following modifications to our already rigorous approach for investigations into allegations of unreported potential conflicts of interest. JAMA will require that the individual bringing the allegations provide a written detailed explanation of the unreported conflicts of interest and provide documentation to support the allegation. The person bringing the allegation will be specifically informed that he/she should not reveal this information to third parties or the media while the investigation is under way, will be informed about progress of the investigation, upon request, as appropriate, and will be notified when the investigation is completed. In addition, once the investigation into unreported conflicts of interest is completed and the letter of explanation and the correction are finalized, those documents will be immediately posted online and linked from the article, and then subsequently published in the print journal.
This paragraph would make sense in your basic totalitarian society. After all, one of the first rules of a dictatorship is "control the press". The press monitors the government, and monitors its competitors. A free press is critical to democracy. If JAMA were the only medical journal in the world, they could set whatever draconian rules they wished, and the coercion to follow them would be future ability to publish in the world's only journal. This is of course, not the case.
As this case shows, when a journal is suspected of having undisclosed COIs, its competitors can scoop them. There is no need to go directly to JAMA to complain about the error---you can go straight to another outlet. This bothers JAMA, and causes them to make ridiculous pronouncements that are sure to be laughed away in seconds. If I find an error in JAMA, I have even less incentive now to write them to let them know. I'll just write to the New England Journal, or put it right here in my blog. In fact, I think all medical writers and bloggers should give JAMA increased scrutiny and publish every little error we can find.
If you want a piece published in a particular journal, you must follow whatever guidelines they lay down. A journal has complete control over its content. This control does not extend to the rest of the world, no matter how overblown your sense of importance is. The difference between JAMA and Superman is that when Superman leaps off a building, he flies. When JAMA's editors jump, their is a resounding "splat" after which we all go back to drinking our coffee and reading our paper.
There's nothing like the sound of a little kid laughing. It's not just a sound, but an experience of the entire body and mind. They lose control---often of the bladder, and without shame. Anything sets them off---a joke, a pratfall, a burp (and everyone's favorite, the butt-trumpet).
We had a great weekend together. Lot's of play time and cuddling. Her cousin came over to play. They're about a year-and-a-half apart and have sleep-overs all the time. They might as well be sisters (they sure fight like sisters).
Nights are the best, laughs or not. She loves my iPod (as do I) and we listen to a couple of songs every night, ending up with "Golden Slumbers". There's nothing cuddlier than a four-year-old in pj's. I really do not want her to grow up.
Janet and I have another bloggingheads discussion up. We talk about ethics, alternative medicine, and her prostate. Go and watch.
My recent post on head trauma got me thinking. The practice of trepanation (the drilling of holes in the head) is thousands of years old. While looking up information on the practice I came upon this woodcut.
The engraving is, I believe, from 16th century England. Over at wikipedia, editors were discussing whether or not this diagram actually showed trepanation, or some other surgical procedure (neither of which I would wish to undergo). Either way, the picture is quite revealing. According to the good folks at wikipedia, the original caption states:
This instrumente is for to worke upon the heed/whan the brayne pan is beten in/for to lyfte it up agayne.
Let's take a closer analysis of the instrument and the patient.
If you look closely at the instrument, it would appear to be a screw drill with a scaffolding that clamps it to the scalp. It would appear from the caption and the picture, that the drill may have in fact been used to attach to a depressed piece of skull and lift it up again (although I'm not sure why a drill would be the best method).
More interesting to me is the patient himself. The artist paid very close attention to detail. Aside from the obvious hole in the head, there are several abnormalities. Knowing that my readers are generally quite bright, I'd like to see what you folks come up with by way of description and explanation for the patient's findings.