74 posts · 34,085 views

The miscellaneous ramblings of a surgeon/scientist on medicine, quackery, science, pseudoscience, history, and pseudohistory (and anything else that interests him).

Orac
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August 19, 2010
09:00 AM
52 views

Another pointless "acupuncture" study misinterpreted

by Orac in Respectful Insolence

At the risk of once again irritating long time readers who've hear me say this before, I can't resist pointing out that, of all the various forms of "alternative medicine" other than herbal medicines (many of which are drugs, just adulterated, impure drugs), acupuncture was the one treatment that, or so I thought, might actually have a real therapeutic effect. Don't get me wrong; I never bought magical mystical mumbo-jumbo about "meridians" and "unblocking the flow of qi" (that magical mystical life energy that can't be detected by scientists but that practitioners of woo claim to be able to manipulate for therapeutic intent). The point is (sorry, couldn't resist) that acupuncture actually involves doing something physicial to the body, namely inserting thin needles into it. Shorn of its trappings of prescientific Eastern mysticism, acupuncture struck me as something that might have something to it.

Five years ago.

Since I started actually studying acupuncture and acupuncture studies, I've become acutely aware that my previous assessment was incorrect, and my pointing that out from time to time sometimes results in comments along the lines of, "We don't need to hear this again." Tough. For the benefit of new readers and readers who might not have read some of my previous posts on acupuncture before, I consider it important to reinforce that I have, in fact, undergone a bit of a change of heart. I have reviewed studies that showed that sham acupuncture works as well or even better than "true" acupuncture, with the needles placed right where those fancy acupuncture charts say they should be placed and that you don't even need needles. Toothpicks with their points twirled against the skin will do. I've also come to realize that many of the explanations postulated by acupuncturists and doctors who believe in acupuncture are actually far less interesting than actual scientific results that they produce in their search for "proof" that "acupuncture works." Sometimes, acupuncturists substitute active sorts of treatment for acupuncture and call it something else, like "electroacupuncture, which involves hooking up a weak electrical current to acupuncture needles. Electroacupuncture is in essence nothing more than transcutaneous electrical nerve stimulation (TENS), an accepted modality to treat pain.

Add to the evidence pile yet another study demonstrating that acupuncture is placebo medicine, reported in Arthritis Care & Research by a team of investigators based primarily at the M.D. Anderson Cancer Center that I heard about via the TIME Magazine Wellness Blog. The study, entitled A Randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication, demonstrates about as unequivocally as one can imagine that one form of so-called "acupuncture" is, as far as can be detected, virtually all placebo. What is surprising about this study is not so much that it shows that acupuncture doesn't work. In fact, it doesn't actually show that, because what is being used is not acupuncture. What is being used is "electroacupuncture, which is in essence nothing more than TENS! More amazingly, no one whom I've yet seen seems to be mentioning this. In essence, the results of this study are entirely consistent with the hypothesis that it doesn't matter whether you place TENS needles on acupuncture points or not. Will wonders never cease? Actually, that's not quite the right interpretation, as we shall soon see. Read the rest of this post... | Read the comments on this post...... Read more »

Suarez-Almazor, M., Looney, C., Liu, Y., Cox, V., Pietz, K., Marcus, D., & Street, R. (2010) A Randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication. Arthritis Care . DOI: 10.1002/acr.20225

August 5, 2010
10:00 AM
56 views

Fructose and pancreatic cancer

by Orac in Respectful Insolence

I hate science press releases.

Well, not exactly. I hate science press releases that hype a study beyond its importance. I hate it even more when the investigators who published the study make statements not justified by the study and use the study as a jumping off point to speculate wildly. True, it's not always the fault of the investigators, particularly if they don't have much experience dealing with the press, but all too often scientists fall prey to the tendency to gab glibly and give the reporter what he or she wants: Pithy, juicy quotes that relate the results to what the reporter wants them related to. It's irritating as hell, not so much because it's pure self-promotion. (After all, self-promotion is not in and of itself a bad thing) but rather because it's almost inevitably an excuse for the investigators to say what they want without peer pesky peer reviewers telling them that they should keep their remarks focused on what the evidence will support. Often these press releases lead to credulous news stories that make conclusions that aren't justified from the actual study. Sometimes an investigators' comments are taken out of context. Sometimes the investigator says something dumb. Sometimes it's all three.

There's a certain Reuters story entitled Cancer cells slurp up fructose, U.S. study finds making the rounds, and it's being represented as yet more evidence about the evils of high fructose corn syrup. That it might be viewed as a few years in the future, after followup studies have been done, but for right now all it is is an intriguing study being used to serve an agenda that it doesn't serve well: Read the rest of this post... | Read the comments on this post...... Read more »

Liu, H., Huang, D., McArthur, D., Boros, L., Nissen, N., & Heaney, A. (2010) Fructose Induces Transketolase Flux to Promote Pancreatic Cancer Growth. Cancer Research, 70(15), 6368-6376. DOI: 10.1158/0008-5472.CAN-09-4615

June 23, 2010
09:00 AM
106 views

Don't get sick in July? (Revisited)

by Orac in Respectful Insolence

June is almost over. If you work in an academic medical center, as I do, that can mean only one thing.

The new interns are coming, and existing residents will soon be advancing to the next level. The joy! The excitement! The trepidation! And it's not all just the senior residents and the faculty feeling these emotions. It's the patients too. At least, it's the patients feeling the trepidation. The reason is the longstanding belief in academic medical centers, a belief that has diffused out of them and into "common wisdom," that you really, really don't want to get sick in July?

But is there any truth to this common wisdom, passed down from hoary emeritus faculty to professor to assistant professor to resident to medical student every year? Is there any truth to the belief commonly held by the public that care deteriorates in July? It turns out that a recent study published in the Journal of General Internal Medicine has tried once again to answer this question and come to a rather disturbing answer.

Imagine, if you will, that you want to determine whether there really is a "July effect," that quality of care really does plummet precipitously as common wisdom claims. How would you approach it? Mortality rates? That's actually fairly hard, because mortality rates fluctuate according to the time of year. For example, trauma admissions tend to spike in the summer. Well do I remember during my residency the fear of the fourth of July weekend, because it was usually the busiest trauma weekend of the year--and we had new residents to have to deal with it all. It was an attending's and senior resident's worst nightmare. In any case, if a hospital has an active trauma program it would naturally be expected that it would have more deaths during the summer regardless of resident status, quite simply because there is more trauma. Complication rates? That might also be a useful thing to look at, but that's actually not as easy as it seems either. How about comparing morbidity and mortality rates between teaching hospitals and community hospitals throughout the year and test whether mortality rates increase in academic hospitals relative to community hospitals. That won't work very well, either, mainly because there tends to be a huge difference in case mix and severity between academic institutions and community hospitals. Community hospitals tend to see more routine cases of lower severity than teaching hospitals do. Read the rest of this post... | Read the comments on this post...... Read more »

Phillips, D., & Barker, G. (2010) A July Spike in Fatal Medication Errors: A Possible Effect of New Medical Residents. Journal of General Internal Medicine. DOI: 10.1007/s11606-010-1356-3

Clinical Research

June 11, 2010
09:00 AM
152 views

More evidence for a genetic basis for most autism

by Orac in Respectful Insolence

I wonder what the loons at Age of Autism will say about this.

