Respectful Insolence

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84 posts · 129,410 views

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

Orac
84 posts

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  • September 29, 2008
  • 10:00 AM
  • 2,254 views

Does genistein interfere with breast cancer therapy?

by Orac in Respectful Insolence

More than two-thirds of breast cancers make the estrogen receptor. What that means is that these tumors have the protein receptor that binds estrogen, which then activates the receptor and causes all the genes that are turned on or off by estrogen to be turned on and off. That's how estrogen acts on normal breast epithelial cells and on breast cancer cells. The significance of this observation is that estrogen receptor-positive (ER+) breast cancers respond to estrogen. Indeed, estrogen contribut........ Read more »

  • December 3, 2008
  • 08:22 AM
  • 2,137 views

Yet another acupuncture meta-analysis: Garbage in, garbage out

by Orac in Respectful Insolence

Ever since I started paying attention to it, acupuncture has, at least until recently, inspired ambivalence more than anything else in me. As a skeptic and science-based physician, I found it very easy to dismiss utter quackery like homeopathy or the various "energy healing" modalities, such as reiki or therapeutic touch strictly on the science alone. After all, homeopathy is based on magical thinking more than anything else, specifically the concepts of "like cures like," the concept that dilut........ Read more »

  • March 19, 2009
  • 09:37 AM
  • 2,131 views

Religion and end-of-life care

by Orac in Respectful Insolence

Given that I'm the proverbial lapsed Catholic cum agnostic, religion just doesn't play that large a role in my life and hasn't since around six years ago. I don't know if I'll ever discuss or explain on this blog what the last straw resulting in that transformation was (it's too personal), but a couple of years ago I did go through a period where I became hostile to religion, perhaps spurred on by PZ and the whole anti-religion gestalt of the ScienceBlogs Collective here. That lasted maybe a yea........ Read more »

Andrea C. Phelps, MD, Paul K. Maciejewski, PhD, Matthew Nilsson, BS, Tracy A. Balboni, MD, Alexi A. Wright, MD, M. Elizabeth Paulk, MD, Elizabeth Trice, MD, PhD, Deborah Schrag, MD, MPH, John R. Peteet, MD, Susan D. Block, MD.... (2009) Religious Coping and Use of Intensive Life-Prolonging Care Near Death in Patients With Advanced Cancer. JAMA, 301(11), 1140-1147. DOI: http://jama.ama-assn.org/cgi/content/short/301/11/1140  

  • February 11, 2009
  • 10:00 AM
  • 2,043 views

Bummer about them vitamins...again

by Orac in Respectful Insolence

I have to say, this is getting monotonous.

Let me back up a minute. One of the most common beliefs among users and advocates of "complementary and alternative" medicine (CAM) is that supplementation with vitamins will have all sorts of beneficial health effects. True, this belief is also pervasive among people who wouldn't go to an acupuncturist if you held a gun to their head, but it has become most associated with CAM. That this is so can actually be viewed as evidence of just how successful ........ Read more »

Marian L. Neuhouser, Sylvia Wassertheil-Smoller, Cynthia Thomson, Aaron Aragaki, Garnet L. Anderson, JoAnn E. Manson, Ruth E. Patterson, Thomas E. Rohan, Linda van Horn, James M. Shikany.... (2009) Multivitamin Use and Risk of Cancer and Cardiovascular Disease in the Women's Health Initiative Cohorts. Arch Intern Med, 169(3), 294-304. DOI: http://archinte.ama-assn.org/cgi/content/full/169/3/294  

  • June 12, 2008
  • 09:07 AM
  • 2,026 views

When surgical dogma is challenged

by Orac in Respectful Insolence

From my perspective, one thing that's always been true of surgery that has bothered me is that it is prone to dogma. I alluded to this a bit earlier this week, but, although things have definitely changed in the 20 years since I first set foot, nervously and tentatively, on the wards of the Cleveland VA Medical Center for my first ever surgical rotation, some habits of surgeons die hard.

Of course, regardless of the tendency towards dogma, one thing that differentiates evidence- and scienc........ Read more »

Kristoffer Lassen, Jorn Kjoeve, Torunn Fetveit, Gerd Trana, Helgi Kjartan, Arild Horn, & Arthur Revhaug. (2008) Allowing Normal Food at Will After Major Upper Gastrointestinal Surgery Does Not Increase Morbidity: A Randomized Multicenter Trial. Annals of Surgery, 247(5), 721-729. http://www.annalsofsurgery.com/pt/re/annos/abstract.00000658-200805000-00001.htm;jsessionid

  • October 7, 2008
  • 10:00 AM
  • 2,002 views

Hypnosis and hot flashes: When will they ever learn?

by Orac in Respectful Insolence

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 w........ Read more »

