Archive for the 'Absurd medical claims' category

When a "scientific study" is neither

Aug 18 2011 Published by under Absurd medical claims, Medicine

There is quite a bit of art to the practice of medicine: knowing how to get and to give information to a patient, how to create a sense of worry without creating a feeling of panic, how to use the best available science to help them maintain or return to health. Underlying all of the art is the science: what blood pressure is likely to be harmful in a particular patient? What can I offer to mitigate this harm? This science is developed over years by observation and systematic study. We have a very good idea of what blood pressure levels are optimal to prevent heart attacks in various populations. These data are hard-won. It has taken decades and it continues.

If a researcher were to discover a promising, new blood pressure intervention, they would have a long way to go from bench to bedside. They would have to prove as well as possible that it is safe and effective---and from a science-based medicine perspective, that it is even plausible. If the discovery is a drug that relaxes blood vessels, or a type of exercise, we have good reason to believe it might work and can go on to figuring out if it does work. If the intervention is wearing plaid every day, we have little reason to think this would be effective, and it probably isn't worth the time and cost of looking into it.

The well-respected journal Cancer has just wasted space in the study of wearing plaid. Well, not really; it's worse than that. The article is called, "Complementary medicine for fatigue and cortisol variability in breast cancer survivors: A Randomized Controlled Trial." There is nothing that isn't wrong with this study, and if it weren't published in a major journal, it might even be light comedy.

Tragedy wins the day, however, because cancer is a big deal, and I don't like it when people mess around with cancer.

People with cancer suffer from a number of vague and specific discomforts related to the disease and its treatment. Everything from life-threatening blood clots, to intractable pain and nausea, to depression threaten to kill or disable people with cancer. One symptom common to many illnesses is fatigue, and during chemotherapy, fatigue can be debilitating. This new "study" allegedly investigates an intervention to alleviate fatigue.

Fatigue is one of those symptoms whose study can be difficult and deceptive. It rarely has a single cause, is subjective, and waxes and wanes naturally. Because of this natural variability, it is easy to attribute changes in fatigue to an intervention when if fact we may be observing the natural course of the symptom. My patients with colds often want antibiotics. Without antibiotics, their cold will likely last a week or two; with them, 7-14 days. If I give them antibiotics, they will certainly credit me with curing their cold, but were I to take credit I would be riding nature's coattails.

In the current study, the authors have chosen to ride the coattails of nature but rather than cling to them with medicine, they have chosen "biofield therapy". My spell checker doesn't recognize "biofield" and neither should you. The authors at least acknowledge this in passing:

Biofield therapies are complementary and integrative medicine modalities often used by breast cancer patients,
and have been described as therapies that are intended to affect energy fields that purportedly surround and penetrate the human body for the purposes of healing. (Emphasis mine, PalMD)

I have a big problem with studies built around something that only purportedly exists. What's next, a study of cancer rates in Sasquatch?

This paragraph effectively nullifies everything that follows, but what follows is so horrid and humorous that we can't just stop here.

The "biofield healing" technique chosen for the study? "Energy Chelation". It's almost as if they looked for a term that took all of quackery and combined it into two simple words. Nowhere does it tell us what sort of "energy" is being "chelated"; so I looked it up.

According to the study, the technique was chosen by one of the authors, Reverend Rosalyn L. Bruyere. Is she an oncologist? A physicist?

Rosalyn L. Bruyere is an internationally acclaimed healer, clairvoyant and medicine woman.

You don't need to be a capital-S Skeptic to translate that as "con-artist", although that would simply be an opinion. The real question isn't whether or not she is a con-artist (she may in fact be very sincere despite a website that makes her look like a cult leader) but why in the world any real physician or scientist would take such a person seriously?

Still, I want to know what the hell "energy chelation" is. It's not an easy question to answer, but various searches describe it as a hands-on energy healing technique that, analogous to chelation therapy, "chelate" and remove negative energies from the body. In other words, it's a fantasy spun out of happy thoughts and a juvenile imagination.

The "science-y" bit of the study isn't any better, relying of famously inaccurate "saliva cortisol" measurements, and something called "cortisol variability", which does not appear to be a validated marker of the symptom in question (fatigue). From my reading, I'm unclear that it's ever been validated to measure anything.