Actually, I know what they'll say. Whenever a scientific study like the one just published earlier this week the top tier journal Nature, which examines genetic variations (CNVs) associated with autism and autism spectrum disorders (ASDs), comes out, they have a standard reply. Even though, as of this writing, I haven't seen yet seen a reply on the anti-vaccine crank blog Age of Autism to the study I'm about to describe, I'm sure it's coming and I'm sure it will look something like this article from a year ago by Mark "Not A Scientist Not a Doctor" Blaxill entitled Latest Autism Gene Studies Find....Not Very Much:

There's a familiar rhythm to the most prominent autism gene hunt publications. Their authors hype their newly minted study aggressively in the media. The prestigious journals that publish them lend their imprimatur to press releases that say, "this study is a big deal." The findings sound impressive in the press release (and the authors get plenty of time on camera and in leading newspapers to tell us how truly impressive they are). In the meantime--in papers that are so densely written that making sense of what they really say requires far more reflection than the media hype cycle permits--skillfully concealed evidence reveals the truly important news in the findings: the authors whisper quietly (if at all) that the new analysis negates the most important findings of some of the most prominent previous gene hunts, while crucial detail on their new findings is often relegated to "supplementary material" that's not available on the publication date.

Such a declaration is then almost inevitably followed by rants against scientists for concentrating on genes rather than vaccines as a cause of autism, claims of "conflicts of interest," and an "analysis" of the findings of the study that betray an incredible lack of understanding of molecular biology, genetics, and developmental biology. I expect that the response to this study will be no different and may well appear on AoA by tomorrow morning, quite possibly written by Mark "Not a Scientist Not a Doctor" Blaxill. The study by Pinto et al, looks at the functional impact of global rare copy number variation in autism spectrum disorders. Read the rest of this post... | Read the comments on this post...... Read more »

Pinto, D., Pagnamenta, A., Klei, L., Anney, R., Merico, D., Regan, R., Conroy, J., Magalhaes, T., Correia, C., Abrahams, B.... (2010) Functional impact of global rare copy number variation in autism spectrum disorders. Nature. DOI: 10.1038/nature09146

June 10, 2010
09:04 AM
148 views

NaturalNews.com slimes breast cancer research again

by Orac in Respectful Insolence

Let's see. Now that I'm back from Chicago, having recently attended a major cancer meeting, not to mention having already blogged about the meeting, what to do next? Sure, the whole thing about Andrew Wakefield finding himself just one step away from appearing on Jeff Rense's or Alex Jones's radio show was amusing in the extreme to me, and no doubt there will be much more blogging material to mine in that vein, but if you really want to bring home the crazy there's only one place shy of Whale.to to visit.

That's right, I'm talking about that wretched hive of medical scum and villainy, Mike Adams' NaturalNews.com. Now, usually it's the Grand Master of Woo and Quackery himself, Mike Adams, who really knows how to deliver the crazy quacky goods. Usually. This time, it's one of Mike's minions doing the duty, and addressing the nonsense in her post is a perfect post-ASCO thing for a surgical oncologist to do. The minion of woo is S. L. Baker, and the post is entitled Study shows how radiation causes breast cancer.

The first thing you need to remember about NaturalNews.com is that Mike Adams has a deep and abiding hatred of scientific medicine. One manifestation of this hatred is that, when it comes to breast cancer, to Adams surgery, chemotherapy, and radiation kill, not the cancer; "natural" therapies like vitamin D can prevent cancer with near 100% certainty and cure it with near 100% certainty if you happen to be someone who didn't listen to Adams; and that early detection tests like mammography are always bad, although, ironically enough, a modality that claims to do the same thing as mammography without radiation (thermography, an unvalidated and not particularly useful old technology that, for reasons that I've never been able to understand, "alternative" medicine practitioners love) is the greatest thing ever. I've written about NaturalNews.com and its hatred of conventional therapy for breast cancer before. For instance, seven months ago, Mike Adams himself mined similar territory that his apparent acolyte has done, while earlier he abused Breast Cancer Awareness month to castigate the "breast cancer industry." This time around his flunky Baker is doing the castigating: Read the rest of this post... | Read the comments on this post...... Read more »

Rituparna Mukhopadhyay, Sylvain V Costes, Alexey V Bazarov, William C Hines, Mary Helen Barcellos-Hoff, & Paul Yaswen. (2010) Promotion of variant human mammary epithelial cell outgrowth by ionizing radiation: an agent-based model supported by in vitro studies. Breast Cancer Research, 12(1). info:/10.1186/bcr2477

June 1, 2010
09:00 AM
151 views

When what an acupuncture study shows is much more interesting than what acupuncture believers think it shows

by Orac in Respectful Insolence

Of all the "alternative" therapies out there, arguably the most studied is the modality known as acupuncture. Perhaps the reason is that, unlike homeopathy, which based on physics, chemistry, and biology alone is so implausible that, for it to "work," huge swaths of well-established physics and chemistry would have to be shown to be not just wrong but extravagantly and outrageously wrong (making homeopathy far more akin to magic than science), or reiki, which, when you come right down to it, is nothing more than faith healing based on Eastern mysticism rather than Christianity, acupuncture actually involves doing something physical. Indeed, at the risk of annoying or boring long time readers, who have seen me write this many times before, even I used to think that there might be something to acupuncture. Certainly, I recognized that the concepts of meridians along which life energy (qi) flows and how sticking needles into just the right locations on these meridians somehow "unblocks" the flow of qi and thereby relieves pain and heals disease was prescientific nonsense on the order of thinking that evil spirits cause disease. Such ideas may have made sense hundreds of years ago, before scientists developed an understanding of how the body works, but now, in 2010, they are vestiges of a time when medicine really had close to no idea how the body works and when medicine was more often worse than the disease being treated.

