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.


Se Habla “woo-woo”

Posted in Denialism by Skepdude on November 21, 2008


So, America is changing. We have an African American president. The Latino population continues to grow. How can the alternative medicine community adjust to this demographic shift? What are they to do?

I’m glad you asked! It turns out that immigrants are palomas ripe for the plucking. Now, we’ve talked about the ethics of alternative medicine, and how “meaning well” is not exculpatory. If you promote quackery, it’s wrong, even if you believe your own drivel.

One of the worst types of drivel is naturopathy. This “specialty” advertises itself as “medicine-plus”, but really it’s “healing-minus”: minus the evidence, minus the training, minus intelligent thought.

It should be no surprise that recent immigrants, who may have low educational levels, especially in English, and have less access to the health care system financially, culturally, and linguistically should be ripe targets.

And targeting these vulnerable individuals is a naturopathic “doctor” in Connecticut.

This doc sounds like she really cares. But that doesn’t mitigate the fact that she is diverting people from real medical care. For example, Latinos have a much higher rate of diabetes than Anglos (6.6% of non-Hispanic whites have diabetes, 10.4% of Hispanics have diabetes). Naturopaths don’t have much to offer these folks. Let me explain.

We’ve talked before about the complications of diabetes, and how they are divided into macro- and micro-vascular. We’ve also talked about how we prevent these complications. Certain medications prevent blindness, strokes, and heart attacks in diabetics. These effects are separate from diet and exercise. As part of taking care of diabetics, I must educate them about their disease and track several different parameters, such as weight, blood pressure, kidney function, urine protein, foot exams, eye exams, cholesterol, etc. What does our naturopath have to offer? Is it all of that “plus”? Her website gives all sorts of generalities about prevention, lifestyle change, and helping the body heal itself, but there is no evidence that she knows anything about the science of disease and health.

First, like all fake doctors, this place has lots of testimonials in place of real evidence. I don’t list testimonials at my office. It’s tacky, and it doesn’t give a measure of success in keeping people healthy. All it measures is how much someone liked a doctor as a person.

And what are these folks testifying about? Probably how nice the doctor is. They certainly aren’t giving us a measure of how well she prevents and treats disease. How do I know?

Here’s what she says about herself:

She has worked with children and teenagers with various conditions such as ADHD, and food allergies. Likewise she treats women’s related issues including menopause, PMS, breast cancer and hormone related issues. Dr. Robinson is very knowledgeable in diet and exercise related issues including weight gain/loss, detox-cleansing diets, and obsessive compulsive disorders. She also does guided imagery, coupled with counseling techniques. Her philosophy is to meet the patient where they are and work with them based on their needs. She acts as a coach-motivater-cheerleader and most importantly educator. She has a vested interest in seeing her patients achieve and sustain better health. Dr. Robinson will combine whatever conventional regime currently in place with Naturopathic medicines for a safe, effective way to maximum health.

I’m a general internist. I claim an expertise in the prevention, evaluation, and management of adult diseases. That’s it. I’m not a pediatrician, a psychiatrist, gynecologist, or surgeon.

What qualifies this “doctor” to treat adults and children, and a variety of conditions such as ADHD, food allergies, breast cancer, guided imagery, and OCD? And the fact that she admits to being “very knowledgeable” about “detox-cleansing diets” is not a mark in her favor. How does a detox diet prevent stroke? Will guided imagery prevent kidney failure?

She is apparently popular in the Hispanic community where she practices. Of course, science isn’t a democratic process, and since her popularity cannot be due to her ability to implement science-based medicine, it must be based on something else.

According to a news article:

Robinson, one of many doctors in the small but growing field of naturopathic medicine, has helped build her private practice in Stamford by offering her services to the Hispanic community at affordable rates.Early in her practice, Robinson discovered Hispanic patients were drawn to the type of natural medicine she offered. Now most of her business comes from Hispanics, she said.


She went through the routines of a primary doctor – taking blood pressure, listening to Shutte’s heartbeat, taking his weight. But instead of writing a prescription for blood pressure medication, which S. once took and disliked because of side effects, Robinson recommended he supplement his diet with fish peptides, flax, pumpkin seeds and cucumber.


I’m sure the patient felt cared-for, but hypertension is a killer, and Hispanics have high rates of strokes and other complications of hypertension than non-Hispanic whites. Additionally, Hispanics are statistically more likely to have poorly-controlled blood pressure.

Look, I’m willing to accept that this naturopath may mean well, and I certainly believe that her patients like her. But she is doing a double-disservice. Not only is she practicing incorrect medicine, but she has singled out a particularly vulnerable group and preyed on them. The fact that she means well or that they like her is less important that the fact that this represents a type of altmed racism. It takes trusting, at-risk folks, abuses their trust, takes their money, and diverts them from care they desperately need.

This is shameful.


Why good medicine requires materialism

Posted in Denialism by Skepdude on October 30, 2008


I don’t like to repost, but Steve Novella has some great pieces up right now, and this is directly related. –PalMD

s I’ve clearly demonstrated in earlier posts, I’m no philosopher. But I am a doctor, and, I believe, a good one at that, and I find some of this talk about “non-materialist” perspectives in science to be frankly disturbing, and not a little dangerous.

To catch you up on things, consider reading one of Steve Novella’s best posts ever over at Neurologica. While you are there, you can also follow his debate with neurosurgeon Michael Egnor, the latest guru of mind-body dualism.

To sum up (remember, IANAP), most of us science-y types hold to a materialist view of reality, that is, reality is all there is. This reality is susceptible to the investigations of science. Non-materialists and mind-body dualists hold that there is also a “non-material” reality. What exactly this might be, and how one might observe or measure it is never specified. Instead, they usually use a god-of-the-gaps argument, whereby any gaps in scientific understanding are automatically ascribed to the supernatural. The proof of the supernatural is stated is a lack of disproof of the supernatural.