For all I know, the editors of Cancer are detoxifying themselves in a sweat lodge to rid themselves of the embarrassment of publishing such dreck. I just hope they remember to drink lots of water---faith healers do not have a great track record for patient safety.
References

Jain S, Pavlik D, Distefan J, Bruyere RR, Acer J, Garcia R, Coulter I, Ives J, Roesch SC, Jonas W, & Mills PJ (2011). Complementary medicine for fatigue and cortisol variability in breast cancer survivors: A Randomized Controlled Trial. Cancer PMID: 21823103

(h/t Genevra Pittman at Reuters)

16 responses so far

The "hCG diet": a fraud literally without substance

Jul 14 2011 Published by under Absurd medical claims, Medicine

Back in the 1950s, a British endocrinologist named ATW Simeons had an idea: a human pregnancy hormone called hCG (human chorionic gonadotropin) could help people lose weight without feeling hungry.  His idea was to put obese patients on a 500 kcal a day diet (in contrast, you probably eat about that much or more at each meal) and give injections of hCG which was supposed to blunt their hunger.  According to his writings, his results were not reproduced by anyone else, which, rather than make him doubt his own hypothesis, hardened his belief that only he could do it right.  Several studies in the 1970s effectively discredited his work, but in the 90's, famous shill and convicted felon Kevin Trudeau published a book that helped revive the hCG diet craze.

hCG has a number of clinical uses mostly related to fertility medicine.  It's also used as a biomarker for pregnancy (it's what we detect on home pregnancy tests) and for certain tumors.  Despite many negative studies in the 70s, hCG has made a spectacular return as a diet fad.   Not only does it not aid in weight loss, but as an active hormone, it may have other unintended effects (for example, it's not known if it can contribute to tumor formation or growth, but it is produced by a number of different tumors).

So put yourself in the shoes of a convicted felon like Kevin Trudeau: you want to continue to sell a weight loss scam, but you want to avoid getting sued if you happen to cause a tumor.  How can you still market the hCG diet without the hCG?  Homeopathy!

A product called KetoMist Spray (not, as far as I know, connected to Trudeau in any way) is purportedly a homeopathic dilution of hCG, that is, there is no hCG in it.  Using it, in conjunction with a 500kcal diet, should be no different than using, say, a spray of water.  The FDA recently came down on so-called homeopathic hCGs  because they are not FDA-approved drugs, nor are they in the "Homeopathic Pharmacopoeia", a list that allows fake drugs to be sold as real drugs.

But hucksters are endlessly clever.  KetoMist appears to skirt the FDA regulations by a bit of sleight-of-hand:

What is in each bottle?
Each bottle contains the 'Energy Profile' of HCG in multiple potencies (6c / 12c / 30c) imprinted onto a solution of Steam Distilled Water (80%) and Kosher Corn Alcohol (20%). If you want to know more about homeopathic remedies, search online - there is a ton of info on homeopathy.Since an 'energy signature' cannot be listed as a physical ingredient (for what should be obvious reasons) it isn't on the 'ingredients list' on the label, but it IS on the label.

In other words, KetoMist "contains" the  same homeopathic ingredient which was banned, but it's called an "energy signature", hoping to avoid the wrath of the FDA and to separate more husky consumers from their money.

hCG does not contribute to weight loss, and ultra-dilute hCG isn't even real---there is no hCG in it.  It's all, in my opinion, more fraud, but if consumers read the fine print they will see the truth:

Legal Disclaimer: The FDA has not approved HCG Therapy to lose weight. “HCG HAS NOT BEEN DEMONSTRATED TO BE EFFECTIVE ADJUNCTIVE THERAPY IN THE TREATMENT OF OBESITY. THERE IS NO SUBSTANTIAL EVIDENCE THAT IT INCREASES WEIGHT LOSS BEYOND THAT RESULTING FROM CALORIC RESTRICTION, THAT IT CAUSES A MORE ATTRACTIVE OR "NORMAL" DISTRIBUTION OF FAT, OR THAT IT DECREASES THE HUNGER AND DISCOMFORT ASSOCIATED WITH CALORIE-RESTRICTED DIETS.”

A tiny but truthful Quack Miranda Warning inserted  at the bottom of the webpage specifically refutes all of the claims in big, bold print above.  But humans are endlessly hopeful, and looking for that miracle.  This isn't it.

