Science-Based Medicine

All posts tagged Science-Based Medicine

brains gears_600px
by via Science-Based Medicine

In his first book, On Being Certain: Believing You Are Right Even When You’re Wrong, neurologist Robert Burton showed that our certainty that we are right has nothing to do with how right we are. He explained how brain mechanisms can make us feel even more confident about false beliefs than about true ones. Now, in a new book, A Skeptic’s Guide to the Mind: What Neuroscience Can and Cannot Tell Us About Ourselves, he investigates the larger question of how a brain creates a mind. There is no alternative to the scientific method for studying the physical world, but Burton thinks there are essential limitations to science’s ability to investigate conundrums like consciousness and free will. Brain scientists fall into error because:

…our brains possess involuntary mechanisms that make unbiased thought impossible yet create the illusion that we are rational creatures capable of fully understanding the mind created by these same mechanisms.

He has a bone to pick with neuroscientists. They are discovering fascinating information, but their interpretations often go beyond what the data can really tell us. They often draw questionable conclusions from imaging studies that could have other explanations.

understanding-the-brain 02_200pxThere is a lot going on in our brains that we’re not aware of.  Subconscious brain mechanisms are like a gigantic committee. Everything from your DNA to your past experiences to your political leanings to your emotions is given a vote, and only the result is passed on to your conscious awareness. If all the raw input to the committee were accessible to consciousness, it would be too much information and would hopelessly impair our ability to act. For the mind to function, mental sensations have to override contradictory evidence to create certainty and motivation.

The brain tries to make our experiences meaningful by tricks like re-ordering the temporal sequence of events. When the batter swings, he thinks he is seeing the ball and then reacting; but he initiates his swing before he could possibly be consciously aware of the ball’s trajectory.

Our minds are not truly individual and independent.

MORE . . .

by via Science-Based Medicine

Vitamin-B-InjectionsVitamins are magic. Especially when they’re injected. Roll up the sleeve, find a vein, insert a needle and watch that colourful concoction flow directly into the bloodstream. It may sound somewhat illicit, but that person infusing it is wearing a white coat, and you’re sitting in a chic clinic. There must be something to it, right? Intravenous vitamin injections are popular with celebrities and have even been described by Dr. Oz as “cutting edge”. Advocates claim vitamin injections can benefit serious conditions like cancer, Parkinson’s disease, macular degeneration, fibromyalgia, depression, and that modern-day obsession, “detoxification”. And vitamin infusions aren’t just for the ill. They’re also touted as helpful for preventing illness, too. A search for vitamin injections brings up millions of hits and dozens of advertisements. There is no question that vitamin injections are popular. But despite all the hype and all the endorsements, there is no credible evidence to suggest that routine vitamin infusions are necessary or offer any meaningful health benefit. Vitamin infusions are a marketing creation, giving the illusion you’re doing something for your health, but lacking any demonstrable efficacy. What’s more concerning, providers of vitamin therapies target their marketing at those fighting life-threatening illnesses like cancer, selling unproven treatments in the absence of good scientific evidence that they are beneficial.

The intravenous vitamin industry is a sideshow to science-based health care. Yes, there is an established medical role for injectable vitamins, though it’s no energy-boosting cure-all – they’re used to replace what we should obtain in our diet. As a hospital-based pharmacist I used to prepare sterile bags of total parenteral nutrition (TPN), a mixture of vitamins, carbohydrate, protein and fat that completely replaced the requirement to eat. TPN is effective, but not without risks, and far less preferable than getting your nutrients the old fashioned way – by eating them. There’s also the routine use of injectable vitamins like B12, or iron, all of which can be science-based when used to address true deficiencies, or to manage specific drug toxicities. And there is the therapeutic use of high-dose minerals like intravenous magnesium for acute asthma attacks. But there is no medical justification to infuse vitamins into a vein when you can more appropriately obtain those nutrients in your diet.

MORE . . .

by via Science-Based Medicine

energyhealingSo-called complementary and alternative medicine (CAM) is largely philosophy-based medicine rather than science based. There are a few core concepts that are endlessly recycled in various forms, but it is mythology and culture, not grounded in the rigorous methods of science that allow us to tell the difference between our satisfying fantasies and hard reality. Sometimes proponents of such philosophies try to cloak their beliefs in the appearance of science, resulting in what we simply call pseudoscience.

Harriet Hall coined an excellent term to refer to such pseudoscience -” Tooth Fairy science.” In her metaphor, pseudoscientists sometimes act like scientists by describing the details and statistics of their claimed phenomenon (such as examining all the details of the Tooth Fairy phenomenon) without ever testing the reality of the phenomenon itself. The fundamental concept at the core of their belief is never challenged, or only superficially so, and they proceed prematurely from their faulty premise.

