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Last Several Weeks In Science Based Medicine PDF Print E-mail
Swift
Written by Harriet Hall   

Here is a recap of the stories that appeared last week at Science-Based Medicine, a multi-author skeptical blog that separates the science from the woo-woo in medicine. 

 

Medical marijuana as the new herbalism, part 1: Science versus the politics of weed in New York and beyond (David Gorski)
Marijuana is alleged to have many medical benefits, but the hype goes way beyond the evidence. Dr. Gorski reviews the evidence for its effectiveness in pain and several other medical conditions and explains why he supports legalization but not for medical reasons. Parts 2 and 3 will cover autism and cancer. 

An Egregious Example of Ordering Unnecessary Tests (Harriet Hall)
A healthy 21-year-old man asked for a routine physical and got $3700 worth of lab tests he didn’t need. His insurance paid only $13.09. Gasters are flabbered.

Consortium of Academic Health Centers for Integrative Medicine research conference disappoints even NCCAM (Jann Bellamy)
The director of research for the NCCAM expressed her disappointment at the quality of research reported at this conference. Many clinical research projects were not developed from adequate mechanistic studies, and their outcomes were not very informative. Examples demonstrate rebranding, tooth fairy science, and other problems.

The Truth? (Mark Crislip)
Autonomy is a basic principle of medical ethics, but patients can only make autonomous decisions if they are given accurate, truthful information. Even integrative medicine clinics at major institutions provide biased information about alternative medicine that is not just misleading but ethically questionable. Examples are discussed.

One Million Page Views (Paul Ingraham)
Science-Based Medicine’s traffic has passed a milestone and is now competing effectively with many popular websites about not-so-science-based medicine. 

 Did Facebook and PNAS violate human research protections in an unethical experiment? (David Gorski)
Facebook feeds were manipulated without informing customers that they were subjects in an experiment. This was unethical, and it wasn’t even particularly good research.  The Proceedings of the National Academy of Sciences (PNAS) failed to enforce its own requirements for publishing studies.

Stanislaw Burzynski’s propaganda victory on antineoplastons: The FDA really caves (David Gorski)
The FDA has lifted the restrictions they had placed on clinical trials run by the infamous Dr. Burzynski. They ignored 37 years of his abuse of the clinical trial process and his ethical violations. The FDA decision is an extreme dereliction of its duty to the public.

Why Doctors Order Too Many Tests (Harriet Hall)
Doctors who order unnecessary tests try to justify their actions with excuses that don’t hold up. Too many tests can harm patients in several ways. Patients should insist on understanding why a test is being ordered and what difference the results will make.
 

Beware The P-Value (Steven Novella)
The p-value is commonly misunderstood. It is not a measure of whether the phenomenon being studied is likely to be real; it only measures the probability that the data would demonstrate as much or more of a difference if the treatment had no actual effect. For unlikely phenomena, a significant p-value is even more likely to be misleading; a Bayesian analysis can be helpful in putting alternative medicine research into the context of basic scientific knowledge. 

The Center for Inquiry weighs in on the FDA’s mishandling of Stanislaw Burzynski’s clinical trials (David Gorski)
The Center for Inquiry has sent a hard-hitting letter to legislators protesting the FDA’s action in lifting the clinical hold on Burzynski’s research. They characterize the FDA’s action as “enabling his deceptive, antiscientific, and unethical medical adventurism and profiteering.”

Multiple Chemical Sensitivity: Separating facts from fiction (Scott Gavura)
Multiple chemical sensitivity (MCS) is a debilitating but subjective condition attributed to a variety of environmental agents. There is no real evidence that such a condition exists; it is not defined by any objective evidence or laboratory findings. There is no justification for treating these patients with “detoxification” or any other of the therapies being used.

The Buzzy: Revolutionary Acute Pain Management or Simple Distraction… (Clay Jones)
Buzzy is a cute device that looks like a bee and is used to apply cold and vibration to  children’s skin to relieve the pain of blood draws and injections. The proposed mechanism and research are unconvincing, but the device may serve as an effective means of distraction.

 Ketogenic diet does not “beat chemo for almost all cancers” (David Gorski)
Dr. Thomas Seyfried’s claim that low carb, high-fat ketogenic diets “can replace chemo for even the deadliest cancers” has been making the rounds on the Internet. The hypothesis is simplistic and based on misunderstandings of cancer biology; the idea is to starve cancers by decreasing the availability of glucose. It might be helpful for some tumors, but the evidence so far is thin and unconvincing, consisting only of preclinical studies and case reports.      