References 

Miller R, & Schneiderman LJ (1977). A clinical study of the use of human chorionic gonadotrophin in weight reduction. The Journal of family practice, 4 (3), 445-8 PMID: 321723

Young RL, Fuchs RJ, & Woltjen MJ (1976). Chorionic gonadotropin in weight control. A double-blind crossover study. JAMA : the journal of the American Medical Association, 236 (22), 2495-7 PMID: 792477

Bosch B, Venter I, Stewart RI, & Bertram SR (1990). Human chorionic gonadotrophin and weight loss. A double-blind, placebo-controlled trial. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 77 (4), 185-9 PMID: 2405506

Stein MR, Julis RE, Peck CC, Hinshaw W, Sawicki JE, & Deller JJ Jr (1976). Ineffectiveness of human chorionic gonadotropin in weight reduction: a double-blind study. The American journal of clinical nutrition, 29 (9), 940-8 PMID: 786001

Rabe T, Richter S, Kiesel L, & Runnebaum B (1987). [Risk-benefit analysis of a hCG-500 kcal reducing diet (cura romana) in females]. Geburtshilfe und Frauenheilkunde, 47 (5), 297-307 PMID: 3609673

4 responses so far

Alternative medicine: same thing, different words?

Apr 30 2011 Published by under Absurd medical claims, Medicine

When discussing the absurdity of religious disagreements, peacemakers often make the point that all religions believe in one underlying Truth or Deity, that all religions are guided by the idea that we should be excellent to each other.  I don't believe this, but it serves as a useful analogy.

In medicine, those trying to bring together science-based practitioners and alternative practitioners (or more honestly, alternative docs trying to justify their practices) often argue that we are simply using different words for the same concepts, that one person's chi is another one's "life force", "energy", or some such thing.

In religious arguments, no one can be proven wrong about who's god is the real one, but it can be pretty well determined whether or not religions "believe in" the same underlying principles.    One question deals with the unanswerable, the other with written texts and observable practices---in other words, data.  The same is true for medicine.

The idea that there is some sort of animating force travelling through channels or meridians in the body is an old one.  Sometimes the language is explicitly mystical, and sometimes it is couched in science-y words.  Chiropractors speak of "subluxations" blocking the flow of something-or-other and causing disease.  Whether such a phenomenon exists (it doesn't) is easily discovered.

Lay people very often buy in to vitalist ideas about human health. It goes well with our propensity to believe in mind-body dualism, with religious ideas of soul. People like to believe things, like to find patterns to organize their world based on their own observations, even if these observations are based on false premises.  This is why we have professionals.  We don't let anyone design a bridge, but someone who understands the physics involved.  And we shouldn't let people practice medicine if they have a fundamental misunderstanding of how the body works.

All this is in support of the premise that Dr. Oz is no longer a real doctor, but more of a mystic.  Currently his website is hosting a series on "Fighting Fat with Ayurveda".  Ayurveda is a form of pre-scientific medicine from the Indian subcontinent.  It is based on thousands of years of tradition, but has been largely abandoned by those who can afford real medicine.  It shares with other traditional systems vitalist ideas of unmeasurable life-forces.

As I read the first part of the series I am struck by two patterns.  First, it shows a supposedly real doctor (Oz) implicitly supporting disproved ideas about health and failing to give the real data. Just as disturbing is the "carnival barker" tone of the series:

Over the next several weeks, I will be sharing some of the most powerful ayurvedic secrets for removing amafrom your body and helping you achieve your weight loss resolution.

This idea that there is some secret out there for fat people, diabetics, people with cancer, or whomever, a secret so powerful yet simple, is patently absurd, yet alluring.   But what follows could have been lifted from any internet quack site.  It is a list of symptoms that supposedly tells you if you have excessive "toxins" in your body.  The whole idea of "toxins" being the cause of disease is also old, and also not based on reality.  It's not that toxic substances aren't important, it's that the word is not used the same by real doctors and quacks.

But the language!  Vey's mir, it could have been lifted from any Morgellons, chronic Lyme disease, or other fake disease websites.

The first step is to determine if you have an excessive amount of toxins in your body. If you answer “yes” to the majority of the statements below, you have an excessive accumulation of ama:

1.  I tend to feel obstruction/blockages in my body—constipation, congestion/heaviness in the head area, blocked nose, or a general feeling of non-clarity.