Personally, I have no problem with people believing in God, Satan, fairies, or the Flying Spaghetti Monster (may we all be touched by His Noodley Appendages). What I have a problem with is people applying these beliefs to science and medicine.

Non-scientific medical practices, such as homeopathy, faith-healing, and reiki state various claims of efficacy and of mechanism of action. They can never prove these, but ask us to take their word, and the word of their clients. Once again, if someone takes communion and feels closer to their God, it’s none of my business. But if someone is claiming to affect the health of an individual by invoking supernatural powers, this is immoral and harmful

The point is simple: if reiki manipulates unseen, unmeasurable forces by unseen and unmeasurable means, creating solely subjective individual results, then reiki (and practices like it) is completely irrelevant to health. What matters in medicine is results, and results that cannot be observed and measured do not, for all practical purposes, exist.

We can measure the effect of beta blockers on a population of heart attack survivors. We can compare the number of subsequent heart attacks in those who do and do not receive the drug. We can come up with a scientifically valid explanation for the results, and we can replicate them.

None of the cult medicine practices that are so popular can do this. Their effects are either unmeasurable by definition (show me a qi), or when we try to measure the results of their application, results in aggregate are no better than by chance alone.

In all this discussion about naturopathy over the last week or so, what has been left out is that it doesn’t matter if naturopaths consider what they do to be “medicine-plus”—the plus is irrelevant because it cannot be measured or observed reliably. Unless and until it can, forget the “plus”. It’s only a dream.


Jenny McCarthy on CNN: The stupid burns out the Intranets

Posted in Respectful Insolence by Skepdude on October 2, 2008

I guess that since my resistance failed, and I couldn’t resist posting yesterday about the burning stupid that is Jenny McCarthy and her arrogance of ignorance in claiming that vaccines caused her son’s autism and her campaigning to “Green Our Vaccines” (in reality, a smokescreen to hide her antivaccinationism), I thought why not go whole hog and get it out of my system? Let’s just take in a concentrated dose, as the more Jenny talks the more she discredits the antivaccine movement among anyone with a lick of scientific literacy:


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.


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.]


To kill and cure cancer, you must first understand it

Posted in Respectful Insolence by Skepdude on August 27, 2008

Yesterday, I was annoyed by a particularly vile article by quackery promoter supreme Mike Adams claiming that Christina Applegate didn’t need a bilateral mastectomy and could have “cured” herself of cancer with “natural” methods. Indeed, my contempt for Mike Adams knows no bounds, given that he is the purveyor of a seemingly never-ending stream of antiscience and quackery, much of it directed at cancer patients, who if they follow Adams’ “advice” could very well miss their best chance at treating their cancer and thereby wind up dead. Indeed, so great is the amount of quackery emanating from that website that I could easily devote this blog to nothing other than refuting it all and I’d still never be able to counter it. On the other hand, when Adams gets to a certain point and I get into a certain mood, I feel that it’s my duty to do what I can for a while and then move on, lest the concentrated stupidity of that site drive me to drink.

Oddly enough, this time around, I found an article with a title that I actually agree with, that title being To Kill and Cure Cancer, You Must First Understand It, although I’m sure that neither Adams nor the writer of this piece has any idea just how ironic the title is. This being, of course, the author Kal Sellers, a man who describes himself as a “Master Herbalist, a Massage Therapist, Technician of the Rolf Method of Structural Integration, Iridologist, Mind-Body Medicine Practitioner, Mental Re-programmer, Life Coach, Natural Nutritionist, Reflexologist” who is preparing to enter chiropractic school and runs a website called Kal’s School of Vitalistic Botanical and Holistic Medicine, demonstrates unequivocally that he does not have even a clue about cancer. Given the sheer concentration of woo Sellers is into, I was not in the least bit surprised.


How we know what we know

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


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.


Live forever!

Posted in Altie Meds, Denialism, Medicine by Skepdude on August 18, 2008


Look, whether you like it or not, you can’t live forever. I bring this up because there is always a new book or new add purporting to have “the answer” to long life and good health, which never includes modern, evidence-based medicine. Still, perhaps some of these books contains good advice. Or not. Let me explain.

First let me disabuse some of you of the thought that doctors don’t “do” nutrition and life-style advice. In fact, we do. And as attractive as the idea seems, life-style modification will never be the answer to all of (or even most of) our medical problems. Leaving aside the fact that many people cannot make permanent and beneficial changes in their life-styles, there are many other reasons. Human health and disease is complex. Most diseases are multifactorial. For example, type II diabetes is caused by a combination of genetic factors and diet. Some patients can remain off medication using diet and exercise. Some cannot, as even with a good body mass index, good diet, and good exercise habits, their blood sugars are still out of control. Another example is hypertension. Dietary sodium reduction has been shown to reduce blood pressure, but many patients will not have significant enough improvements in blood pressure through diet and exercise alone.

Another reasons that lifestyle changes aren’t the whole answer is that sometimes drugs provide benefit that diet and exercise cannot. For example, beta blockers reduce blood pressure, but they also prevent sudden and premature death in certain groups of patients (i.e. those with significant heart failure), independent of the effect on blood pressure.

Finally, many purely genetic diseases are not amenable to lifestyle modification. No amount of diet and exercise will fix cystic fibrosis or congential adrenal hyperplasia.

Living healthy is important, but there is no miracle to maintaining health and treating disease. No one book is going to help you live forever. Lifestyle modification is not the answer to every medical question, no matter how much we all wish it were.


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