Yet the fascination with acupuncture remains, so much so that an inordinate amount of research dollars are spent on studying it. Of course, as Steve Novella has pointed out, in general in medicine (at least these days), the trajectory of research is from bench research to animal models to small scale, less rigorous, pilot studies in humans to large scale, rigorously designed studies using many subjects. True, this order doesn't always hold. For instance, if physicians make a compelling observation "at the bedside" of response to therapy or how a disease progresses, frequently, after making closer observations to confirm the initial observation, researchers will jump back to animal models and bench top research to try to figure out what's going on. For such a progression to be useful, though, scientists have to be sure that the phenomenon in human patients under study actually exists. Unfortunately, such is not the case for acupuncture. As larger, more well designed studies using real placebo or sham acupuncture techniques, have increasingly shown that acupuncture does not function any better than placebo in human beings (and sometimes even worse), acupuncturists and acupuncture believers have been reversing the usual order of things, doing smaller studies and "pragmatic" (i.e., uncontrolled) clinical trials, where the placebo effect is not controlled for. Never mind that it doesn't matter where the needles are placed (thus blowing the whole "meridian" idea out of the water) or even if the needles puncture the skin. Toothpicks work just as well as needles. Also never mind that the mythology of acupuncture as having been routinely practiced for over two thousand years (or, sometimes, four thousand years, is largely a creation of Chairman Mao, who elevated what was a marginal practice at the time to a modality that the state supported and promoted (1,2,3,4). Unfortunately, even the National Center for Complementary and Alternative Medicine (NCCAM) falls for this mythology.

Sometimes, acupuncture studies even end up in high impact journals like Nature Neuroscience. Of course, what is being studied is not really "acupuncture" per se, but rather sticking needles into either people or animals. Since a bunch of you have deluged my mail box with this particular study, I felt obligated to have a look at it. Before I get to the study itself, though, let's take a look at the press release: Read the rest of this post... | Read the comments on this post...... Read more »

Goldman, N., Chen, M., Fujita, T., Xu, Q., Peng, W., Liu, W., Jensen, T., Pei, Y., Wang, F., Han, X.... (2010) Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neuroscience. DOI: 10.1038/nn.2562

May 25, 2010
03:58 AM
152 views

No difference between "too many too soon" and "too few too late" when it comes to vaccines

by Orac in Respectful Insolence

Regular readers know that I have a tendency every so often to whine about when writing about the antics of the anti-vaccine movement seems to engulf this blog. Yes, it's true. Every so often I get really, really tired of the bad science, pseudoscience, magical thinking, misinformation, and even outright lies that emanate from various anti-vaccine websites and blogs. This week, I promised myself I would try not to do it. There are times when duty calls, and this is one of those times. For better or for worse, as hard as I still find it to believe, somehow I've become one of the top bloggers defending vaccines, and there are times when I have to stop whining and just embrace this role. Given the one-two-three triple whammy of the start of the anti-vaccine autism quackfest Autism One, Andrew Wakefield having had his license to practice medicine in the U.K. yanked, and the hilariously insane anti-vaccine rally to take place in Grant Park in Chicago tomorrow, it's time just to go with the flow and do what needs to be done.

Today this is something I'm more than happy to do, at least today.

If there's one thing about the anti-vaccine movement that I've learned over the last several years, it's that it's nothing if not, for lack of a better word, nearly infinitely pliable. To put it more simply, anti-vaccine activists are experts at throwing out as much stuff as they can and seeing if anything sticks, adjusting their stories, and moving the goalposts every time each of their successive demands for more evidence are met by scientists. Although there has always been an anti-vaccine movement, its most recent incarnation is built primarily around the idea that vaccines cause autism somehow. First it was Andrew Wakefield presenting dubious, trial lawyer-funded "research" purporting to show that the MMR vaccine causes "autistic enterocolitis" and even autism itself. Then, not long after that, the U.S. version of this manufactrovery showed up in the form of the concept that mercury in the thimerosal preservative that used to be in vaccines cause autism, promoted initially by David Kirby and Robert F. Kennedy, Jr. Fortunately, more than a decade's worth of research consisting of large epidemiological studies has utterly failed to find even a whiff of a hint of a link between either the MMR vaccine or thimerosal-containing vaccines and autism. Unfortunately, the anti-vaccine movement simply moved the goalposts to the "toxins" gambit, in which it is claimed that vaccines are laced with "toxins" such as formaldehyde, antifreeze, and tissue from aborted fetuses. Never mind that there are no parts from aborted fetuses or antifreeze in vaccines, and scary-sounding chemicals like formaldehyde are present in concentrations far too low to be a problem. Even so, "Green our Vaccines" sure sounds like a slogan that means something, even though it doesn't.

The latest gambit, and arguably one of the most successful because it's the most vague and difficult to falsify, is the "Too Many Too Soon" slogan. Under this idea, anti-vaccine propagandists claim that infants are getting too many vaccines too soon (hence the slogan) and that all those nasty vaccines being given to such young infants is somehow messing up their immune system, attacking their brains, and giving them autism. This is a tough one to combat because the only definitive way to refute it would involve studying unvaccinated versus vaccinated children (which, not surprisingly, is the latest demand of the anti-vaccine movement). Doing such a study in a rigorous prospective randomized fashion would be completely unethical because it would leave the control group unprotected, while retrospective studies would be prone to a lot of confounders, given that there are likely to be other factors besides vaccination status that make populations who aren't vaccinated different from those who are.

That's why a study hot off the presses yesterday (well, hot off the web, as it were, given that it's an E-pub ahead of print) is so well timed. Released right as Autism One starts and Andrew Wakefield tanks, what better time for a study to look right at the very question that anti-vaccinationists seem to want answered? The title of the article is even an arrow aimed right at the heart of the "too many too soon" mantra, namely On-time Vaccine Receipt in the First Year Does Not
Adversely Affect Neuropsychological Outcomes. Read the rest of this post... | Read the comments on this post...... Read more »

Michael J. Smith, MD, MSCE, Charles R. Woods, MD, MS. (2010) On-time Vaccine Receipt in the First Year Does Not Adversely Affect Neuropsychological Outcomes. Pediatrics. info:/

May 19, 2010
10:37 AM
176 views

Oh no! My cell phone's going to kill me! (The revenge)

by Orac in Respectful Insolence

Here we go again.

I've written a few times before about the controversy over whether cell phones (a.k.a. mobile phones in most of the rest of the world) cause brain cancer, concluding on more than one occasion that the evidence does not support a link. For example, there has not been a large increase in brain cancer or other cancers claimed to be due to cell phone radiation in the 15 to 20 years since the use of cell phones took off back in the 1990s, nor has any study shown a convincing correlation between cell phone use and brain cancer.