2.  When I wake up in the morning, I do not feel clear; it takes me quite some time to feel really awake.

3.  I tend to feel tired or exhausted mentally and physically.

4.  I get common colds or similar ailments several times a year.

5.  I tend to feel heaviness in the body.

6.  I tend to feel that something is not functioning properly in the body – breathing, digestion, elimination or other.

7.  I tend to feel lazy (i.e., the capacity to work is there, but there is no inclination).

8.  I often suffer from indigestion.

9.  I tend to spit repeatedly or have a bad taste in my mouth.

10.  Often, I have no taste for food and no real appetite.

11.  My tongue is often coated with a thick film, especially in the morning.

Everyone has some or many of these complaints at one time or another, and many of these are normal.  Most people get several colds a year.  Most people get indigestion.  These vague statements are usually designed, in my opinion, to show how "common" an imaginary problem is by making all readers victims of this excess of ama.  And on many websites, such lists, in my opinion, are simply used to draw in pigeons for the fleecing.

Believers in alternative medicine and real doctors are most certainly not talking about the same concepts using different words.  We physicians are talking about real, measurable, testable concepts; things that can be seen, touched, altered.  They are talking about imaginary energies and toxins that cannot be demonstrated to even exist, much less be manipulated to improve health.

There is a long history of real medicine, flaws and all, saving lives and improving health.  All the rest is based on dreams and greed.

16 responses so far

Mercola appears to lie about vaccines and fertility (#vaxfax)

Oct 18 2010 Published by under Absurd medical claims, Medicine, Vaccination inanity

When well-reasoned discussion fails to convince someone of your strongly-held beliefs, the most effective tool of persuasion you have left is lying. This has always been the fall back position for quacks and politicians (a group with perhaps some significant overlap). This week, as reported by Respectful Insolence, anti-vaccination activists are launching a week of activism based on their usual fall back strategy.  Everyone is encouraged to spread the news, and help refute the lies with the cold, harsh light of truth.  On twitter, the news will be trending at the hashtag #vaxfax.  There is not formal aggregation of posts yet, but we'll let you know as soon as we have a website up.

Meanwhile, bloggers and others are strongly encouraged to refute the lies coming from infamous antivaccination nuts such as Barbara Loe Fisher and Joe Mercola.  As my first contribution to this week's battle, I give you an over-the-top piece of idiocy which is either mendacious or blindingly stupid.  Or maybe both, who can really say.

It comes from one of the biggest gurus of medical misinformation, Joe Mercola.   He titles his post, "What is in the flu vaccine that can cause infertility?" which is akin to asking, "when did you stop beating your wife?"  He could just as easily have asked, "What is in the flu vaccine that can cause an alien invasion?"  In this case, he bases his question (which I cannot say with completely certainty to be the product of fantasy, intentional lying, idiocy, or whatever) on a package insert for flu vaccines.  His entire article goes on to state the usual thought-free lies about vaccine contents, but we'll focus on his headline.  Is there evidence that flu vaccines cause fertility problems?

First, is the idea plausible?  What causes infertility?  Fertility can have male causes, female causes, or can be a combined cause.  It can be temporary or permanent.  Common causes (other than intentional interruption of fertility) include disorders of sperm production, egg production, fertilization---there are many causes and combinations of causes.  If a flu vaccination were to be contaminated with a significant amount of a hormone or hormone analog, I suppose it could contribute to temporary infertility, but it's hard to conceive of how this could happen.

Here is Mercola's smoking gun:

A study done in Slovakia on female rats found that when newborn rats were injected with the substance [flu vaccine] within a week of birth, they developed damage to the vagina and uterine lining, hormonal changes, ovarian deformities and infertility.

The package insert for Fluarix mentions that the manufacturer cannot guarantee your fertility will be unharmed...

What does this compelling evidence actually tell us?  First, from the package insert:

FLUARIX has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility.

The issue of fertility and this flu vaccine has not been specifically tested in humans, mostly because the idea is insanely improbable. But what about the rats? He doesn't cite any actual Slovak study, but the package insert says this:

A reproductive and developmental toxicity study has been performed in female rats at a dose approximately 56 times the human dose (on a mg/kg basis) and revealed no evidence of impaired female fertility or harm to the fetus due to FLUARIX. There are, however, no adequate and well-controlled studies in pregnant women.

