Here is a recap of the stories that appeared last recently at Science-Based Medicine, a multi-author skeptical blog that separates the science from the woo in medicine.
Does peer review need fixing? (David Gorski) Peer review, whereby a scientific article must be scrutinized and approved by the authors’ peers prior to publication, is a flawed system with many defects; but it is still better than the absence of peer review. The peer review process should not be abandoned or radically changed, but it can be improved.
High Fructose Corn Syrup: Tasty Toxin or Slandered Sweetener? (Jim Laidler) HFCS has only a slightly higher percentage of fructose than table sugar (55% vs. 50%) and a lower percentage than some fruits and natural sweeteners. It is sweeter, so using it can reduce the total sugar content of a processed food. A high fructose diet increases the risk of certain diseases, but switching to other sweeteners is not likely to prevent those diseases. Reducing total intake of sweeteners makes more sense than worrying about the evils of HFCS.
Antioxidant Supplements for Macular Degeneration (Harriet Hall) There is limited evidence (from one trial, the AREDS study) that a combination of antioxidant vitamins and zinc can slow the progression of moderate to advanced macular degeneration, a common cause of blindness. Some are recommending it for prevention (without any supporting evidence), and the manufacturer is unwisely hyping a new formula that has not been tested.
Peer Review and the Internet (Steven Novella) Thanks to the speed and interactivity of the Internet, experiments are underway that may improve the traditional peer-review process or offer some new hybrid of peer review and open publication. Dr. Novella discusses the implications.
Tai chi and fibromyalgia in the New England Journal of Medicine: An “alternative” frame succeeds (David Gorski) A new study showing that tai chi benefits patients with fibromyalgia is being touted as a success of “alternative” medicine, but when examined closely it appears that there is nothing “alternative” about any of their findings. Exercise, stretching, relaxation and other components of tai chi can be studied within conventional scientific medicine without invoking any “alternative” concepts like qi or energy medicine.
Why bother? (Peter Lipson) Criticism of alternative medicine can be counterproductive, especially if critics act like dicks. On the other hand, basic errors (like “it can’t be studied by Western reductionist scientific methods”) must be confronted without pulling any punches.
A pox on your bank account: failure to vaccinate and its legal consequences (Jann Bellamy) A lawyer discusses the legal liabilities involved when a child catches a vaccine-preventable disease from an unvaccinated child.
“Integrative” oncology: Trojan horse, quackademic medicine, or both? (David Gorski) Pseudoscience is infiltrating academia; “integrative” oncology all too often serves to integrate science-based medicine with quackery. It promotes nonsense like “energy medicine” and homeopathy and tries to claim ownership of adjunctive treatments like diet and exercise that rightfully belong to scientific medicine.
Testosterone: Not an Anti-Aging Panacea (Harriet Hall) Testosterone replacement therapy is being promoted as a general pick-me-up and anti-aging treatment. Several new studies support the consensus of mainstream medicine that testosterone replacement is only useful for patients with specific problems attributable to low testosterone levels.
Pertussis Epidemic 2010 (Steven Novella) We are in the midst of an epidemic of pertussis that is likely to result in the highest incidence in 50 years. Several factors are probably contributing; the solution is to support herd immunity with boosters for adults.
Medical Science and Public Opinion: The Avandia Story (James Dougherty) The anti-diabetes drug Avandia is effective, but concerns have been raised about its safety. Dr. Dougherty describes how the FDA review process works to evaluate confusing evidence and how science and public opinion interact to determine the approval of a medical treatment.
How to make a difference – Responsible vaccine advocacy (Joseph Albietz) Dr. Albietz recently lost a patient, an infant too young to have been vaccinated, to pertussis after a month of cutting edge medical treatment proved insufficient to save his life. The only way to prevent such deaths is to support herd immunity with vaccination; recent innovative efforts to educate the public are praiseworthy.
Germ theory denialism: A major strain in “alt-med” thought (David Gorski) Just as some people continue to deny evolution, there are still many people who deny the germ theory of disease and employ spurious reasoning and misconceptions about “terrain” and “toxins.” Bill Maher, anti-vaccine activists, naturopaths, and other alternative medicine proponents have failed to understand the strong evidence for germ theory and how it forms the basis of much of modern medicine.
Alchemy Is Back (Harriet Hall) Modern alchemists claim to have found the philosopher’s stone that can change lead to gold and that acts as a elixir of life to cure every disease. You can make it yourself out of dew and Celtic sea salt; it will completely eliminate the pharmaceutical industries.
Venous Insufficiency in Multiple Sclerosis (Steven Novella) Dr. Paolo Zamboni believes that multiple sclerosis patients have chronic cerebrospinal venous insufficiency and he claims to cure it with vascular surgery. Hopeful patients are requesting the surgery, but their enthusiasm is premature. Early research reports are not promising: only one of four replications agreed with Zamboni’s findings.
Homeoprophylaxis: An idea whose time has come – and gone (Peter Lipson) Researchers in Cuba tried to show that homeopathy could prevent an infection called leptospirosis. They conducted a study of questionable ethics and questionable methodology, and came up with questionable conclusions. They didn’t use a control group or consider possible alternative explanations for their data.
NEJM and Acupuncture: Even the best can publish nonsense (Mark Crislip) Dr. Crislip adds his comments to those of previous SBM posts by Drs Novella and Gorski: all three have roundly criticized the recent acupuncture article in the New England Journal of Medicine. The editors have destroyed the credibility of their journal by publishing language and reasoning reminiscent of Animal Farm: saying that even though acupuncture doesn’t work, and isn’t first line therapy for pain, it should be used for first line therapy.
“Hard science” and medical school (David Gorski) Medical school education emphasizes practical applications rather than a deep understanding of the scientific method. A recent program that de-emphasizes pre-med science courses in favor of the humanities is probably misguided; the pre-med curriculum is essential to the development of science-based doctors.
Home Birth Safety (Harriet Hall) A new study reviews all the published evidence on the safety of home birth. While home birth is associated with fewer interventions and fewer maternal infections, it is associated with a tripling of the neonatal mortality rate.
Credulity about acupuncture infiltrates the New England Journal of Medicine (David Gorski) A credulous article by proponents of integrative medicine constitutes an intrusion of quackademic medicine into our most respected medical journal. After showing that acupuncture is no more effective than sham acupuncture (placebo) for low back pain, the authors recommend using it, and even specify the number of treatments! It doesn’t work, but we should use it anyway (!?).
Acupuncture Pseudoscience in the New England Journal of Medicine (Steven Novella) The article on acupuncture for low back pain (see above) contains recommendations that contradict the authors’ own conclusions and amount to an elaborate and misleading plea to use acupuncture for its placebo effects. Dr. Novella calls their tactics “a bait and switch con game.”
Supplement Regulation: Be Careful What You Wish For (Scott Gavura) A discussion of the Diet Supplement Health and Education Act (DSHEA) and how American regulations compare to those of Canada. Canada requires evidence of efficacy, but lowers the standards to where they are practically meaningless, giving bogus remedies a prestige they do not deserve. We need a system that properly informs consumers about product effectiveness and safety: neither country achieves that goal.
Can it get any worse?: industrial bleach as cancer and HIV cure (David Kroll) The FDA has issued a warning about Miracle Mineral Solution ( MMS), an “egregious and obscene” product that produces an industrial bleach that can cause serious harm to health. Its promoters claim it can treat everything from AIDS to warts; they not only encourage patients to use a harmful substance and even inject it IV, but they encourage them to stop taking life-saving prescription drugs.