  • October 6, 2008
  • 11:00 AM
  • 1,998 views

Vitamin C and cancer revisited

by Orac in Respectful Insolence

Sometimes I have to look for blog ideas, trolling through various alternative medicine sites, medical news sites, or science news feeds or my medical and science journals. Sometimes ideas fall on me seemingly out of the blue. This is one of the latter situations. This time around, as I do twice a month I was perusing the very latest issue of Cancer Research, hot off the presses October 1. As I did so, it didn't take me long to come across an article from the Memorial-Sloan Kettering Cancer Cente........ Read more »

M. L. Heaney, J. R. Gardner, N. Karasavvas, D. W. Golde, D. A. Scheinberg, E. A. Smith, & O. A. O'Connor. (2008) Vitamin C Antagonizes the Cytotoxic Effects of Antineoplastic Drugs. Cancer Research, 68(19), 8031-8038. DOI: 10.1158/0008-5472.CAN-08-1490  

  • December 31, 2009
  • 09:00 AM
  • 1,985 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 stu........ Read more »

  • October 3, 2008
  • 10:00 AM
  • 1,963 views

The life cycle of translational research

by Orac in Respectful Insolence

You can tell I'm really busy when I fall behind my reading of the scientific literature to the point where I miss an article highly relevant to topics I'm interested in, be they my laboratory research, clinical interests, or just general interests, such as translational research. As you know, I like to think of myself as a translational researcher. Translational research is research that (or so we try to do) spans both basic science and clinical science; i.e., bridges the gap between basic and c........ Read more »

D. G. Contopoulos-Ioannidis, G. A. Alexiou, T. C. Gouvias, & J. P. A. Ioannidis. (2008) Life Cycle of Translational Research for Medical Interventions. Science, 321(5894), 1298-1299. DOI: 10.1126/science.1160622  

  • October 15, 2008
  • 04:00 AM
  • 1,938 views

It's not just acupuncture; it's laser acupuncture!

by Orac in Respectful Insolence

Why, oh, why do I keep perusing NaturalNews.com?

Why do I subject myself to wave after wave of neuron-apoptosing stupidity of a magnitude that even activation of NF-kappaB, Akt, and neuronal cell survival signaling pathways can barely keep the killing stupidity at bay? I guess it's because it provides such good blog fodder for a skeptical blog dedicated to science- and evidence-based medicine. On the other hand, it often gives me a headache to read its contents. Really, it does. I mean, looking........ Read more »

  • January 29, 2009
  • 09:00 AM
  • 1,936 views

Can we finally just say that acupuncture is nothing more than an elaborate placebo? Can we?

by Orac in Respectful Insolence

I think my title says it all: Can we finally just say that acupuncture is nothing more than an elaborate placebo? Can we?

The reason I ask this question is because yet another large meta-analysis has been released that is entirely consistent with the hypothesis that acupuncture is a placebo. Because I've written about so many of these sorts of studies over the last year or two that I really had a hard time mustering up the will to write about one more. But I got in pretty late last night and th........ Read more »

  • October 8, 2008
  • 10:00 AM
  • 1,930 views

Yawn. Another worthless acupunct--I mean acupressure--study

by Orac in Respectful Insolence

Here we go again.

It seems just yesterday that I was casting a skeptical eye on yet another dubious acupuncture study. OK, it wasn't just yesterday, but it was less than two weeks ago when I discussed why a study that purported to show that acupuncture worked as well as drug therapy for hot flashes due to breast cancer therapy-induced menopause. Unfortunately, these days these sorts of dubious studies seem to be popping up fast and furious like Whac-A-Mole, so much so that I can't always keep u........ Read more »

Shu-Ming Wang, Sandra Escalera, Eric C. Lin, Inna Maranets, & Zeev N. Kain. (2008) Extra-1 Acupressure for Children Undergoing Anesthesia. Anesthesia , 107(3), 811-816. DOI: 10.1213/ane.0b013e3181804441  

  • July 6, 2009
  • 09:28 AM
  • 1,909 views

Popularity versus reliability in medical research

by Orac in Respectful Insolence

Two of the major themes on this blog since the very beginning has been the application of science- and evidence-based medicine to the care of patients and why so much of so-called "complementary and alternative" medicine, as well as fringe movements like the anti-vaccine movement, have little or--more commonly--virtually no science to support their claims and recommendations. One major shortcoming of the more commonly used evidence-based medicine paradigm (EBM) that has been in ascendance as the........ Read more »

  • May 27, 2009
  • 05:00 AM
  • 1,893 views

The anti-vaccine movement: Is it too late for scientists to bridge the gap between evidence and fear?