So other than a putative Slovak study that may have shown "something", a something not borne out in any human studies after billions vaccinations over decades, what does Mercola have to offer?

The package insert for Fluarix mentions that the manufacturer cannot guarantee your fertility will be unharmed.

While I cannot find this particular phrase in the manufacturer's literature, let's pretend it's there.  The manufacturer also cannot guarantee that aliens won't come probe your rectum after your flu shot.  There are lots of negatives that cannot be proven.  The overwhelming evidence is that flu shots are not only safe, but beneficial in preventing flu and complications from the flu.

I got mine, and so did my six year old daughter who is everything to me.  If even one person is harmed by following Mercola's advice, he is morally culpable for the injury or death of that person. He should be ashamed.

18 responses so far

Christiane Northrup: more bad medicine

Sep 23 2010 Published by under Absurd medical claims, Medicine

A question popped up on facebook the other day about Dr. Christiane Northrup, an OB/GYN who has been a frequent guest on Oprah.  I hadn’t heard much about her for a while, but a foul taste still lingered from previous encounters with her work.  So I went over to her website to see what fare she's currently dishing up.  It isn’t pretty. (Cached version).

This month’s news item is titled “Angst Over Not Vaccinating Children is Unwarranted.” Regular readers will be expecting a typical antivax screed, and they won’t be disappointed, but I’d like to highlight some of the propaganda techniques Northrup uses to advance her dangerous lies.

She begins her story with this:

In June, 2010 there was an outbreak of pertussis (whooping cough) in California that reporters were calling the worst epidemic in 50 years.

There are two problems with this opening sentence.  The outbreak is ongoing, and it’s not “reporters” who are calling it “the worst epidemic in 50 years.”  The California Department of Public Health reports that the state has seen the largest number of cases in the last 55 years.  Of course the state was much smaller 55 years ago, so for comparison they give us an incidence rate: 10.3 cases/100,000 in 2010, the highest rate in 48 years (when the rate was 10.9 cases/100,000).  So far in California, there have been 9 deaths.  All of the deaths were in babies eight of whom were unvaccinated and one of whom had been vaccinated only days before becoming ill, not early enough to develop immunity.

The precise reason(s) for this outbreak are unclear, but there are probably a number of factors.  Pertussis outbreaks are cyclical, so increases in disease incidence are expected, but not to this extent.  The vaccine itself is imperfect, and immunity wanes fairly quickly.  Adults who have not been re-vaccinated can serve as a reservoir of the disease.  While adults do not normally become seriously ill (although I’ve seen plenty of cases of adults with pertussis coughing so hard that they fainted and injured themselves), adults can pass it on to those who do suffer more dire consequences: infants.  There are also significant reservoirs of disease in communities of vaccination refusniks throughout California, and while these communities tend to be wealthy, it is the poor who suffer.

Because the vaccine is not completely effective and not terribly long-lasting, herd immunity is even more important, and adults younger than 65 who haven’t had a tetanus shot in the last 2 years can get a TDaP, which includes a pertussis booster.

But since Christiane Northrup doesn’t believe in pesky things like germs and cellular and humoral immunity, she doesn’t get it:

Getting your child or yourself immunized is a culturally agreed-upon ritual, designed to shore up your first chakra. The first chakra, or first emotional center, of your body controls your bones, joints, bone marrow, blood, and immune system.

It’s sometimes hard for me to believe that someone who isn’t under the influence of a controlled substance can write something like that without a shred of irony.  She goes on to cite---I kid you not---Sherri Tenpenny, a noted antivax loon who writes for the Huffington Post.

Most people don’t know that the pertussis vaccine doesn’t provide lifetime immunity! Unlike chicken pox, having the disease once doesn’t protect you from having it a second time. This is why I don’t believe there was an epidemic at all. According to my colleague Dr. Sherri Tenpenny, who I consider to be the foremost medical expert in vaccine safety, “Outbreaks of pertussis are cyclical and tend to peak every two to five years, regardless of the vaccination rate….” Further, “Your child can be fully vaccinated and still contract pertussis.”

Um, no.  Outbreaks occur cyclically, but outbreaks this large do not.  Neither is Tenpenny a medical expert in vaccine safety.  Nor are doctors ignorant of the imperfections of the pertussis vaccine.