Of course, one would not expect a priori, based on what is known about basic science, that cell phone radiation would cause cancer. After all, the development of cancer in general ultimately requires mutations in critical genes regulating cell growth and development. For an outside treatment to cause such mutations, as far as we know, requires the ability to cause DNA damage through the breaking of chemical bonds. Ionizing radiation can do this, as can certain cehmicals and chemotherapeutic agents. Indeed, that's how these agents work against cancer because cancer cells tend to be more sensitive to DNA damaging agents than normal cells due to defective DNA repair mechanisms. Thus, it is highly implausible based on basic science that cell phone radiation could cause cancer. It's not homeopathy level-implausible, but it's pretty implausible. Nor is it impossible, as has been claimed, because there may be biological mechanisms behind cancer that we do not yet understand, and it's almost always physicists with little knowledge of epigenetics and other mechanisms of cancer development who make such dogmatic claims. Still, such physicists are not too far off; if cell phones could cause cancer, it would have to be through a previously unknown physiological or genetic mechanism. Absent compelling evidence of a link between cell phones and cancer, then, it is not unreasonable to rely on the basic science and consider the possibility of such a link to be remote. Read the rest of this post... | Read the comments on this post...... Read more »

, . (2010) Brain tumour risk in relation to mobile telephone use: results of the INTERPHONE international case-control study. International Journal of Epidemiology. DOI: 10.1093/ije/dyq079

May 17, 2010
04:00 AM
171 views

Dichloroacetate (DCA) and cancer: Déjà vu all over again

by Orac in Respectful Insolence

Late last week, a crank I hadn't heard from in a while showed up in my comments. I'm referring to DaveScot, who normally was known for promoting anti-evolution rhetoric in the service of the pseudoscience known as "intelligent design" creationism. This is what he said:

Hi Orac,

terrasig suggested you do a followup article on dichloroacetate (DCA) given the paper just published on the phase 1 trial in Edmonton.

Three years have passed and countless cancer patients were denied this drug. Now at the end of its first phase one trial we know exactly what we did from the reports of people self-medicating in 2007 before the FDA forced it off the market - it shows great promise.

Explain to me again how these controlled trials are oh-so-much better than the ad hoc trial of self-organized self-medicants? Lay that old woo stick on me again, buddy.

How can I refuse such a heartfelt request for a loving application the clue by four (a.k.a. the cluestick). Apparently DaveScot forgot the last time I laid it on him. Oddly enough, it was not over evolution or creationism, and the loving application occurred over three years ago. Specifically, it was about a topic that I hvaen't written about for about a year and a half now, mainly because there wasn't any real news to write about, namely (as I've put it) the "cancer cure that big pharma doesn't want you to know about," dichloroacetate (DCA for short).

Actually, DaveScot wasn't the first this week. Over the last several days, I've received a trickle of e-mails about DCA. These generally fell into two categories. One category was simply asking me to update the story; the other category was of the type demonstrated by DaveScott, gloating that I was wrong when I threw cold water on the ridiculous level of hype over this drug on the basis of a single paper reporting that DCA showed significant efficacy against various cancers in cell culture and rodent models of cancer.

I suppose I shouldn't be too hard on DaveScot. After all, when the DCA saga began in January 2007, I started noticing a bunch of posts by various bloggers as well as news stories that all had similar titles, such as Cheap, safe drug kills most cancers, Objectively pro-cancer, Gotta pay, When promising cures are ignored, and, my personal favorite, Potential cheap, safe cure for cancer: Will Big Pharma Allow It?

Note that there were two assumptions about the study three years ago. First, these bloggers and pundits assumed that the cell culture and animal work were definitive evidence that DCA might be a "cure" for cancer. Second, the assumption was that, because the drug was out of patent and very cheap to make, neither the government nor pharmaceutical companies would be interested in funding it, thus condemning thousands, maybe millions, of people to die of cancer unnecessarily. Unfortunately, the New Scientist article and articles in the Edmonton Sun featured headlines to that effect and quotes by the investigator Evangelos Michelakis lamenting how he had had difficulties finding funding to do the next step, clinical trials in cancer. As a result of these sensationalistic stories, unscrupulous "businessmen" sought to bring DCA to the masses. A frenzy of sorts was unleashed, with desperate cancer patients scrambling to find DCA. If you're interested in the details, scroll to the end of this post for a list of the numerous blog posts that I did on the topic as the story was evolving. That's the past, and all the "Insolence" and science are there for you if you want to read it. I'm concerned with today (well, last week), when apparently DCA bubbled to the surface in news reports such as this, which were apparently what "inspired" DaveScot's and some e-mails challenging me. For example: Read the rest of this post... | Read the comments on this post...... Read more »

Michelakis, E., Sutendra, G., Dromparis, P., Webster, L., Haromy, A., Niven, E., Maguire, C., Gammer, T., Mackey, J., Fulton, D.... (2010) Metabolic Modulation of Glioblastoma with Dichloroacetate. Science Translational Medicine, 2(31), 31-31. DOI: 10.1126/scitranslmed.3000677

May 14, 2010
10:00 AM
234 views

Knowledge versus certainty in skepticism and science

by Orac in Respectful Insolence

"I don't want knowledge. I want certainty!"--David Bowie, from Law (Earthlings on Fire)

If there's one universal trait among humans, it seems to be an unquenchable thirst for certainty. This should come as no surprise to those committed to science and rational thinking because there is a profound conflict between our human desire for certainty and the uncertainty of scientific knowledge. The reason is that the conclusions of science are always provisional. They are always subject to change based on new evidence. Although by no means the only reason, clearly this craving for certainty the human mind appears to demand is likely to be a major force that drives people into the arms of religion, even radical religions that have clearly irrational views, such as the idea that flying planes into large buildings and killing thousands of people is a one-way ticket to heaven. However, this craving for certainty isn't limited to religion. As anyone who accepts science as the basis of medical therapy knows, there's a lot of the same psychology going on in medicine as well.

Although I'm not going to discuss this phenomenon primarily in the context of unscientific and pseudoscientific quackery in the "alternative" medicine world, I think it's instructive as an example. Much of quackery involves substituting the certainty of belief for the provisional nature of science. Examples, abound. Perhaps my favorite two examples include Hulda Clark, who attributed all cancer and serious disease to a common liver fluke, and Robert O. Young, who believes that virtually all disease is due to "excess acid." Time and time again, if you look carefully at "alt-med" concepts and the therapies that derive from those concepts, you find simplicity tarted up in complicated-sounding jargon. Homeopathy, for instance, is at its heart nothing more than sympathetic magic, with its concept of "like cures like," combined with the principle of contagion, with its concept that water somehow has a "memory" of the therapeutic substances with which it's come in contact but can somehow manage, as Tim Minchin so hilariously put it, forget all the poo it's been in contact with. Reiki and other "energy healing" modalities can be summed up as "wishing makes it so," with "intent" having the power to manipulate some fantastical life energy to heal people. It's faith healing, pure and simple. Read the rest of this post... | Read the comments on this post...... Read more »

Munro, G. (2010) The Scientific Impotence Excuse:ï¿½Discounting Belief-Threatening Scientific Abstracts. Journal of Applied Social Psychology, 40(3), 579-600. DOI: 10.1111/j.1559-1816.2010.00588.x

April 8, 2010
09:26 AM
229 views

Eat your fruit and veggies?

by Orac in Respectful Insolence

Eat your fruits and vegetables.

