Here is a recap of the stories that appeared in recent weeks at Science-Based Medicine, a multi-author skeptical blog that separates the science from the woo in medicine.
Avastin and metastatic breast cancer: When science-based medicine collides with FDA regulation ( David Gorski) The FDA expedited approval of Avastin for treatment of metastatic breast cancer because studies showed it increased progression-free survival. Post-approval studies showed it didn’t increase overall survival and it caused complications, so a panel recommended its approval be revoked. This has led to a controversy where science, economics, politics, and dying cancer patients intersect in what are sometimes very ugly ways.
Kaiser Rejects Neck Manipulation (Harriet Hall) A major HMO, Kaiser Permanente, has announced the elimination of neck manipulation from its chiropractic coverage due to a paucity of evidence for benefit and the potential for catastrophic adverse events. They are to be applauded for following the scientific evidence. Chiropractors predictably objected, making claims that are not supported by the evidence.
WHO Partnering with Traditional Healers in Africa (Steven Novella) The World Health Organization and the International HIV/AIDS Alliance are teaming up with the Traditional Health Practitioners Association of Zambia to enlist traditional healers in the fight against AIDS. This may seem like a practical way to remedy the lack of health services, but it is a Devil’s bargain with serious pitfalls: it will tend to validate traditional healing methods that are not safe or effective.
Direct-to-Consumer Genetic Testing: Road Map or Tarot Cards? (Scott Gavura) Companies are marketing direct-to-consumer tests for genetic traits that predict the risk of disease and guide drug treatments. An investigation has raised questions about the accuracy of these tests and has exposed confusion about their interpretation. Our access to genetic information currently exceeds our understanding of what that information actually means.
Yes, drug companies do pay attention to herbal medicine (David Kroll) The criticism that researchers and drug companies don’t evaluate traditional folk medicines is demonstrably false. One example: an herbal medicine used in Europe in the Middle Ages was developed into the modern diabetes drug metformin. It is currently being actively investigated for its anti-cancer properties.
Mike Adams on Dr. Mehmet Oz’s colon polyps: “Spontaneous” disease? (David Gorski) Dr. Oz had a precancerous polyp removed during a colonoscopy. Mike Adams says, “There is no law of the universe by which Dr Oz could follow a diet of perfect health and yet somehow a colon polyp would spontaneously appear in his body without cause.” This is a win/win argument because if you still get cancer he can say your diet wasn’t “perfect.” It ignores the roles of genetics and chance. One wonders if Adams actually believes what he says?
“Complex, multi-component therapy” can be studied well (Tim Kreider) It is often claimed that complex, multi-component therapies like tai chi can’t be evaluated by randomized controlled trials because an appropriate sham can’t be designed. A recent study demonstrates that that claim is false: it evaluated a complex, multi-component intervention for ADHD using adequate controls to rule out nonspecific effects. Nothing is exempt from proper scientific study.
Write for Oprah? Wrong for Me (Harriet Hall) Dr. Hall wrote a column for O, The Oprah Magazine from January through June, 2010. She describes a bizarre, frustrating experience that ended when the editors stopped answering her e-mails and dropped the column without even having the decency to tell her so.
Ghostwriting As Marketing Tool (Steven Novella) Pharmaceutical companies have employed ghost writers to manipulate the peer-reviewed literature as a method of distributing marketing messages to physicians. Steps must be taken to stop this exploitation and distortion of the medical literature: we must maintain a wall between science and marketing.
Your disease, your fault (Peter Lipson) A common theme of alternative medicine is the idea that all disease is preventable: that’s just not true. There are evidence-based preventive measures that can reduce the incidence of disease but they can’t hope to entirely eradicate it. Alternative medicine proponents dispense false promises, fake science, and a heaping portion of blame to those who don’t do everything they tell them to.
Chronic Fatigue Syndrome: Lots of Speculation (Mark Crislip) The cause of CFS is unknown. Dr. Crislip’s experience and pattern recognition suggest that a previous infection may cause at least some cases. The idea that the XMRV virus might be to blame is only speculative at this point. We’ll have to be content with uncertainty until science can sort out the facts.