Another term that I find extremely apt is “Cargo Cult science,” a term coined by Richard Feynman. This is a reference to the cargo cults of New Guinea – the pre-industrial tribes were observed building straw mock-ups of control towers, planes, and runways in hopes that the planes they observed flying over head would deliver their cargo to them. In other words – the cargo cults mimicked the superficial appearance of an aviation infrastructure but had none of the real essence or function (because of lack of understanding). This is a perfect analogy to much of what passes for science within the world of CAM.

reiki-hand_200pxNot that we need another analogy, but I have often described such pseudoscience as being lost in the noise. In any endeavor to detect something there is the issue of the signal to noise ratio.  Often the core challenge of scientific research is pulling the signal out from the background noise, or (more to the point) deciding if there is a signal in the noise, or if the information represents pure noise. In this analogy “noise” refers to any randomness in the data or interference from effects other than the alleged signal of interest. What I find is that pseudoscientific investigations of tooth fairy phenomena are completely lost in the noise of data, seeing whatever phantom “signals” support their philosophy. Elaborate but entirely illusory constructs are often crafted (or retrofitted to) these phantom signals.

Energy medicine is a perfect example of cargo-cult, Tooth Fairy, noise-based pseudoscience.

Energy medicine began its life as a philosophy-based notion, and is still philosophy-based, but many of its modern practitioners are desperate for the respectability that science has to offer. Some have therefore erected a pseudoscientific facade for this pre-scientific superstition.

One example I was recently asked to investigate is the Heartmath institute., which promotes an energy-medicine based claim that the heart sends out “energy” waves that regulate the body, including the brain.

MORE . . . .

dr_oz_1
by via Science-Based Medicine

“Medicine is a very religious experience. I have my religion and you have yours. It becomes difficult for us to agree on what we think works, since so much of it is in the eye of the beholder. Data is rarely clean. You find the arguments that support your data, and it’s my fact versus your fact.”

- Mehmet Oz

pilla809_250pxThe above quote is from a recent article for the New Yorker by Michael Specter about Dr. Oz, the most currently popular TV doctor. Specter described this sentiment as “chilling.” To me it sounds like a manifesto – a postmodernist attack on the scientific basic of modern medicine.

In my experience, this sentiment is often at the core of belief in so-called complementary and alternative medicine (CAM). In order to seem respectable and infiltrate the institutions of medical academia, proponents of CAM will say that their treatments are evidence-based and that they are scientific. They have a serious problem, however – their treatments are not evidence-based and are often grossly unscientific. Whenever someone bothers to look at their evidence and examine their science, therefore, they start to backtrack, eventually arriving at their true position, a postmodernist dismissal of science resembling Oz’s statement above. I have heard a hundred versions of the Oz manifesto from CAM supporters.

dr-oz-john-edward1_250pxAs with the postmodernist critique of science itself, there is a kernel of truth to the notion that science has its limits (which makes the sentiment more insidious). Scientists are humans, they have their biases and flaws, scientific studies are imperfect and often conflict, and there are often multiple opinions on specific clinical practices. Where postmodernists fall off the cliff, however, is in concluding from this that science has no legitimacy, that it is entirely a culturally-determined narrative with no special relationship to external reality.

This view, while flirted with by philosophers of science, has been rejected because it neglects the fact that science uses a valid method of justification. The process may be messy, but over time scientific evidence can objectively resolve differences of opinion. Experts can eventually agree on what works and what doesn’t, and from that a standard of care emerges. High quality evidence can become so overwhelming that there is no room left for personal opinion.

Short of a solid consensus, science-based practitioners can follow a hierarchy of evidence – we can base our practices on the best evidence currently available. CAM practitioners also fail to follow such a hierarchy of evidence.

MORE . . .

red-palm-oil-dr-oz

Recommended Reading: Top Ten Things You Should Know About Alternative Medicine – Harriet Hall,M.D. (PDF)

2011_quackery
via Science-Based Medicine

Any sociological question is likely going to have a complex answer with many variables that are not easy to tease apart. We should therefore resist the temptation to make simplistic statements about X being the cause of Y. We can still, however, identify correlations that will at least inform our thinking. Sometimes correlations can be triangulated to fairly reliable conclusions.

When the data is complex and difficult to interpret, however, evidence tends to be overwhelmed by narrative. The recent Sandy Hook tragedy is an excellent example. No one knows exactly why the shooter did what he did, so it is easy to insert your own preferred narrative as the explanation.

miracle-hat_300pxAnother example is the phenomenon of so-called complementary and alternative medicine (CAM). Why has it been increasing in popularity (and is it, really?). Is it slick marketing, relaxed regulations, scientific illiteracy, a gullible media,  or the failures of mainstream medicine? You can probably guess I think it’s all of these things to some degree. The most common narrative I hear by far, however, is the latter – if people are turning to CAM it must be because mainstream medicine has failed them. This version of reality is often promoted by CAM marketing.

