Skepfeeds-The Best Skeptical blogs of the day

University comes back to its senses

Posted in Skepdude by Skepdude on January 22, 2009

At least one of them did. University of Salford (UK I believe) has decided to stop giving alternative medicine courses in accupuncture and complementary medicine because they are  “no longer considered “a sound academic fit“.” It should never have been considered a sound fit in the first place, but what can you do. Better late then never!

New study dispels common medical myths

Posted in News by Skepdude on January 21, 2009

“It is that we are susceptible to believing unproven concepts if they are repeated often enough by ‘experts’ (real or self-perceived/self-proclaimed),” Mosqueda said.

So, believe it or don’t, but:

Drink eight glasses of water each day: The authors found references as early as 1945 suggesting that healthy people should stay hydrated by drinking eight glasses of water each day. But they say there’s a complete lack of evidence supporting that recommendation. Studies also show that most people get enough fluids through daily consumption of juice, milk and even caffeinated drinks.

People only use 10 percent of their brains: This myth has been around for more than a century. Some believe it came from Albert Einstein, although the authors found no evidence of that. What they did find were studies that show people use much more than 10 percent of their brains. For example, when almost any area of the brain is damaged, it has “specific and lasting effects on mental, vegetative and behavioral capabilities.” Also, imaging studies have found no area of the brain is completely inactive.

READ THE REST OF THIS ARTICLE AT THE TAMPABAY.COM

How they do the voodoo that they do so well – Part 2

Posted in Photon in the Darkness by Skepdude on September 22, 2008

End Games:

Eventually, even the most successful, charismatic “alternative” practitioner will have a patient who doesn’t improve enough to satisfy the parents. Not only are these parents a real drag on the “alternative” practitioner’s ego, there is the very real chance that they might start to talk about how “the Emperor has no clothes”. For those situations, there are a number of strategies that are typically used.

Did you follow my instructions to the letter?:

One of the oldest dodges in the “alternative” medicine “biz” is to prescribe a regimen of treatment that is too complicated for most patients to follow. If they get better (by chance), then it was due to the “treatment” – if they don’t get better….well, they didn’t follow all of the instructions exactly, did they?

Much the same is happening in “alternative” autism therapy. One of the first chelation regimens promoted for treating autism required that the parents give their children a dose every four hours around the clock for two weeks. This meant waking the child up in the middle of the night – every night – for two weeks and getting them to drink a foul-smelling liquid.

The parents were cautioned that missing a single dose – or being late by more than two hours – meant risking having more mercury deposited in the brain. This – needless to say – was absolute nonsense. But no parent who failed to see the promised results could honestly say that they had given every dose on time.

READ THE REST OF THIS ENTRY AT “A PHOTON IN THE DARKNESS”

How they do the voodoo that they do so well – Part 1

Posted in Photon in the Darkness by Skepdude on September 22, 2008

You’ve probably heard the story. A child is diagnosed with autism and the desperate (yes, I said “desperate”) parents search for answers. The “mainstream” doctors tell them that there is little that they can do (note: ”mainstream” doctors almost never say, “There’s nothing that can be done.”). Not satisfied with that answer (and what parent would be satisfied?), the parents try “alternative” practitioners.

And sure enough, the “alternative” practitioner has just the answers the parents are looking for. He or she can help them “recover” their child.

Or can they?

Over the years, I’ve shown how many of the “therapies” that claim to “cure” or “recover” autistic children haven’t been shown to work. But how do the practitioners keep the parents “on the hook”, even when the treatments aren’t working? That’s the topic of today’s lecture.

Before I get started, I need to make one thing perfectly clear. Despite being a hard-bitten cynic, I am convinced that most of the “alternative” practitioners truly believe that what they are doing is helping their patients. There are, of course, a minority that are consciously trying to deceive their patients (or their parents), but I believe that the majority are convinced that their treatments actually work.

Once again, being honest is no protection against being wrong.

So, with that disclaimer, what are some of the techniques that the “alternative” practitioners use to keep parents satisfied even when the treatments don’t work?

[Note: the same techniques are used by most “alternative” practitioners, but I will approach them from the perspective of the parents of an autistic child.]

READ THE REST OF THIS ENTRY AT “A PHOTON IN THE DARKNESS”

How we know what we know

Posted in Denialism, Medicine by Skepdude on August 19, 2008

CLICK HERE TO GO TO THE ORIGINAL ENTRY AT THE “DENIALISM” BLOG.

Over the last few decades, the nature of medical knowledge has changed significantly. Before the revolution in evidence-based medicine, clinical medicine was practiced as more of an art (in the “artisan” sense). Individuals were treated empirically with a strong knowledge of medical biology, and the guidance of “The Giants”, or particularly skilled and respected practitioners. While the opinions of skilled practitioners is still valued, EBM adds a new value—one of “show me the evidence”.

Evidence-based medicine refers to the entire practice of gathering and applying medical knowledge. This includes evaluating diagnostic tests (e.g. how well does an CT scan diagnose pulmonary embolism?) and evaluating treatments (e.g. which anticoagulant is most effective, which one is safer, how long should you treat, etc.) There will always be some questions that are untestable, and some for which no testing is needed, and practices for which evidence is sketchy.

In corresponding with a friend recently, I started thinking about how we look at the quality of medical evidence, and how we can communicate this to the lay public.

Let’s take, for example, cholesterol.

It has been found over the years that there is a strong association between elevated cholesterol and coronary artery disease. Through many studies, it was found that LDL cholesterol is a useful marker of cardiac risk due to elevated cholesterol. Finally, it was found that lowering LDL cholesterol, especially with statin drugs, dramatically reduces heart disease risk and mortality.

That’s the facts. But what are they based on? How strong is the evidence?

Evidence-based medicine has many ways of grading quality of evidence. The primary reference for cholesterol treatment in the U.S. is the National Cholesterol Education Program’s Adult Treatment Panel III (NCEP and ATP III).

Before the report gets to any recommendations, it presents a table explaining how evidence used in the report is graded. First is the type of evidence (from randomized controlled trials down to clinical experience) then is the quality (from “very strong evidence” to “strong trend”).

For example, the ATP gives the following recommendation (among many):

Evidence statements: Secondary prevention trials demonstrate that reduction of LDL-cholesterol levels significantly reduces risk for recurrent major coronary events in persons with established CHD (A1).

That “A1” at the end gives an idea what kind of evidence we’re working with. In this case the statement is based on RCTs and there very strong evidence to support it.

Evidence-based medicine is about evidence. Sometimes that evidence is quite good, sometimes it isn’t: the quality of evidence is something we take into consideration when treating patients.

This is in stark contrast to so-called alternative medicine. Alternative medicine never discusses quality of evidence. The quality is usually, however, quite poor, relying on patient and physician anecdotes, uncontrolled “trials”, and fantasy.

Making use of EBM doesn’t have to be difficult. You don’t have to be able to interpret every chi-squared analysis, you don’t have to calculate every number needed to treat. You just have to be able to read the basic literature in your field, look up recommendations, and know how strong they are.

Anyone practitioner who ignores evidence-based medicine is not practicing the best of modern medicine. Anyone who treats disease without understanding the difference between evidence-based practice and non-evidence-based practice should hand you a Quack Miranda Warning when you walk in the door.

CLICK HERE TO GO TO THE ORIGINAL ENTRY AT THE “DENIALISM” BLOG.