84 posts · 118,599 views
The miscellaneous ramblings of a surgeon/scientist on medicine, quackery, science, pseudoscience, history, and pseudohistory (and anything else that interests him).
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 »
Y. H. Ju, D. R. Doerge, K. A. Woodling, J. A. Hartman, J. Kwak, & W. G. Helferich. (2008) Dietary Genistein Negates the Inhibitory Effect of Letrozole On The Growth Of Aromatase-expressing Estrogen-Dependent Human Breast Cancer Cells (MCF-7Ca) In Vivo. Carcinogenesis. DOI: 10.1093/carcin/bgn161
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
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 »
Yanxia Sun, & Tong J. Gan. (2008) Acupuncture for the Management of Chronic Headache: A Systematic Review. Anesthesia , 107(6), 2038-2047. DOI: 10.1213/ane.0b013e318187c76a
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
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
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 »
G. Elkins, J. Marcus, V. Stearns, M. Perfect, M. H. Rajab, C. Ruud, L. Palamara, & T. Keith. (2008) Randomized Trial of a Hypnosis Intervention for Treatment of Hot Flashes Among Breast Cancer Survivors. Journal of Clinical Oncology. DOI: 10.1200/JCO.2008.16.6389
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
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 »
M. V. Madsen, P. C Gotzsche, & A. Hrobjartsson. (2009) Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ, 338(jan27 2). DOI: 10.1136/bmj.a3115
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 »
S GOTTSCHLING, S MEYER, I GRIBOVA, L DISTLER, J BERRANG, L GORTNER, N GRAF, & M SHAMDEEN. (2008) Laser acupuncture in children with headache: A double-blind, randomized, bicenter, placebo-controlled trial. Pain, 137(2), 405-412. DOI: 10.1016/j.pain.2007.10.004
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 »
Pfeiffer, T., & Hoffmann, R. (2009) Large-Scale Assessment of the Effect of Popularity on the Reliability of Research. PLoS ONE, 4(6). DOI: 10.1371/journal.pone.0005996
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 »
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
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 »
Gross, L. (2009) A Broken Trust: Lessons from the Vaccine–Autism Wars. PLoS Biology, 7(5). DOI: 10.1371/journal.pbio.1000114
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
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
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
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 »
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
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 »
Anu Karinen, Sirpa Heinavaara, Reetta Nylund, & Dariusz Leszczynski. (2008) Mobile phone radiation might alter protein expression in human skin. BMC Genomics, 9(1), 77. DOI: 10.1186/1471-2164-9-77
A AGARWAL. (2008) Effect of cell phone usage on semen analysis in men attending infertility clinic: an observational study. Fertility and Sterility, 89(1), 124-128. DOI: 10.1016/j.fertnstert.2007.01.166
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
Chang, E., Glissmeyer, M., Tonnes, S., Hudson, T., & Johnson, N. (2006) Outcomes of breast cancer in patients who use alternative therapies as primary treatment. The American Journal of Surgery, 192(4), 471-473. DOI: 10.1016/j.amjsurg.2006.05.013
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
I have to hand it to acupuncture mavens. They are persistent. Despite numerous studies failing to find any evidence that acupuncture is anything more than an elaborate placebo whose effects, such as they are, derive from nonspecifice mechanisms having nothing to do with meridians, qi, or "unblocking" qi. Moreover, consistent with the contention that acupuncture is no more than an elaborate placebo, various forms of "sham" acupuncture (needles that appear to insert but don't or acupuncture in the........ Read more »
Daniel C. Cherkin, Karen J. Sherman, Andrew L. Avins, Janet H. Erro, Laura Ichikawa, William E. Barlow, Kristin Delaney, Rene Hawkes, Luisa Hamilton,, Alice Pressman.... (2009) A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain. Arch Intern Med, 169(9), 858-866. DOI: http://archinte.ama-assn.org/cgi/content/short/169/9/858
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