Hasn't that been a constant refrain over the years from public health authorities? Certainly, I have. The benefits of eating fruits and vegetables have been widely touted, and seemingly with good reason. A diet high in fruits and vegetables, it is said, reduces the risk of cardiovascular disease and cancer. In the case of the latter, it as claimed that potential decreases in the risks of some cancers could be as high as 50% a day. As a result, the National Cancer Institute developed the 5-A-Day program, whose goal was to increase people's consumption of fruits and vegetables to five or more servings a day. Indeed, on the NCI website, this effort is described thusly:

In 1981, Doll and Peto concluded that about 35 percent of all cancer deaths were related to nutrition, with a plausible range of 10 to 70 percent.26 This conclusion was driven largely by data on dietary behaviors that might increase risk. Evidence for the role of plant foods in cancer risk coalesced in the late 1980s and early 1990s, based on summaries of the epidemiologic literature specific to the relationship between vegetables and fruit and cancer.

The evidence supporting the role of vegetables and fruit in cancer prevention provided a foundation for several documents that were the basis of national nutrition policy in the 1980s and 1990s. In 1982, the National Research Council (NRC) published the seminal document, Diet, Nutrition and Cancer, which summarized the research literature on the relationship between various chronic diseases and dietary patterns.36 Other Federal documents followed such as Healthy People 2000, the first Surgeon General's Report on Nutrition, Dietary Guidelines for Americans, and the Food Guide Pyramid.

There's no doubt that diet is critically important to health, but does it have that dramatic an effect on cancer, with a possible effect size potentially as large as 70%? Answering that question has been difficult and has been very dependent on the methodology of the studies used to address the question. Studies have been conflicting regarding the existence and magnitude of benefit of a diet rich in fruit and vegetables when it comes to preventing cancer. Enter the EPIC Study (European Prospective Investigation into Cancer and Nutrition), whose results were just published in the Journal of the National Cancer Institute (JNCI) this week and have made the news all over the world, with some news stories having titles like Fruit and vegetables have little effect on cancer risk, study finds. Is it true? Should you stop worrying about eating five portions a day of fruits and vegetables. (Given how bad I am at trying to be healthy, I never came close to that on an average day, anyway.) Read the rest of this post... | Read the comments on this post...... Read more »

Boffetta, P., Couto, E., Wichmann, J., Ferrari, P., Trichopoulos, D., Bueno-de-Mesquita, H., van Duijnhoven, F., Buchner, F., Key, T., Boeing, H.... (2010) Fruit and Vegetable Intake and Overall Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition (EPIC). JNCI Journal of the National Cancer Institute. DOI: 10.1093/jnci/djq072

Willett, W. (2010) Fruits, Vegetables, and Cancer Prevention: Turmoil in the Produce Section. JNCI Journal of the National Cancer Institute. DOI: 10.1093/jnci/djq098

March 31, 2010
09:31 AM
260 views

Is there publication bias in animal studies?

by Orac in Respectful Insolence

Last month, in response to some truly despicable activities by animal rights zealots, I wrote a series of posts about how animal rights activists target even researchers' children and appear to fetishize violence. This simply continued a string of posts that I've done over the years, the longest (and, in my not-so-humble-opinion, the best) deconstructs a lot of the bad scientific arguments used by animal rights activists to claim that animal research is useless, or nearly so, as well as other arguments made by extremists. One of the key points emphasized in these responses is that, regardless of their shortcomings, animal models for many conditions provide useful data, have lead to medical breakthroughs, and are better than any of the alternatives currently touted by animal rights activists. Someday, for example, cell culture and computer models may allow us to replace the use of animals for a lot of studies.

Not surprisingly, then, I've had a few readers make me aware of a recently released study published in PLoS Biology, entitled Publication Bias in Reports of Animal Stroke Studies Leads to Major Overstatement of Efficacy. I actually knew about this study last week, because I'm on the PLoS press list. But the study was embargoed until Monday night, and for some reason I let Mike Adams distract me from taking on a real scientific study. On the other hand, it's always a good time to have some fun with our favorite woo-meister of all. It's just fortunate that my readers didn't let me forget about this study.

Science-based medicine depends upon preclinical studies in cell culture and animal models in order to determine disease mechanisms and, just as importantly, to test new therapies before testing them in humans. I've pointed out before that animal studies don't always correlate as cleanly as we would like with human studies. However, for all their imperfections, animal studies can allow us to study phenomena that require three dimensional structure with all the different types of cells normally in the organ in question. One example I like to use is the study of tumor angiogenesis, which requires complex interactions between the tumor cells, vascular cells, and the stroma. Although I'm aware of models that examine endothelial cells, fibroblasts, and tumor cells in three dimensional coculture that can produce some pretty cool results, but they are still just cells in dishes. They're cells in dishes using sophisticated culture systems, but cells in dishes nonetheless.

It's thus of great interest to know what the predictive capability of animal models is. In the case of this study, the authors performed a metaanalysis of animal models of acute ischemic stroke to try to estimate the effect of publication bias on the reported results. As you may be aware, publication bias is an insidious generalized form of bias that creeps into the medical literature because studies showing a positive result are more likely to be published than studies that show a negative result. Also known as "the file drawer effect" (where negative studies tend to be left in the "file drawer" rather than to be published, publication bias is a problem in the clinical trial literature, so much so that clinical trial registries such as Clinicaltrials.gov, have been set up to make sure that the results of all human clinical trials see the light of day. The authors lay out this problem right in the introduction: Read the rest of this post... | Read the comments on this post...... Read more »

Sena, E., van der Worp, H., Bath, P., Howells, D., & Macleod, M. (2010) Publication Bias in Reports of Animal Stroke Studies Leads to Major Overstatement of Efficacy. PLoS Biology, 8(3). DOI: 10.1371/journal.pbio.1000344

February 9, 2010
07:00 AM
328 views

Differences between CAM practice and primary care practice

by Orac in Respectful Insolence

If there is one aspect of "complementary and alternative" medicine (CAM) that can puzzle advocates of science-based medicine, it's why, given how nonsensical much of it is given that some of it actually goes against the laws of physics (think homeopathy or distance healing), CAM is so popular. Obviously one reason is that there are conditions for which SBM does not have any "magic bullet" treatments. Diabetes, heart disease, other chronic illnesses, SBM can manage them quite well, but it can't cure them. Then there are conditions that science doesn't understand very well, conditions like, for example, fibromyalgia. It would be less than honest of me (or any other supporter of SBM) not to acknowledge that SBM sometimes has little to offer some patients. Of course, there's no evidence that CAM has anything therapeutic or concrete to offer these patients either, although certainly CAMsters would like you and their other marks to believe that they do.