The final nail in the mercury-autism hypothesis? (David Gorski) Against all reason, some anti-vaccine activists continue to believe that mercury (thimerosal) in vaccines caused autism. Now a new study further supports the already firm scientific consensus that there is no correlation between thimerosal exposure and the diagnosis of autism-spectrum disorders.
Brain Balance (Harriet Hall) The “Brain Balance” program promises to treat ADHD, dyslexia, autism, Asperger’s, Tourette’s, and other related disorders. Their website says their program is “clinically proven,” yet they provide only testimonials and one published study that was not even a controlled study, that turns out not to support their claims, and that was done at the Carrick Institute, an organization headed by a “chiropractic neurologist” whose understanding of science is suspect.
Aspartame – Truth vs Fiction (Steven Novella) Claims that the artificial sweetener aspartame causes MS, cancer and other problems are false rumors; the idea that there is a conspiracy tocover up that knowledge is urban legend. Scientific research supports the safety of aspartame.
Evidence-Based Medicine, Human Studies Ethics, and the ‘Gonzalez Regimen’: a Disappointing Editorial in the Journal of Clinical Oncology Part 1 (Kimball Atwood) Evidence-based medicine is poorly equipped to evaluate implausible claims because it ignores prior probability. A trial of the Gonzalez protocol for pancreatic cancer clearly showed it was inferior to standard chemotherapy, but the study was unethical and should not have been published. An editorial in the JCO shows an inadequate understanding of the issues.
Using attacks on science by the anti-vaccine movement as a “teachable moment” (David Gorski) The anti-vaccine movement’s criticism of the recent thimerosal/autism study showed a misunderstanding of basic clinical trial design that provides a teachable moment to educate SBM readers about epidemiological studies. The study in question was a well-designed case-control study showing that there was no difference in thimerosal exposure between cases of autism and controls. The anti-vaccine criticisms of it are not valid.
Evidence-Based Medicine, Human Studies Ethics, and the ‘Gonzalez Regimen’: a Disappointing Editorial in the Journal of Clinical Oncology Part 2 (Kimball Atwood) Dr. Atwood continues his critique of the editorial about the Gonzalez Regimen study, showing that the study was unethical and failed to meet the standards required for human trials, and that the editorial relied on a flawed concept of evidence-based medicine that failed to consider prior probability.
Clinical equipoise versus scientific rigor in cancer clinical trials (David Gorski) Clinical equipoise demands that a scientific trial be conducted only when there is genuine uncertainty about which treatment is more effective and safer. It is easily stated in principle but not so easy to apply in practice. In trials of treatments for life-threatening diseases like melanoma, there is a tension between getting “clean” data and doing the best for each individual patient.
PTSD Breakthrough? It’s Not Science Just Because Someone Says So (Harriet Hall) A book about PTSD treatment by Frank Lawlis claims to be science-based. It isn’t: it’s merely an indiscriminate catalog of things that Dr. Lawlis thinks might possibly help patients, from colon cleansing to going on a vision quest. He offers false hopes and useless treatments that may harm patients by delaying effective treatments.
How not to consult your biostatistician before doing an experiment (David Gorski) A link to a humorous cartoon video lampooning an uninformed approach to statistics.
CFLs, Dirty Electricity and Bad Science (Steven Novella) Compact fluorescent lightbulbs have environmental advantages but have been the target of fearmongering about “dirty electricity,” headaches, mercury toxicity, symptoms attributed to electromagnetic sensitivity and something called “type 3 diabetes.” These irrational fears are not supported by any scientific data; EMF does not pose any credible health risk.
Christiane Northrup: more bad medicine (Peter Lipson) Dr. Northrup rejects the science of immunology and thinks vaccination is merely a culturally agreed-upon ritual designed to shore up your first chakra. She doesn’t know a virus from a bacterium. She represents a danger to public health.
Short Attention Span SBM (Mark Crislip) Brief reports: flu really does kill people, flu vaccination may reduce the risk of heart attacks, vitamin D may have a modest effect on preventing colds and it may improve the response to the flu vaccine, and acupuncture is all placebo effect.
The mammography wars heat up again (David Gorski) New evidence further muddies the picture regarding the benefits of screening mammography. We are learning that it is probably not as effective as advertised in preventing deaths from breast cancer, especially in the 40-50 age group, where decisions to screen should be individualized, with full disclosure of the risks andbenefits.
