Science-Based Medicine

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47 posts · 114,257 views

Exploring issues and controversies in the relationship between science and medicine

Peter Lipson
13 posts

5 posts

Scott Gavura
12 posts

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  • August 25, 2011
  • 04:00 PM

When a “scientific study” is neither

by Peter Lipson in Science-Based Medicine

There is quite a bit of art to the practice of medicine: knowing how to get and to give information to a patient, how to create a sense of worry without creating a feeling of panic, how to use the best available science to help them maintain or return to health.  Underlying all of the [...]... Read more »

  • July 23, 2011
  • 01:01 AM

Asthma, placebo, and how not to kill your patients

by Peter Lipson in Science-Based Medicine

A number of years ago I was walking along Lake Michigan with a friend (a fellow medical resident) when she turned to me and said, “are you wheezing?  Do you have asthma?”  I had always been physically active and assumed my breathlessness while walking down the trail was due to the thirty extra pounds of [...]... Read more »

Wechsler ME, Kelley JM, Boyd IO, Dutile S, Marigowda G, Kirsch I, Israel E, & Kaptchuk TJ. (2011) Active albuterol or placebo, sham acupuncture, or no intervention in asthma. The New England journal of medicine, 365(2), 119-26. PMID: 21751905  

  • July 21, 2011
  • 09:00 AM

Salt: More confirmation bias for your preferred narrative

by Scott Gavura in Science-Based Medicine

Judging by the recent press reports, the latest Cochrane review reveals that everything we’ve been told about eating salt, and cardiovascular disease, is wrong: The New York Times: Nostrums: Cutting Salt Has Little Effect on Heart Risk The Daily Mail: Cutting back on salt ‘does not make you healthier’ (despite nanny state warnings) Scientific American: [...]... Read more »

Taylor RS, Ashton KE, Moxham T, Hooper L, & Ebrahim S. (2011) Reduced dietary salt for the prevention of cardiovascular disease. Cochrane database of systematic reviews (Online). PMID: 21735439  

  • July 8, 2011
  • 10:48 AM

Scientific evidence for synergy in a botanical product

by David J Kroll in Science-Based Medicine

So, you’re curious about herbal medicine. Is there any truth to this stuff? Uncle Howie tells you that he read in the National Enquirer about an herb that has better antibacterial effects on cuts and scrapes than Neosporin ointment – never mind that Neosporin is composed of three different antibiotics that come originally from bacteria [...]... Read more »

Junio HA, Sy-Cordero AA, Ettefagh KA, Burns JT, Micko KT, Graf TN, Richter SJ, Cannon RE, Oberlies NH, & Cech NB. (2011) Synergy-Directed Fractionation of Botanical Medicines: A Case Study with Goldenseal (Hydrastis canadensis). Journal of Natural Products. PMID: 21661731  

  • July 7, 2011
  • 09:00 AM

Vaccine Confidence: Attitudes and Actions

by Scott Gavura in Science-Based Medicine

Few groups are more hazardous to public health than the anti-vaccine movement – because there’s a body count affiliated with their actions. When vaccination rates drop, communicable diseases re-emerge, and people suffer. While anti-vaccine sentiment will probably persist as long as vaccines are around, we’re fortunate that vaccination rates, on balance, remain very high. In [...]... Read more »

Kennedy A, Lavail K, Nowak G, Basket M, & Landry S. (2011) Confidence about vaccines in the United States: understanding parents' perceptions. Health affairs (Project Hope), 30(6), 1151-9. PMID: 21653969  

  • June 23, 2011
  • 08:30 AM

Et tu, Biomarkers?

by Scott Gavura in Science-Based Medicine

Everything you know may be wrong. Well, not really, but reading the research of John Ioannidis does make you wonder. His work, concentrated on research about research, is a popular topic here at SBM.  And that’s because he’s focused on improving the way evidence is brought to bear on decision-making. His most famous papers get [...]... Read more »

  • May 16, 2011
  • 04:02 AM

Surprise, surprise! Dr. Andrew Weil doesn’t like evidence-based medicine

by David Gorski in Science-Based Medicine

Dr. Andrew Weil is a rock star in the “complementary and alternative medicine” (CAM) and “integrative medicine” (IM) movement. Indeed, it can be persuasively argued that he is one of its founders, at least a founder of the its most modern iteration, and I am hard-pressed to think of anyone who did more in the [...]... Read more »