Actually, that may not be entirely accurate. There does appear to be something that CAMsters offer patients that we practitioners of SBM appear to have a problem providing. It's unfortunate that this is true, but it does appear to be, and what it is should be fairly easy to guess. Basically, it's time. Anecdotally, most of us who pay attention to the issue of CAM and the infiltration of pseudoscience into medicine have suspected this, but there hasn't been a lot of data one way or the other to determine whether this is indeed the case and, if so, what the difference is. Last week, however, Dr. RW pointed me to a study that takes a stab at answering that very question. Published by a Dutch group, the study examined the practices of conventional physicians and CAM practitioners in terms of diagnoses seen and time spent with patients. The CAM practitioners included physicians practicing homeopathy, acupuncture, and naturopathy. A total of 5919 visits in 1839 patients were studied for diagnoses and time spent with each patient. These data were then compared with data from general practitioners (GPs) participating in the second Dutch national study in general practice (DNSGP-2). One result of this study was not surprising: Read the rest of this post... | Read the comments on this post...... Read more »

Heiligers, P., de Groot, J., Koster, D., & van Dulmen, S. (2010) Diagnoses and visit length in complementary and mainstream medicine. BMC Complementary and Alternative Medicine, 10(1), 3. DOI: 10.1186/1472-6882-10-3

January 6, 2010
09:00 AM
391 views

Gut disorders and autism: A new consensus statement

by Orac in Respectful Insolence

One of the key claims of the "autism biomedical" movement is that something about autism derives from or is exacerbated by the gut; i.e., that there is some sort of link between GI problems, particularly inflammatory diseases of the GI tract, and autism. Although I may not be as versed in the history of this claim as I could be, as far as I can tell, even if this idea didn't originate with Andrew Wakefield, he certainly did a lot to popularize it. Indeed, a common misconception about his misbegotten 1998 Lancet paper that launched the anti-MMR anti-vaccine movement in the U.K. is that it claimed that there was a link between autism. In reality, its claim was that the MMR vaccine was somehow connected with what he considered to be a novel syndrome of bowel disease and autism associated with MMR vaccination that has been referred to as "autistic enterocolitis."

Of course, Wakefield's study showed nothing of the sort and has since been thoroughly discredited, but the idea lives on. Since then, science doesn't support the concept that there is some sort of unique GI syndrome associated with autism (indeed, "autistic enterocolitis" is a made up syndrome--made up by Wakefield), and it has been very controversial whether autistic children suffer from more GI complaints than neurotypical children. However, in the "autism biomed" world, regardless of whether there is an increased incidence of GI problems in autistic children, the concept of "autistic enterocolitis" is a concept that's launched a thousand quacks (at least) and continues to support a cottage industry of quackery involving supplements, special diets, and "detoxification" regimens. Indeed, Jenny McCarthy thoroughly embarrassed herself trying to explain the rationale for "biomed treatments" and gluten-free diets, so much so that the video is no longer on the Generation Rescue website after it became the subject of mockery throughout the blogosphere. Moreover, she's made some rather amazing claims for using diet to treat her son Evan, even going so far as to assert in one interview: Read the rest of this post... | Read the comments on this post...... Read more »

Buie, T., Campbell, D., Fuchs, G., Furuta, G., Levy, J., VandeWater, J., Whitaker, A., Atkins, D., Bauman, M., Beaudet, A.... (2010) Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report. PEDIATRICS, 125(Supplement). DOI: 10.1542/peds.2009-1878C

Buie, T., Fuchs, G., Furuta, G., Kooros, K., Levy, J., Lewis, J., Wershil, B., & Winter, H. (2010) Recommendations for Evaluation and Treatment of Common Gastrointestinal Problems in Children With ASDs. PEDIATRICS, 125(Supplement). DOI: 10.1542/peds.2009-1878D

December 31, 2009
09:00 AM
463 views

Radiation from CT scans: Balancing risks and benefits

by Orac in Respectful Insolence

NOTE: Orac is on semi-vacation this week, trying very hard to recharge his Tarial cells. Actually, although he is at home, he is spending much of his time in his Sanctum Sanctorum (i.e., his home office) working on an R01 for the February submission cycle. Given that the week between Christmas and New Years Day tends to be pretty boring, both from a blogging and blog traffic standpoint, he's scaling back the new, original stuff and mixing in some "best of" reruns, as well as some more recent stuff that appeared in a different form elsewhere, modified a bit to be more appropriate to this blog. Why? Because he likes them enough that he wants to make sure that as many people as possible see them.

Fear not, though. If something sufficiently interesting happens, Orac will welcome a break from the drudgery of grant writing to apply some appropriate not-so-Respectful Insolence to it. Oh, wait. He already did break his "vacation" to post two or three times....

Science-based medicine consists of a balancing of risks and benefits for various interventions. This is sometimes a difficult topic for the lay public to understand, and sometimes physicians even forget it. My anecdotal experience suggests to me that surgeons are probably more aware of this basic fact. Of course, that isn't because we're better than other doctors or anything like that; rather, it's because our interventions generally involve taking sharp objects to people's bodies and using steel to remove or rearrange parts of people's anatomy for (hopefully) therapeutic effect. Ditto oncologists, who prescribe highly toxic substances to treat cancer, the idea being that these substances are more toxic to the cancer than they are to the patient. Often they are only marginally more toxic to the cancer than to the patient. However, if there's one area where even physicians tend to forget that there is potential risk involved, it's the area of diagnostic tests, in particular radiological diagnostic tests, such as X-rays, fluoroscopy, computed tomography (CT) scans, and the variety of ever more powerful diagnostic studies that have proliferated over since CT scans first entered medical practice in the 1970s. Since then, the crude images that the first CT scans produced have evolved, thanks to technology and ever greater computing power, to breathtaking three dimensional-views of the internal organs. Indeed, just since I finished medical school back in the late 1980s, I'm continually amazed at what these new imaging modalities can accomplish.