by Orac in Respectful Insolence

Hot on the heels of yesterday's paper in Pediatrics showing that vaccine refusal elevates the risk of pertussis in a child by nearly 23-fold, a commentary in PLoS Biology asks what can be done to combat anti-vaccine misinformation. Entitled A Broken Trust: Lessons from the Vaccine-Autism Wars, it's an interview with a professor of medical anthropology at UCSF named Sharon Kaufman, who took a 26 month hiatus from her usual work on aging and longevity to study the anti-vaccine movement from an ant........ Read more »

  • December 1, 2008
  • 09:00 AM
  • 1,887 views

The spontaneous regression of breast cancer?

by Orac in Respectful Insolence

I tell ya, I'm on the light blogging schedule for a mere four days, thanks to the Thanksgiving holiday weekend, the happy invasion of family on Thursday and Friday, and a significant amount of grant writing I've had to deal with on Saturday and Sunday, and somehow I missed not only a study relevant to my field of interest, but the reaction of antiscientific quackery apologists to said study. First, let's look at the reaction, then the study, which reports that as many as 22% of mammographically ........ Read more »

Per-Henrik Zahl, MD, PhD, Jan Mæhlen, MD, PhD, & H. Gilbert Welch, MD, MPH. (2008) The Natural History of Invasive Breast Cancers Detected by Screening Mammography. Archives of Internal Medicine, 168(21), 2311-2316. DOI: http://archinte.ama-assn.org/cgi/content/abstract/168/21/2311  

  • January 6, 2009
  • 09:00 AM
  • 1,886 views

How not to do a study on the efficacy of "alternative" medicine

by Orac in Respectful Insolence

If there's one thing I've learned over the last four years of examining the various forms of woo out there, it's to be very, very skeptical whenever an advocate of a highly dubious-sounding "therapy" points to a study as "proof" that the therapy, whatever it is, works. Usually, what I find is a small pilot study with inadequate controls or even a poorly designed study. For example, the acupuncture literature is rife with these sorts of studies. It's also rife with larger studies for which the co........ Read more »

A. M Sullivan, S. Bauer-Wu, & M. Miovic. (2008) The Tong Ren Healing Method: A Survey Study. Complementary Health Practice Review. DOI: 10.1177/1533210108329265  

  • February 27, 2008
  • 09:10 AM
  • 1,881 views

Do cell phones make men sterile?

by Orac in Respectful Insolence

A few days ago, I came across an article on Engadget that mentioned almost in passing some studies that seemed to indicate health problems or no health problems, depending on the specific study, due to the ubiquitous and maligned cellular telephone. Not having dealt with this issue much on my blog, I decided to take a look, mostly out of curiosity. The claims that cell phones somehow cause cancer have been circulating for many years, and the studies marshaled to show such a link have in general ........ Read more »

  • January 20, 2009
  • 09:00 AM
  • 1,857 views

Surgical checklists as a strategy to reduce morbidity and mortality

by Orac in Respectful Insolence

About a year ago, I discussed an article by Dr. Atul Gawande describing a quality improvement initiative that appeared to have been stalled by the Office for Human Research Protections and its apparent tendency to apply human subjects research protection rules to initiatives that are not exactly research using human subjects. The problem appeared to be an excessively legalistic and a "CYA" attitude more than a genuine concern for protecting human subjects. At the time, I was more concerned with ........ Read more »

A. B. Haynes, T. G. Weiser, W. R. Berry, S. R. Lipsitz, A.-H. S. Breizat, E. P. Dellinger, T. Herbosa, S. Joseph, P. L. Kibatala, M. C. M. Lapitan.... (2009) A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England Journal of Medicine. DOI: 10.1056/NEJMsa0810119  

  • March 23, 2009
  • 09:46 AM
  • 1,802 views

Does alternative medicine use result in worse outcomes in breast cancer?

by Orac in Respectful Insolence

Has it really been that long?

More than two years ago, I wrote a post entitled Death by Alternative Medicine: Who's to Blame? The topic of the post was a case report that I had heard while visiting the tumor board of an affiliate of my former cancer center describing a young woman who had rejected conventional therapy for an eminently treatable breast cancer and then returned two or three years later with a large, nasty tumor that was much more difficult to treat and possibly metastatic to the........ Read more »

H. J. G. Bloom,, W. W. Richardson, & E. J. Harries. (1962) Natural History of Untreated Breast Cancer (1805-1933). British Medical Journal, 213-221. DOI: PMC1925646  

Verkooijen, H., Fioretta, G., Rapiti, E., Bonnefoi, H., Vlastos, G., Kurtz, J., Schaefer, P., Sappino, A., Schubert, H., & Bouchardy, C. (2005) Patients' Refusal of Surgery Strongly Impairs Breast Cancer Survival. Annals of Surgery, 242(2), 276-280. DOI: 10.1097/01.sla.0000171305.31703.84  

  • December 28, 2009
  • 08:00 AM
  • 1,797 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 stu........ 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  

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