  • May 13, 2011
  • 11:02 AM

Fungus yields new prescription drug for multiple sclerosis

by David J Kroll in Science-Based Medicine

The following post appeared earlier this week at my Chemical & Engineering News CENtral Science blog, Terra Sigillata. For some odd reason – perhaps this week’s frantic academic schedule of commencement activities – it was not highly read there. I thought that our Science-Based Medicine readers would appreciate it because this new prescription drug is [...]... Read more »

  • May 12, 2011
  • 09:00 AM

Placebo Prescriptions

by Scott Gavura in Science-Based Medicine

Whether it’s acupuncture, homeopathy or the latest supplement, placebo effects can be difficult to distinguish from real effects. Today’s post sets aside the challenge of identifying placebo effects and look at how placebos are used in routine medical practice.  I’ve been a pharmacist for almost 20 years, and have never seen a placebo in practice, [...]... Read more »

  • April 28, 2011
  • 09:00 AM

Do calcium supplements cause heart attacks?

by Scott Gavura in Science-Based Medicine

Calcium is good for us, right? Milk products are great sources of calcium, and we’re told to emphasize milk products in our diets. Don’t (or can’t) eat enough dairy? Calcium supplements are very popular, especially among women seeking to minimize their risk of osteoporosis. Osteoporosis prevention and treatment guidelines recommend calcium and vitamin D as [...]... Read more »

  • March 3, 2011
  • 08:30 AM

Topical NSAIDs

by Scott Gavura in Science-Based Medicine

I have a mental basket of drugs that I suspect may be placebos. In that basket were the topical versions of non-steroidal anti-inflammatory drugs (NSAIDs). When the first products were commercially marketed over a decade ago, I found the clinical evidence unconvincing, and I suspected that the modestly positive effects were probably due to simply [...]... Read more »

Massey T, Derry S, Moore RA, & McQuay HJ. (2010) Topical NSAIDs for acute pain in adults. Cochrane database of systematic reviews (Online). PMID: 20556778  

Trelle, S., Reichenbach, S., Wandel, S., Hildebrand, P., Tschannen, B., Villiger, P., Egger, M., & Juni, P. (2011) Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ, 342(jan11 1). DOI: 10.1136/bmj.c7086  

Haroutiunian, S., Drennan, D., & Lipman, A. (2010) Topical NSAID Therapy for Musculoskeletal Pain. Pain Medicine, 11(4), 535-549. DOI: 10.1111/j.1526-4637.2010.00809.x  

  • February 17, 2011
  • 09:00 AM

Are you sure you’re allergic to penicillin?

by Scott Gavura in Science-Based Medicine

As a pharmacist, when I dispense medication, it’s my responsibility to ensure that the medication is safe and appropriate for the patient. There are numerous checks we go through including verifying the dose, ensuring there are no interactions with other drugs, and verifying the patient has no history of allergy to the product prescribed. Asking [...]... Read more »

Caubet JC, Kaiser L, Lemaître B, Fellay B, Gervaix A, & Eigenmann PA. (2011) The role of penicillin in benign skin rashes in childhood: a prospective study based on drug rechallenge. The Journal of allergy and clinical immunology, 127(1), 218-22. PMID: 21035175  

  • January 20, 2011
  • 08:45 AM

The risks of CAM: How much do we know?

by Scott Gavura in Science-Based Medicine

Working in pharmacies where supplements are sold alongside traditional (over-the-counter) medications, I’m regularly astonished at the different perceptions consumers can have about the relative efficacy and safety of different types of products. Once, speaking with a customer about a medical condition she wanted to treat, I indicated that there were no effective non-prescription therapies — [...]... Read more »

  • January 6, 2011
  • 07:00 AM

Energy Drinks

by Scott Gavura in Science-Based Medicine

My stimulant of choice is coffee. I started drinking it in first-year university, and never looked back. A tiny four-cup coffee maker became my reliable companion right through graduate school. But since I stopped needing to drink a pot at a time, an entirely new category of products has appeared — the energy drink. Targeting [...]... Read more »

  • December 23, 2010
  • 07:00 AM

Vaccines are a pain: What to do about it

by Scott Gavura in Science-Based Medicine

As much as I support vaccines, I see the short term consequences. Vaccines can be painful. Kids don’t like them, and parents don’t like seeing their children suffer. That this transient pain is the most common consequence of gaining  protection from fatal illnesses seems like a fair trade-off to me. But that’s not the case [...]... Read more »

Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, Hanrahan A, Ipp M, Lockett D, Macdonald N.... (2010) Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline (summary). CMAJ : Canadian Medical Association journal , 182(18), 1989-95. PMID: 21098067  