The evidence that we have, however, simply does not support this narrative. Studies show that satisfaction with mainstream medicine is not an important factor in deciding to use CAM, that CAM users are generally satisfied with their mainstream care, and they use CAM because it aligns with their philosophy, and they simply want to expand their options.

None of this is to imply that mainstream medicine has no problems or failings – it does. We should, however, be working toward keeping and improving what works and fixing what doesn’t, not discarding science and reason to embrace fantasy as an alternative. This is often the false choice presented by CAM proponents, and is analogous to creationists pointing out alleged weaknesses in the theory of evolution as an argument for creationism as an alternative.

MORE . . .

via Science-Based Medicine

That Dr. Mehmet Oz uses his show to promote quackery of the vilest sort is no longer in any doubt. I was reminded yet again of this last week when I caught a rerun of one of his shows from earlier this season, when he gazed in wonder at the tired old cold reading schtick used by all “psychic mediums” from time immemorial, long before the current crop of celebrity psychic mediums, such as John Edward, Sylvia Browne, and the “Long Island Medium” Theresa Caputo, discovered how much fame and fortune they could accrue by scamming the current generation of the credulous. LongIslandMedium_250pxSpeaking of Theresa Caputo, that’s exactly who was on The Dr. Oz Show last week (in reruns), and, instead of being presented as the scammer that she is, never was heard even a hint of a skeptical word from our erstwhile “America’s doctor,” who cheerily suggested that seeing a psychic medium scammer is a perfectly fine way to treat crippling anxiety because, well, Caputo claims that it is. Even worse, apparently it wasn’t even the first time that Dr. Oz had Caputo on his show, and Caputo wasn’t even the first psychic whose schtick he represented as somehow being a useful therapeutic modality for various psychological issues. “Crossing Over” psychic John Edward was there first in a segment Oz entitled Are Psychics the New Therapists? I could have saved him the embarrassment and simply told him no, but apparently Oz is too easily impressed. As I said before, if he’s impressed by clumsy cold readers like Browne, Caputo, and Edward, it doesn’t take much to impress him. Also, apparently his producers aren’t above editing science-based voices beyond recognition to support their quackery.

I was further reminded how Dr. Oz promotes quackery by an article in Slate yesterday entitled Dr. Oz’s Miraculous Medical Advice: Pay no attention to that man behind the curtain. I suppose it would be mildly hypocritical of me to snark at the rather obvious “Wizard of Oz” jokes aimed at Dr. Oz. After all, I’ve used the same joke myself at one time or another and, in light of the Slate.com article, couldn’t resist using it in the title of my post. However, I wasn’t about to let that distract me from the article itself, which is very good. The reason is that there are two aspects to Dr. Oz’s offenses against medical science. psychic-john-edward-2012-events_02There is the pure quackery that he features and promotes, such as psychic scammers like John Edward and Theresa Caputo, faith healing scammers like Dr. Issam Nemeh, and “alternative health” scammers like reiki masters, practitioners of ayruveda, Dr. Joe Mercola, who was promoted as a “pioneer” that your doctor doesn’t want you to know about. Never was it mentioned that there are very good reasons why a competent science-based physician would prefer that his patients have nothing to do with Dr. Mercola, who runs what is arguably the most popular and lucrative alternative medicine website currently in existence and manages to present himself as reasonable simply because he is not as utterly loony as his main competition, Mike Adams if NaturalNews.com (who has of late let his New World Order, anti-government, “Obama’s coming to take away your guns” conspiracy theory freak flag fly) and Gary Null.

The second aspect is that Dr. Oz also does give some sensible medical advice.

MORE . . .

by

If you believe everything you read on the internet, then is seems that a chemical found in thousands of products is causing an epidemic of severe neurological and systemic diseases, like multiple sclerosis and lupus. The FDA, the companies that make the product, and the “medical industrial complex” all know about the dangers of this chemical but are hiding the truth from the public in order to protect corporate profits and avoid the pesky paper work that would accompany the truth being revealed. The only glimmer of hope is a dedicated band of bloggers and anonymous e-mail chain letter authors who aren’t afraid to speak the truth. Armed with the latest anecdotal evidence, unverified speculation, and scientifically implausible claims, they have been tirelessly ranting about the evils of this chemical for years. Undeterred by the countless published studies manufactured by the food cartel that show this chemical is safe, they continue to protect the public by spreading baseless fear and hysteria.

Hopefully, you don’t believe everything you read on the internet, and you don’t get your science news from e-mail SPAM, where the above scenario is a common theme. While there are many manifestations of this type of urban legend, I am speaking specifically about aspartame – an artificial sweetener used since the early 1980s. The notion that aspartame is unsafe has been circulating almost since it first appeared, and like rumors and misinformation have a tendency to do, fears surrounding aspartame have taken on a life of their own.

Keep Reading: Science-Based Medicine » Aspartame – Truth vs Fiction.