The downside of these imaging modalities is that most of them require the use of X-rays to produce their images. True, over the last 15 years or so MRI, which uses very strong magnetic fields and radiofrequency radiation rather than ionizing radiation to produce its images, has become increasingly prevalent. MRI is great because it produces more contrast between different kinds of soft tissue than CT scans do. However, CT tends to be superior for examining calcified organs, such as bone. (The breast surgeon in me notes that breast MRI is pretty much useless for detecting microcalcifications, an important possible indicator for cancer.) Also, MRI scans require a prolonged period of laying still in a very tight tube, which is a problem for patients with any degree of claustrophobia, although "open" MRIs are becoming increasingly available. More importantly for the quality of images, because they require a patient to lie more still than a CT, MRIs tend to be prone to more motion artifacts, which is perhaps why CT is more frequently used to image the abdomen other than large solid organs such as the liver. The point is that, although MRI is becoming more prevalent, CT scans aren't going away any time soon. They have different strengths and weaknesses as imaging modalities and are therefore best suited for different, albeit overlapping, sets of indications. Read the rest of this post... | Read the comments on this post...... Read more »

Berrington de Gonzalez, A., Mahesh, M., Kim, K., Bhargavan, M., Lewis, R., Mettler, F., & Land, C. (2009) Projected Cancer Risks From Computed Tomographic Scans Performed in the United States in 2007. Archives of Internal Medicine_id, 169(22), 2071-2077. http://archinte.ama-assn.org/cgi/doi/10.1001/archinternmed.2009.440

Smith-Bindman, R., Lipson, J., Marcus, R., Kim, K., Mahesh, M., Gould, R., Berrington de Gonzalez, A., & Miglioretti, D. (2009) Radiation Dose Associated With Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer. Archives of Internal Medicine, 169(22), 2078-2086. DOI: 10.1001/archinternmed.2009.427

Redberg RF. (2009) Cancer risks and radiation exposure from computed tomographic scans: how can we be sure that the benefits outweigh the risks?. Archives of internal medicine, 169(22), 2049-50. PMID: 20008685

Brenner DJ, & Hall EJ. (2007) Computed tomography--an increasing source of radiation exposure. The New England journal of medicine, 357(22), 2277-84. PMID: 18046031

December 28, 2009
08:00 AM
478 views

The revenge of cell phones and cancer strikes back yet again in the never-ending controversy...

by Orac in Respectful Insolence

NOTE: Orac is on semi-vacation this week, trying very hard to recharge his Tarial cells. Actually, although he is at home, he is spending much of his time in his Sanctum Sanctorum (i.e., his home office) working on an R01 for the February submission cycle. Given that the week between Christmas and New Years Day tends to be pretty boring, both from a blogging and blog traffic standpoint, he's scaling back the new, original stuff and mixing in some "best of" reruns, as well as some more recent stuff that appeared in a different form elsewhere, modified a bit to be more appropriate to this blog. Why? Because he likes them enough that he wants to make sure that as many people as possible see them.

Fear not, though. If something sufficiently interesting happens, Orac will welcome a break from the drudgery of grant writing to apply some appropriate not-so-Respectful Insolence to it. (Yes, I'm referring to Deepak Chopra, who, I'm told, returned over the weekend after Christmas, surpassing even his own usual level of vitriol towards "skeptics.")

It's been about a year and a half since I've written about this topic; so I thought I'd better update the disclaimer that I wrote at the beginning:

Before I start into the meat of this post, I feel the need to emphasize, as strongly as I can, four things:

I do not receive any funding from the telecommunications industry in general, or wireless phone companies in particular. None at all. In other words, I'm not in the pocket of "big mobile" any more than I am in the pocket of big pharma.
I don't own any stock in telecommunications companies, other than as parts of mutual funds in which my retirement funds are invested that purchase shares in many, many different companies, some of which may or may not be telecommunications companies.
None of my friends or family work for cell phone companies.
I don't have a dog in this hunt. I really don't.

There. That's better. Hopefully that will, as it did last time, serve as a shield against the "shill" argument, which is among the frequent accusations I hear whenever I venture into this particular topic area. So, as I did back in 2008, I just thought I'd clear that up right away in order (hopefully) to preempt any similar comments after this post. Unfortunately, as I have known for a long time, I'm sure someone will probably show his or her lack of reading comprehension and post one of those very criticisms of me. It's almost inevitable, either here or elsewhere. Posting such disclaimers never seems to work against the "pharma shill" gambit when I write about vaccines or dubious cancer cures. Even so, even after nearly ten years involved in skepticism and promoting science-based medicine, hope still springs eternal.

There are two reasons that I think the issue of mobile phones and cancer needs an update on our blog: First, it has been a year and a half since I last wrote about it. At that time I castigated Dr. Ronald B. Herberman, who at that time was director of the University of Pittsburgh Cancer Institute for what I viewed as fear mongering over cell phones and cancer based on at best flimsy evidence. Second, there have been two fairly high profile studies looking at whether there is a link between mobile phone use and cancer. One of these my colleague and friend Steve Novella has already discussed, but there was another one that he didn't see because it didn't get quite as much publicity, possibly because the corresponding author is based in Korea. I will take this opportunity to discuss them both. Read the rest of this post... | Read the comments on this post...... Read more »

Myung, S., Ju, W., McDonnell, D., Lee, Y., Kazinets, G., Cheng, C., & Moskowitz, J. (2009) Mobile Phone Use and Risk of Tumors: A Meta-Analysis. Journal of Clinical Oncology, 27(33), 5565-5572. DOI: 10.1200/JCO.2008.21.6366

Deltour, I., Johansen, C., Auvinen, A., Feychting, M., Klaeboe, L., & Schuz, J. (2009) Time Trends in Brain Tumor Incidence Rates in Denmark, Finland, Norway, and Sweden, 1974-2003. JNCI Journal of the National Cancer Institute. DOI: 10.1093/jnci/djp415

December 10, 2009
09:00 AM
544 views

Yet another bad day for the anti-vaccine movement

by Orac in Respectful Insolence

Arguably, the genesis of the most recent iteration of the anti-vaccine movement dates back to 1998, when a remarkably incompetent researcher named Andrew Wakefield published a trial lawyer-funded "study" in the Lancet that purported to find a link between "autistic enterocolitis" and measles vaccination with the measles-mumps-rubella (MMR) trivalent vaccine. In the wake of that publication was born a scare over the MMR that persists to this day, 11 years later. Although peer reviewers forced the actual contents of the paper to be more circumspect, in the press Wakefield promoted the idea that the MMR vaccine either predisposes, causes, or triggers autistic regressions. Even though over the next several years, investigations by investigative journalist Brian Deer revealed that not only was Wakefield's research funded by trial lawyers looking to sue vaccine manufacturers for "vaccine injury" when he did his research (for which he is now being charged by the U.K.'s General Medical Council with scientific misconduct), but during the Autism Omnibus trial testimony by a world-renowed expert in PCR technology showed that he was incompetent. Even worse for Wakefield, in February 2009 Brian Deer published a news expose based on strong evidence that Wakefield may very well have falsified data for his Lancet paper.