This negates accusations of California health officials who assert that when parents don’t vaccinate their children, they can create a rampant resurgence of diseases, like polio or pertussis. These conditions are thought to be under control because of mandatory vaccinations. Our society buys into something that Dr. Tenpenny calls herd immunity: If we vaccinate as many people as we can, especially the healthy ones, it will protect those who are young, elderly, and immuno-compromised. Unfortunately, this isn’t true. Just because you are healthy and vaccinated against pertussis, you can still carry the disease without knowing it and become sick or infect others

This negates no such thing.  And Tenpenny didn’t invent “herd immunity”.  We’ve already established that the vaccination is imperfect.  What is she suggesting?

Babies under six months of age are at risk the most for contracting pertussis and dying from it. Babies have very narrow bronchial passages, which block air flow to the lungs. Sadly, this causes death in some. Six died in California this year as of July 21, 2010. The CDC believes that these same children are at risk because they aren’t fully vaccinated before six months (if you follow the recommended vaccination schedule).

There’s much you can do to support your infant’s health, the most important of which is to breastfeed her. It’s well documented that breast milk contains antibodies against all kinds of germs a newborn is likely to encounter, organisms to which her mother is already resistant.

So, Northrup is saying that because the vaccine is imperfect, we should simply toss up our arms and give in to an horrible, asphyxiating death?  Or is she saying we should rely on a potential passive immunization from breast milk, breast milk which her earlier comments imply no longer contain pertussis antibodies?

I was going to skip the rest of her article, but when I read her take on meningococcal meningitis, I shuddered.  Not only is her advice dangerous, it betrays a fundamental lack of medical knowledge.

The meningitis vaccine is one of the safer vaccines, because it’s acellular. That means there is no live virus in the vaccine. It’s also not preserved with mercury or other toxic material that are still in many vaccines. When my youngest daughter went to college, I threw in the towel and had her vaccinated. (I’m referring to the one given to college-age children, not infants.) It just wasn’t worth the fight with her school’s administration at the time. But I was ambivalent, and would have opted out if it had been easier to do.

Three childhood vaccines protect against meningitis: Hib, pneumococcus vaccine, and meningococcus vaccine.  Meningococcus is most relevant in certain populations and situations, such as college dormatories and military barracks.  She is correct in stating that the vaccine contains no live virus.  One of the main reasons for this (aside from the manufacturing process) is that meningococcus is a bacterium, not a virus.  While Northrup doesn’t come across as entirely against this vaccine, her decision is based purely on superstition and convenience rather than reality:

The main reason kids get sick when they’re in college is they are run down. Meningitis is no different. Like pertussis and HPV, typically a child will be sick and recover—it’s not fatal. The main reason these adult children get sick is due to a shaky first chakra.

Ten percent of people who get meningococcal meningitis die.  They do not get sick because of their “chakras” but because they have been colonized by a dangerous bacteria (not a virus) that becomes invasive, and once it does, you’re in big trouble.

I’m not simply troubled by Northrup’s truth- and fact-impaired version of the science of immunology and infectious disease.  I’m more troubled by her representing herself as a doctor and an authority on health, when she doesn’t know a bacterium from a virus and thinks chakras are real.

She is a danger to the public health, and for the sake of public health, she should retire into obscurity.

18 responses so far

You pulled that out of where?

May 11 2010 Published by under Absurd medical claims, Medicine

Last week I gave you a refresher course on the invalid arguments used by altmed boosters. The Turf Battle Fallacy and Pharma Shill Gambit are classics for a number of reasons. The most amusing thing about these gambits is their hypocrisy.   The alternative medicine movement is  essentially a collection of businesses selling unproven supplements and interventions (not "therapies", as Steven Novella aptly observes).  

Of course, that's an incomplete analysis.   Altmed is also a religion, with zealous adherents.  The arguments made by these adherents are never about the data, but about beliefs.  When asked for data, they often resort to two more of my favorite gambits: moving the goalposts, and the argumentum ex culo. I'm going make an example out of a recent commenter, not because I have anything against him, but because he's just that hilarious.

Our commenter, in defending alternative medicine (but giving few specific examples) states that:

In mentioning diet, I was referring to Pal's own admission that he does not normally bring up diet with his diabetes patients.

