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!

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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

Beth Israel joins the Academic Woo Aggregator!

Posted in Respectful Insolence by Skepdude on October 31, 2008

I feel bad.

I realize that I’ve been completely neglecting my Academic Woo Aggregator. You remember my Academic Woo Aggregator, don’t you? It was my attempt to compile a near-definitive list of academic medical centers that had “integrated” woo into their divisions or departments of “integrative medicine” (i.e., departments of academic-sounding quackery). Perusing it, I now realize that it’s been over five months since I did a significant update to it. You just know that, given the rate of infiltration of unscientific medical practices into medical academia as seemingly respectable treatment modalities that there must be at least several new additions to this role of shame. Alas, even today, having been shamed myself by the realization of my failure to keep the list updated, I’m not going to do the full update and revamping that the Woo Aggregator cries out for. However, that doesn’t mean I can’t do a piecemeal addition here and there. That doesn’t mean I can’t point out new additions to the Woo Aggregator as they pop up, even if it takes me a while to find the time to give it the facelift it needs.

It doesn’t mean I can’t call out hospitals like Beth Israel when they fall into woo, especially when they do it in a big way for cancer patients.

The first thing to know about this degeneration of a once great academic powerhouse is that, as is the case for many centers of “complementary and alternative medicine” (CAM) or of “integrative medicine” (IM), when looking for the reason why physicians ostensibly dedicated to scientific medicine would embrace this woo, look for the financial reason. In this case, the financial incentive comes from Donna Karan, founder of the famous DKNY line of clothing. In search of her dollars, Beth Israel has turned over an entire cancer treatment floor to woo:

Medical advances sometimes happen in strange ways. Someone finds a fungus in dirty lab dishes and — eureka! — penicillin is born. Now a premier Manhattan hospital is turning a cancer-treatment floor over to a world-famous fashion designer in the hope that serendipity, science and intuition will strike again.A foundation run by Donna Karan, creator of the “seven easy pieces” philosophy of women’s wardrobes and founder of the much-imitated DKNY line of clothing, has donated $850,000 for a yearlong experiment combining Eastern and Western healing methods at Beth Israel Medical Center. Instead of just letting a celebrated donor adopt a hospital wing, renovate it and have her name embossed on a plaque, the Karan-Beth Israel project will have a celebrated donor turn a hospital into a testing ground for a trendy, medically controversial notion: that yoga, meditation and aromatherapy can enhance regimens of chemotherapy and radiation.

Whatever happened to the days when a wealthy donor would be happy just to have her name on a building or on a floor? I guess they never truly existed. However, it’s truly depressing to see a former academic powerhouse accommodate such wishes just because they’re trendy, because a wealthy donor is willing to fund them, and because, no doubt, hospital administrators perceive it as good publicity and a draw for credulous patients. I wish I could view this as merely a cynical ploy to add a spoon full of woo to make the real scientific medicine go down easier, but somehow I don’t think that’s the case. I also really, really hate it when I see the same old false dichotomy of “Eastern” versus “Western” medicine. There is no such thing as “Eastern” or “Western” medicine. As blog bud PalMD put it:

I’ll stipulate that by “Eastern and Western healing methods” they mean credulous Americans’ impression of what is done in “the East” vs. science-based medicine as it is practiced around the world (the Eastern and Western bits).

READ THE REST OF THIS ENTRY AT “RESPECTFUL INSOLENCE”

Why good medicine requires materialism

Posted in Denialism by Skepdude on October 30, 2008

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

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.

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

Puncturing the Acupuncture Myth

Posted in Science Based Medicine by Skepdude on October 21, 2008

“Alternative” medicine is by definition medicine that has not been scientifically proven and has not been accepted into mainstream scientific medicine. The question I keep hearing is, “But what about acupuncture? It’s been proven to work, it’s supported by lots of good research, more and more doctors are using it, and insurance companies even pay for it.”

It’s time the acupuncture myth was punctured – preferably with an acupuncture needle. Almost everything you’ve heard about acupuncture is wrong.

To start with, this ancient Chinese treatment is not so ancient and may not even be Chinese! From studying the earliest documents, Chinese scholar Paul Unschuld suspects the idea may have originated with the Greek Hippocrates of Cos and later spread to China. There’s certainly no evidence that it’s 3000 years old. The earliest Chinese medical texts, from the 3rd century BC, don’t mention it. The earliest reference to “needling” is from 90 BC, but it refers to bloodletting and lancing abscesses with large needles or lancets. There is nothing in those documents to suggest anything like today’s acupuncture. We have the archaeological evidence of needles from that era – they are large; the technology for manufacturing thin steel needles appropriate for acupuncture didn’t exist until 400 years ago.

READ THE REST OF THIS ENTRY AT “SCIENCE BASED MEDICINE”

Hypnosis and hot flashes: When will they ever learn?

Posted in Respectful Insolence by Skepdude on October 8, 2008

For women undergoing menopause, hot flashes are a real problem. In my specialty, as I’ve pointed out before, women undergoing treatment for breast cancer are often forced into premature menopause by the treatments to which we subject them. It can be chemotherapy, although far more often it’s the estrogen-blocking drugs that we use to treat breast cancers that have the estrogen receptor. Estrogen stimulates such tumors to grow, and blocking estrogen is a very effective treatment for them, be it with tamoxifen or the newer aromatase inhibors like Arimidex. The utterly predictable consequence, unfortunately, is an artificially-induced menopause.

I’ve written at least twice before about this topic in the context of various poorly designed studies of acupuncture for breast cancer-induced hot flashes. There’s a reason for this. Despite studies demonstrating that hormone replacement therapy doesn’t decrease cardiovascular disease in postmenopausal women and increased the risk of breast cancer, for severe menopausal symptoms in women without breast cancer, estrogen remains the gold standard, and it’s reasonably safe to use for short periods of time. Consequently, for menopause having nothing to do with breast cancer, estrogen can be used, at least for the short term, if nonhormonal therapies don’t work. Not so in the case of women rendered menopausal by breast cancer therapy. Indeed, it defeats the purpose of antiestrogen drugs to replace the estrogen they are blocking. Not only that, but even after breast cancer therapy when a woman undergos menopause naturally, estrogen replacement increases their risk of a recurrence. Consequently, if nonhormonal methods supported by science don’t work, then there’s nothing else, and, unfortunately, most science-based nonhormonal therapies such as antidepressants do not work very well and have significant side effects.

That’s where the temptation to turn to woo comes in.

READ THE REST OF THIS ENTRY AT “RESPECTFUL INSOLENCE”

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.