None of this mattered. Andrew Wakefield still enjoys a cult of personality among the anti-vaccine crowd that no revelation seems able to dislodge, even the revelation that at the time he was both in the pay of trial lawyers and working on his study, Andrew Wakefield was also applying for a patent for a rival measles vaccine. Indeed, the anti-vaccine propaganda blog Age of Autism bestowed upon him last year its "Galileo Award" as the "persecuted" scientist supposedly fighting for truth, justice, and anti-vaccinationism against the pharma-funded or brainwashed minions of the "Church of the Immaculate Vaccination." In the meantime, MMR uptake rates in the U.K. have plummeted over the last decade, far below the level needed for herd immunity, to the point where, last year the Health Protection Agency declared measles to be once again endemic in the U.K., 14 years after the local transmission of measles had been halted.

Since Wakefield's study was released, a number of studies have shown that there is no epidemiologically detectable link between vaccination with MMR and autism, including one by a researcher who once appeared to be a believer in the idea that vaccines are somehow linked with autism, Mady Hornig. Hornig actually tried very hard to replicate Wakefield's 1998 Lancet study, only this time with more children, and she found no link between MMR and autism using methodology similar to Wakefield's. None of this has had any effect on the anti-vaccine movement, except to motivate them to circle the wagons even more, as J.B. Handley of Generation Rescue did when he launched a website called Fourteen Studies, whose sole purpose is to launch fallacious and pseudoscientific attacks on studies failing to find a link between vaccines and autism and to promote the lousy science that gives the appearance of supporting the hypothesis that there is a link between the MMR vaccine and autism and then sliming anyone who points out how deceptive their attacks were.

Last week, yet another study was released investigating whether there is a link between MMR vaccination and autism. Last week, yet another study failed to find a link between MMR vaccination and autism. This week, yet another study is all set to be attacked by Generation Rescue and the anti-vaccine movement. The sad and sordid history of reactions of the anti-vaccine movement to studies that do not support its belief in the unsinkable rubber duck of a myth that vaccines cause autism. This study was published online in The Pediatric Infectious Disease Journal by a group from Department of Epidemiology and Preventive Medicine, Jagiellonian University, Collegium Medicum, Krakow, Poland (a Polish group, my people!) and entitled Lack of Association Between Measles-Mumps-Rubella Vaccination and Autism in Children: A Case-Control Study. It's yet another nail in the coffin of the myth that the MMR causes or contributes to autism. Indeed, this study not only shows that MMR vaccination is not associated with autism but that it may even be protective against autism. True, for reasons I will discuss shortly, I doubt that that latter interpretation is true, but there's no doubt that this study is powerful evidence against the view that there is an association between MMR and autism. Unfortunately, I fear that all the nails in my local Home Depot would not be enough to keep the zombie of this pseudoscience from rising from its grave yet again. Read the rest of this post... | Read the comments on this post...... Read more »

Mrożek-Budzyn D, Kiełtyka A, & Majewska R. (2009) Lack of Association Between Measles-Mumps-Rubella Vaccination and Autism in Children: A Case-Control Study. The Pediatric infectious disease journal. PMID: 19952979

November 10, 2009
09:00 AM
472 views

Rethinking cancer screening?

by Orac in Respectful Insolence

Here we go again.

I see that the kerfuffle over screening for cancer has erupted again to the point where it's found its way out of the rarified air of specialty journals to general medical journals and hence into the mainstream press. This is something that seems to pop up every so often, much to the consternation of lay people and primary care doctors alike, often trumpeted with breathless headlines along the lines of "What if everything you knew about screening was wrong?

It isn't, but some of it may be. The problem is the shaking out process. I'll try to explain.

Over the last couple of weeks, articles have appeared in newspapers such as the New York Times and Chicago Tribune, radio networks like NPR, and magazines such as TIME Magazine pointing out that a "rethinking" of routine screening for breast and prostate cancer is under way. The articles bear titles such as A Rethink On Prostate and Breast Cancer Screening, Cancer Society, in Shift, Has Concerns on Screenings, Cancers Can Vanish Without Treatment, but How?, Seniors face conflicting advice on cancer tests: Benefit-risk questions lead some to call for age cutoffs, and Rethinking the benefits of breast and prostate cancer screening. These articles were inspired by an editorial published in JAMA last month by Laura Esserman, Yiwey Shieh, and Ian Thompson entitled, appropriately enough, Rethinking Screening for Breast Cancer and Prostate Cancer. The article was a review and analysis of recent studies about the benefits of screening for breast and prostate cancer in asymptomatic populations and concluded that the benefits of large scale screening programs for breast cancer and prostate cancer tend to be oversold and that they come at a higher price than is usually acknowledged. Read the rest of this post... | Read the comments on this post...... Read more »

Esserman, L., Shieh, Y., & Thompson, I. (2009) Rethinking Screening for Breast Cancer and Prostate Cancer. JAMA: The Journal of the American Medical Association, 302(15), 1685-1692. DOI: 10.1001/jama.2009.1498

September 22, 2009
10:00 AM
626 views

CAM usage and vaccination status

by Orac in Respectful Insolence

I've often discussed how potentially misleading anecdotal evidence and experience can be. Indeed, I've managed to get into quite a few--shall we say?--heated discussions with a certain woo-friendly pediatrician, who, so confident in his own clinical judgment, just can't accept that his own personal clinical observations could be wrong or even horribly mislead him. Sadly, I've never managed to persuade him just how easy it is for us humans to be deceived or even to deceive ourselves.

However, just because anecdotal evidence can deceive us does not mean that it is worthless. Contrary to the straw man argument that woo-meisters like to level against skeptics, we do not claim that anecdotal evidence is "worthless." Rather, anecdotal evidence is the weakest form of evidence. In science, it is always only a starting point, never an end, at least not if stronger forms of evidence can be generated?

So why am I beginning with this rambling introduction, other than that's the way Orac usually rolls? The reason is that it's always been my anecdotal experience that people who tend to pursue "complementary and alternative medicine" (i.e., CAM) tend also to be anti-vaccine. True, there has been evidence that, for example, chiropractors tend to be hostile to vaccination, and that only a many naturopaths are highly skeptical of pediatric vaccination. This sort of anecdotal evidence and relatively small studies led to some curiosity over whether it was really true that CAM is associated with lower rates of vaccination, which is why researchers from the School of Public Health at the University of Washington and the Office of Health Services and Public Health Outcomes Research, University of Missouri decided to take a look at the question. In the process, they just published the largest series thus far to look at the relationship between pediatric vaccination and CAM usage1.

The results are, alas, not surprising. Read the rest of this post... | Read the comments on this post...... Read more »

Downey, L., Tyree, P., Huebner, C., & Lafferty, W. (2009) Pediatric Vaccination and Vaccine-Preventable Disease Acquisition: Associations with Care by Complementary and Alternative Medicine Providers. Maternal and Child Health Journal. DOI: 10.1007/s10995-009-0519-5

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