John Oliver skewers Dr. Oz for his hawking of diet supplements (David Gorski)
The HBO show “Last Week Tonight with John Oliver” featured a long segment on Dr. Oz and his recent grilling by a congressional committee over his hyping of diet supplements as “miracle” weight loss solutions. It is both entertaining and informative, covering the regulation of dietary supplements and identifying Senators Hatch and Harkin as tools of the supplement industry.

Acupuncture for Macular Degeneration: Why I Reject the Evidence (Harriet Hall)
The Santa Fe protocol is a poorly defined mixture of techniques from 3 different schools of acupuncture (including ear acupuncture and electrical stimulation) that supposedly improves vision in patients with macular degeneration. The only evidence is a case series from one doctor; he used no controls and no blinding.  These and a number of other design flaws make it impossible to accept his study as evidence. 

Food Fears (Steven Novella)
A new study examines the origin of irrational food fears, and possible remedies. People are getting information from dubious sources that promote an ideological, unscientific approach to food safety and misapply the precautionary principle. The science is complex and people tend to fall for the “natural” fallacy and to have “chemophobia,” so they use shortcuts or heuristics to decide which foods to trust.

NY federal court hands triple loss to anti-vaccination ideology (Jann Bellamy)
In two recent cases, a New York court upheld the right of schools to temporarily exclude unvaccinated children from school during outbreaks of vaccine-preventable diseases. It also upheld the denial of a religious exemption from vaccination, saying the students’ and parents’ constitutional rights had not been violated. Parental objections to vaccines are largely fueled by misinformation from anti-vaccine activists. The law is well-settled: states are not constitutionally required to grant non-medical exemptions at all. 

TCM Hodgepodge (Mark Crislip)
Some recent curiosities of TCM. Fire therapy is said to cure impotence: an alcohol-soaked towel is spread over the genitals and burned. The failure rate on acupuncture board exams is high; and the exams are laughable and fail to address sanitation, anatomy underlying the acupoints, or complications. The Cochrane group keeps suggesting more studies even when it finds no supporting evidence for acupuncture. A recent report analyzed 30 patients who contracted TB from acupuncture.

Vani Hari (a.k.a. The Food Babe): The Jenny McCarthy of food (David Gorski)
The Food Babe is the popular blogger who persuaded Subway to stop using a harmless ingredient in its bread because the same chemical is used in yoga mats. Now she is campaigning against allegedly toxic chemicals and GMO ingredients in beer. She is laughably ignorant about chemistry, and instead of going by scientific evidence she goes by whether she can pronounce the name of a chemical.

Turmeric: Tasty in Curry, Questionable as Medicine (Harriet Hall)
Turmeric is claimed to have medicinal properties and to be as effective as 14 major drugs commonly used for serious medical conditions like diabetes, depression, etc. The hype far exceeds the evidence. Claims are based on preliminary findings from animal and in vitro studies but there are only a handful of preliminary pilot studies in humans, and their results are not impressive.

Surgery Under Hypnosis (Steven Novella)
The BBC recently reported another sensational case of surgery under hypnosis, this time a parathyroid operation in a Guinean singer who allegedly sang throughout surgery to protect her voice. The truth is less sensational: along with hypnosis she had local anesthesia which is sufficient to block all pain sensations by itself.  And it is not plausible that damage to the recurrent laryngeal nerve could be avoided by singing.

Dr. Oz and the Terrible, Horrible, No Good, Very Bad Day (Scott Gavura)
Dr. Oz  was recently grilled in a Senate hearing for promoting “miracle”
 weight loss products on his TV show. Senator McCaskill took him to task for saying things he knows are not true, and pointed out that the scientific community is almost monolithic against him.  In his defense, Oz followed his usual M.O.: extrapolating from weak, cherry-picked evidence to make grandiose claims. He did not come off well.

Is There a Role for the Art of Medicine in Science-Based Practice? (Clay Jones)
Medicine is an applied science. The “art” of medicine is often defined as compassion, communication, treating patients as individuals, etc. The “art” of making a diagnosis is really just pattern recognition. The idea that medicine is an art is often taken too far and used as an excuse for all manner of bogus approaches to health care.