  • December 9, 2010
  • 08:00 AM

Good Idea, Bad Execution: Dosing Errors, A Preventable Harm

by Scott Gavura in Science-Based Medicine

We spend a lot time at SBM discussing different elements of the art and science of medicine, and how we believe that practice can be improve. Yet our science-based intentions can be thwarted at the last possible moment – in the form of dosing errors. The workup may have been comprehensive, the diagnosis could be [...]... Read more »

Yin HS, Mendelsohn AL, Wolf MS, Parker RM, Fierman A, van Schaick L, Bazan IS, Kline MD, & Dreyer BP. (2010) Parents' medication administration errors: role of dosing instruments and health literacy. Archives of pediatrics , 164(2), 181-6. PMID: 20124148  

  • November 4, 2010
  • 04:00 AM

Why science reporters should do their homework

by Peter Lipson in Science-Based Medicine

One of the most significant medical advancements of the last few decades has been the use of cholesterol-lowering medications called statins.  These drugs, when used properly, have been shown over and over to lower the risk of heart attacks, strokes, and death.  But like all drugs, they have many effects, both those we like (preventing [...]... Read more »

Quinn, J., Raman, R., Thomas, R., Yurko-Mauro, K., Nelson, E., Van Dyck, C., Galvin, J., Emond, J., Jack, C., Weiner, M.... (2010) Docosahexaenoic Acid Supplementation and Cognitive Decline in Alzheimer Disease: A Randomized Trial. JAMA: The Journal of the American Medical Association, 304(17), 1903-1911. DOI: 10.1001/jama.2010.1510  

Forette F, Seux ML, Staessen JA, Thijs L, Birkenhäger WH, Babarskiene MR, Babeanu S, Bossini A, Gil-Extremera B, Girerd X.... (1998) Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet, 352(9137), 1347-51. PMID: 9802273  

  • October 7, 2010
  • 01:46 PM

Do you have low T?

by Peter Lipson in Science-Based Medicine

If you google “low testosterone” you’ll see lots of ads for testosterone replacement.  Some are from pharmaceutical companies that sell testosterone, others from obvious snake-oil salesmen.
Both types of ads list vague sets of symptoms, encourage you to believe that they are pathologic, and want to sell you something to make you better.  For example, the [...]... Read more »

Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM, & Task Force, Endocrine Society. (2010) Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. The Journal of clinical endocrinology and metabolism, 95(6), 2536-59. PMID: 20525905  

Araujo, A., Esche, G., Kupelian, V., O'Donnell, A., Travison, T., Williams, R., Clark, R., & McKinlay, J. (2007) Prevalence of Symptomatic Androgen Deficiency in Men. Journal of Clinical Endocrinology , 92(11), 4241-4247. DOI: 10.1210/jc.2007-1245  

  • August 12, 2010
  • 04:00 AM

Homeoprophylaxis: An idea whose time has come—and gone

by Peter Lipson in Science-Based Medicine

One of the strengths of modern medical education is its emphasis on basic science.  Conversely, the basic weakness of so-called alternative medicine is its profound ignorance of science and its reliance on magical thinking.  Nowhere is this more apparent than in the attempts of altmed cults to conduct and publish research.  From “quantum water memory” [...]... Read more »

Bracho, G., Varela, E., Fernández, R., Ordaz, B., Marzoa, N., Menéndez, J., García, L., Gilling, E., Leyva, R., & Rufín, R. (2010) Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control. Homeopathy, 99(3), 156-166. DOI: 10.1016/j.homp.2010.05.009  

  • July 8, 2010
  • 10:15 AM

Sunscreen in a Pill?

by Scott Gavura in Science-Based Medicine

I’ve previously described the consequences of acute and chronic sun exposure, and the rationale for topical sunscreen products. But wouldn’t it be easier to just take a pill that can boost our skin’s resistance to to the harmful effects of the sun? Is it possible to get all the benefits of sunscreen without the bother [...]... Read more »

Middelkamp-Hup MA, Pathak MA, Parrado C, Goukassian D, Rius-Díaz F, Mihm MC, Fitzpatrick TB, & González S. (2004) Oral Polypodium leucotomos extract decreases ultraviolet-induced damage of human skin. Journal of the American Academy of Dermatology, 51(6), 910-8. PMID: 15583582  

Middelkamp-Hup MA, Pathak MA, Parrado C, Garcia-Caballero T, Rius-Díaz F, Fitzpatrick TB, & González S. (2004) Orally administered Polypodium leucotomos extract decreases psoralen-UVA-induced phototoxicity, pigmentation, and damage of human skin. Journal of the American Academy of Dermatology, 50(1), 41-9. PMID: 14699363  

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