I mention this as being ex culo as I have written frequently about lifestyle modification, which is not in any way "alternative", but a normal part of medical practice.  I have many times written that advising lifestyle modification is often insufficient. For example (since Nathan gives none):

The truth is that diabetes can, and often is, well-controlled by medicine alone. This isn't because real doctors prefer it that way; it is because many diabetics cannot adhere to diet and exercise programs, and many diabetics do not have enough pancreatic beta cell function left to avoid medications.

When called out on his pulling a "fact" out of the vacuum, he backpedals---and the picks up his goalposts and starts to run:

 

Pal: I may have inferred wrongly from what you wrote earlier.
Dietary adjustments that effectively treat illnesses are rarely mentioned by physicians, in my experience, and are routinely downplayed. If your experience differs, I'm interested to hear about it. Do you ask H. simplex patients about their diet?

"In my experience" is of course a placeholder for, "wait, my rectum is still full of unsupported assertions."  Dietary modification is the mainstay for the treatment of many common diseases: coronary heart disease, hypertension, sleep apnea, obesity, type II diabetes, hyperlipidemia, just to name a few.  It is not "downplayed" but real doctors recognize that real patients should not be punished for their inability to make significant enough lifestyle changes.

I had trouble deciding if the final phrase was truly a "moving of the goalposts" or simply an idiotic non sequitur.  I concluded that it is both.  In my eyes it is a non sequitur because it literally does not follow.  It makes no sense.  It is devoid of reason.  To Nathan, however (who, we should remember, is simply giving us typical examples to work with) he has raised the bar.  Now that he sees that I may actually use dietary advice in my practice, his response is, "yeah, but did you do it for this other disease? Huh?  Didya?"
This simultaneous running away with the goalposts and birthing ideas ex culo leads to some disturbing imagery, but more important is that it reveals the poor thinking habits of those who would critique the need for medicine to be based on science.  There is no "alternative" to medicine.  There is simply that which can be shown to work, and that which cannot.  The humane application of what we know is the art of medicine.  The humane application of alternative medicine is quackery with a smile.

34 responses so far

Update on fake diseases

May 03 2010 Published by under Absurd medical claims, Medicine

I've been a bit busy lately and haven't been able to update you on some important developments in the field of imaginary diseases.
Update 1: Chronic Lyme Disease
So-called "chronic Lyme disease" (CLD) is a diverse constellation of symptoms which are often attributed to Lyme disease, but without objective evidence of infection with the organism that causes Lyme disease. Patient advocacy have been very active in insisting that reality conform to their beliefs, going so far as convincing the Connecticut Attorney General to investigate the Infectious Disease Society of America. As part of an agreement to get the AG to stop this foolishness, the IDSA agreed to review its guidelines, without any guarantee of changing them.
Their review is now complete, and they have decided against any changes. The heart of the AG's investigation was an allegation that the IDSA had too many conflicts of interest. In order to allay some of these concerns (foolishly, in my opinion, as that is akin to trying to tell the Pope not to believe in God), an outside ethicist was brought in who reviewed the panel for conflicts of interest, and found none. According to the IDSA statement:

The Review Panel concurred that all of the recommendations from the 2006 guidelines are medically and scientifically justified in light of the evidence and information provided, including the recommendations that are most contentious: that there is no convincing evidence for the existence of chronic Lyme infection; and that long-term antibiotic treatment of "chronic Lyme disease" is unproven and unwarranted. Inappropriate use of antibiotics (especially given intravenously) has been shown to lead to deadly blood infections, serious drug reactions and C. difficile diarrhea, as well as the creation of antibiotic-resistant bacteria or "superbugs."

And that settles that, right?
Update 2: "Morgellons" syndrome
So-called morgellons syndrome is a term coined by someone who felt she had unexplained skin rashes and strange fibers in her skin. Over the last couple of years, a loose group of people and one or two scientists have come together to try to find the cause of their suffering. They have managed to enlist the CDC in an investigation in an investigation which is still ongoing, but given the history of similar claims, if the CDC does not find an explanation to their liking, the conspiracy theories will make chem-trails and UFOs look rational.
So that's your update. Enjoy the discussion which is sure to erupt.

