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Respectful Insolence
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February 9, 2010
07:00 AM
83 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 c........ 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
157 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 misbego........ 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
206 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 »

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
236 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

December 10, 2009
09:00 AM
273 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........ 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
257 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........ 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
385 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, ju........ 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

September 14, 2009
09:00 AM
329 views

The Gonzalez protocol: Worse than useless for pancreatic cancer

by Orac in Respectful Insolence

The silence is deafening.

Yes, I know it's a cliche, but it's really true this time. Last month, a major study whose results had been anticipated by the alt-med community, as well as those of us who consider it to be highly unethical pseudoscience, were reported. However, they were reported without fanfare, without press releases, without any sort of publicity whatsoever. Only a handful of bloggers who have paid attention to the issue (myself included) even noticed, and even I wouldn't have not........ Read more »

John A. Chabot, Wei-Yann Tsai, Robert L. Fine, Chunxia Chen, Carolyn K. Kumah, Karen A. Antman, & Victor R. Grann. (2009) Pancreatic Proteolytic Enzyme Therapy Compared With Gemcitabine-Based Chemotherapy for the Treatment of Pancreatic Cancer. Journal of Clinical Oncology. info:/10.1200/JCO.2009.22.8429

August 27, 2009
12:00 PM
386 views

Scientists are only two years from developing a cure for breast cancer?

by Orac in Respectful Insolence

Want to know what will start my teeth grinding when I read it in a newspaper? That's easy. It's headlines like this one, which appeared two days ago in The Telegraph:

Scientists two years from developing 'potential cure' for breast cancer

The subtitle was even worse:

British scientists could be just two years away from developing a drug that may be a "potential cure" for breast cancer, it has been claimed.

Hear that grating? It's the sound of my teeth grinding together. The reason is simple......... Read more »

Castellano, L., Giamas, G., Jacob, J., Coombes, R., Lucchesi, W., Thiruchelvam, P., Barton, G., Jiao, L., Wait, R., Waxman, J.... (2009) The estrogen receptor- -induced microRNA signature regulates itself and its transcriptional response. Proceedings of the National Academy of Sciences. DOI: 10.1073/pnas.0906947106

July 6, 2009
09:28 AM
522 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 »

Ioannidis, J. (2005) Why Most Published Research Findings Are False. PLoS Medicine, 2(8). DOI: 10.1371/journal.pmed.0020124

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

June 24, 2009
09:17 AM
473 views

Electroacupuncture: The bait and switch of alternative medicine

by Orac in Respectful Insolence

At the risk of repeating myself (but, then, since when did such concerns ever stop me before?), I'll just start out by mentioning that, of all the non-herbal "alternative" medicine remedies out there, I used to give a bit of a pass to acupuncture. No, I never did buy any of that nonsense about how sticking thin needles into the skin at points along various "meridians" somehow "redirects the flow of qi," that mystical life force upon which so much woo, particularly woo based on Eastern mysticism ........ Read more »

Fu, L., & Longhurst, J. (2009) Electroacupuncture modulates vlPAG release of GABA through presynaptic cannabinoid CB1 receptors. Journal of Applied Physiology, 106(6), 1800-1809. DOI: 10.1152/japplphysiol.91648.2008

June 2, 2009
10:12 AM
488 views

Medicine and evolution, part 12: Using evolution to develop adaptive chemotherapy

by Orac in Respectful Insolence

Three years ago, I wrote about what I considered to be a fascinating and promising approach to understanding tumor biology. This method involved understanding that tumors are in general made up of a heterogeneous collection of cells. Using this knowledge, it is possible to apply evolutionary principles to cancer, treating a tumor as, in essence, an ecosystem. Indeed, that is exactly what Maley et al did three years ago. They applied evolutionary principles to the precancerous lesion in the dista........ Read more »

Gatenby, R., Silva, A., Gillies, R., & Frieden, B. (2009) Adaptive Therapy. Cancer Research, 69(11), 4894-4903. DOI: 10.1158/0008-5472.CAN-08-3658

May 27, 2009
05:00 AM
488 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 »

Gross, L. (2009) A Broken Trust: Lessons from the Vaccine–Autism Wars. PLoS Biology, 7(5). DOI: 10.1371/journal.pbio.1000114

May 26, 2009
09:50 AM
406 views

One more time: Vaccine refusal endangers children

by Orac in Respectful Insolence

One of the claims of the anti-vaccine movement that most irks me is that their actions do not risk harm to anyone other than their own unvaccinated children. Given that vaccination against many infectious diseases also depends on the concept of herd immunity to provide protection to members of the population who either cannot be vaccinated for medical reasons, are too young to be vaccinated, or who belong to the minority who do not develop adequate immunity to vaccination, such claims are patent........ Read more »

Jason M. Glanz, PhD, David L. McClure, PhD, David J. Magid, MD, MPH, Matthew F. Daley, MD, Eric K. France, MD, MSPH, Daniel A. Salmon, PhD, MPH, & Simon J. Hambidge, MD, PhD. (2009) Parental Refusal of Pertussis Vaccination Is Associated With an Increased Risk of Pertussis Infection in Children. Pediatrics, 123(6), 1446-1451. DOI: http://www.pediatrics.org/cgi/doi/10.1542/

May 13, 2009
09:59 AM
509 views

Another acupuncture study misinterpreted

by Orac in Respectful Insolence

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

March 23, 2009
09:46 AM
567 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

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

March 19, 2009
09:37 AM
629 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
650 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

January 29, 2009
09:00 AM
586 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 »

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

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