Eric Pearl “Reconnects” with Hands-Off Healing (Harriet Hall) Chiropractor Eric Pearl practices “reconnective healing,” a variety of therapeutic touch where he does not touch the patient. His fanciful claims include miraculous healings of everything from cancer to cerebral palsy; he and his patients allegedly see an angel in the form of a multicolored parrot named George. He offers no evidence, just stories that are best interpreted as self-delusion.
When (Anti-Vax) Politics Intrudes (Steven Novella) A wealthy Florida chiropractor who is a friend and contributor to governor Charlie Crist has been using his political connections to push for anti-vaccine legislation that goes against science. Now he is trying to force an illegal release of confidential vaccine records to the infamous Geiers, who have a history of misinterpreting data and offering dangerous and unethical autism treatments. Political pressure should not be allowed to subvert the scientific process.
Chelation: Compounding Pharmacy’s Problems (Scott Gavura) A network of pharmacies continues to facilitate the provision of compounded chelation therapies in the absence of any persuasive evidence to support their use. Chelation treatment is usually based on notoriously unreliable provoked urine tests that falsely detect “toxins,” and it amounts to a form of sympathetic magic.
Chiropractic Vertebral Subluxations: Science vs. Pseudoscience (Sam Homola) An orthopedic subluxation is real, a chiropractic subluxation is imaginary; and the chiropractors’ “vertebral subluxation complex” is a rationalization with no valid clinical application. Spinal manipulation has its uses, but has been stigmatized by subluxation theory. It is difficult to find a chiropractor who rejects the subluxation theory and offers manipulation appropriately.
The Guatemala syphilis experiment and medical ethics in science-based medicine (David Gorski) An experiment in Guatemala 60 years ago has recently come to light and is being used by CAM advocates to condemn science. It was one of the worst atrocities ever committed in the name of medical research: prostitutes and prisoners were deliberately infected with syphilis in order to study the effects of antibiotic treatment. A violation like this is a rare exception that does not condemn the entire scientific enterprise nor does it excuse ethical lapses in research on alternative medicine. There can only be one ethical standard for research on human subjects.
I’m not worthy! I’m not worthy! (For the Lorne Trottier Public Science Symposium) (David Gorski) Dr. Gorski will be speaking at a symposium entitled “Confronting Pseudoscience: A Call to Action” at Mc Gill University in Montreal on October 18. Other participants are Ben Goldacre, Michael Shermer, and James “The Amazing” Randi.
The Mayo Clinic on Home Remedies (Harriet Hall) While the Mayo Clinic’s opinions on alternative medicine are sometimes questionable, their new book on home remedies is unobjectionable. It offers practical advice for home treatment based on good science and where the evidence is lacking, it says so.
Skepticamp: Invading the Great White North on October 23 (Scott Gavura) Four Skepticamps are scheduled to take place across Canada on October 23. These are collaborative, interactive, and free conferences on science and critical thinking. The planned events will cover various topics in alternative and science-based medicine.
Some Flu Vaccine Updates (Steven Novella) The 2010/11 seasonal flu vaccine is now available, incorporating the H1N1 strain that was given as a separate vaccine last year. Two recent studies have confirmed that flu vaccines improve outcomes. While there have also been reports of risks, the benefits clearly outweigh the risks.
Do you have low T? (Peter Lipson) Testosterone replacement is being widely touted as a remedy for a variety of symptoms experienced by men as they age. The evidence is problematic, and the ads approach the point of deception.
Pat Schroeder’s endorsement of Rage Reduction Therapy: The Cult of Celebrity Strikes Again (Linda Rosa) Former Congresswoman Pat Schroeder wrote the foreword to a book about Rage Reduction, a dangerous treatment that constitutes child abuse. Such a celebrity endorsement can be a powerful influence. When confronted with the facts about this treatment, she denied that her words constituted an endorsement and she refused to withdraw her support.
Reflexology. Insert Nancy Sinatra Reference Here. (Mark Crislip) Many claims have been made for reflexology, based on the fanciful idea that pressing spots on the sole of the foot can improve the health of distant organs; but studies have not even shown that it can help with foot problems. It has no anatomic or physiologic justification. Any effects are due to human contact, the equivalent of primate grooming.