32 responses so far

Homeopath Dana Ullman is an idiot (in my humble opinion)

Apr 30 2010 Published by under Absurd medical claims, Medicine

Dana Ullman is an idiot. Or maybe insane. I'm not sure which, but his latest article at the Huffington Post reveals such a severe defect in rational thought that it must be one or the other (charitably speaking). He calls it "Lies, Damn Lies (sic), and Medical Research," and the point of it is quite clear: Ullman calls himself an "expert in homeopathic medicine" (which is akin to being a unicorn veterinarian) and since he has never been able to show that his particular health religion has any validity, he lashes out futilely at reality.
His entire argument boils down to a profound ignorance of medical science and a series of rhetorical/logical fallacies. His first straw man is a typical argument of alternative medicine gurus: that modern medicine only treats symptoms and not their causes. His first claim in this regard is that clinical studies define efficacy wrong because we consider symptom relief to be "efficacy". This is simply wrong. End points of studies depend on what is being studied. If, for example, we wish to know if a pain medication works, then pain relief is a reasonable end point. If we want to know if a particular drug prevents heart attacks, then heart attack is a reasonable end point. Ullman is either intentionally raising a straw man, or simply too ignorant to understand the barest basics of medical science:

The bottom line to scientific research is that a scientist can set up a study that shows the guise of efficacy. In other words, a drug may be effective for a very limited period of time and then cause various serious symptoms. For example, a very popular anti-anxiety drug called Xanax was shown to reduce panic attacks during a two-month experiment, but when individuals reduce or stop the medication, panic attacks can increase 300-400 percent (Consumer Reports, 1993). Would many patients take this drug if they knew this fact, and based on what standard can anyone honestly say that this drug is "effective"?

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37 responses so far

Too much of a bad thing

Apr 29 2010 Published by under Absurd medical claims, Medicine

I've never liked Gary Null. Early in my blogging "career" I wasted thousands of words expressing my incredulity at his horrible health advice, his paranoid rants, and his shameless hucksterism. Then I saw something shiny and forgot about him for a while. But now blog bud Orac has ruined my reverie. He informs me that Gary Null took a dose of his own medicine---and nearly died.

As a compassionate human being, I can only hope he recovers quickly with no serious sequelae. As a physician, educator, and writer, I hope we can use this as an object lesson in the dangers of idiotic medical advice.

What happened?

From the news reports, it appears that Null suffered the toxic effects of too much vitamin D, a condition known as "hypervitaminosis D". Vitamin D has multiple, complex effects on our physiology. One of the primary affects of vitamin D is on blood concentrations of calcium and phosphorus. Excessive amounts of vitamin D cause calcium to be released from bone into the blood, which can lead to constipation, kidney stones, and other more serious problems. When the both phosphorus and calcium levels are sufficiently elevated, they can precipitate in the skin leading to a condition called "calciphylaxis" which looks and behaves like a serious (often deadly) burn injury.

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19 responses so far

Vaccination's night of the living dead

Apr 03 2010 Published by under Absurd medical claims, Medicine, Vaccination inanity

Some crazy, currently unbloggable crap is going down around Casa Pal this week, so I'm going to have to open up a bloggy doggy bag for you. I have a nice piece in the works for Sunday or Monday which is brand, spanking new. This was originally published on 5/6/2009. --PalMD
Some bad ideas refuse to die. Others die and then come back to eat your brains. Of course, zombies don't just rise from the grave for no reason. They need some sort of animating principle, like meteors, puffer fish toxin, a voodoo priestess, or all three.

Zombies_NightoftheLivingDead.jpg

Brain-eating, measles-promoting zombies. Not pictured: Andrew Wakefield

I'm sure Oprah can afford any or all of these, and she's certainly putting them to work. The latest reanimation from Oprah's Harpo Studios is Jenny McCarthy, Queen of the Undead, at least as far as the army of infectious disease promoters goes. You see, not only has Jenny been spreading lies about public health, her activities have breathed fresh life into infectious diseases that were "mostly dead". She even admits that increasing the incidence of dangerous infectious diseases is a likely consequence of her actions. Hell, she revels in it.
So Oprah, Queen of TV woo, with friends like Mehmet Oz and Christine Northrup, is helping to keep alive the Bad Idea that Wouldn't Die. Oprah is in a very powerful position, as we all know. If she brings out the Jenny, people will listen.
And when people listen to Jenny, children die. It's really that simple.
So thanks, Oprah. Thanks for raising a zombie army of people who would rather we sicken and die of infectious diseases because of their own baseless fears. Our brains will never be safe again.

16 responses so far

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