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Respectful Insolence
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August 19, 2011
04:00 AM
379 views

Quackademic medicine invades Cancer

by Orac in Respectful Insolence

I don't know if I should thank Peter Lipson or condemn him.

What am I talking about? Yesterday, Peter sent me a brain-meltingly bad study in so-called "complementary and alternative medicine" that shows me just how bad a study can be and be accepted into what I used to consider a reasonably good journal. I say "used to consider," because the fact that this journal accepted a study this ludicrously bad indicates to me that peer review at the journal is so broken that I now wonder about what else I've read at that journal that I should now discount as being so unreliable as to be not worth taking seriously. Maybe everything. I don't know. What I do know is that seldom have I seen such a blatant example of quackademic medicine in action, and, worse, seldom have I seen such a bad study in such a good cancer journal.

No doubt at this point, some of you are thinking that I'm being way too harsh on the editors of this journal for having accepted such a steamy, stinky turd of a paper. I expect that you'll come around to my way of thinking after I describe the paper. In fact, I fully expect that some of you will come to the conclusion that I didn't go far enough after you take a look at this paper. So let's dig in, shall we? The journal is Cancer, which is the official journal of the American Cancer Society and has an impact factor of 5.131, which is, as we say, not too shabby. The investigators are from the Samueli Institute, the University of California San Diego, the RAND Corporation, and Healing Light Center Church, and the paper is Complementary Medicine for Fatigue and Cortisol Variability in Breast Cancer Survivors A Randomized Controlled Trial. It's about as perfect an example of what Harriet Hall refers to as "Tooth Fairy Science" as I've ever seen. Read the rest of this post... | Read the comments on this post...... Read more »

Jain, S., Pavlik, D., Distefan, J., Bruyere, R., Acer, J., Garcia, R., Coulter, I., Ives, J., Roesch, S., Jonas, W.... (2011) Complementary medicine for fatigue and cortisol variability in breast cancer survivors. Cancer. DOI: 10.1002/cncr.26345

June 8, 2011
04:47 AM
580 views

More bad science in the service of the discredited idea that vaccines cause autism

by Orac in Respectful Insolence

More than a week has passed, and I thought that this cup had passed from me, and I was glad. After all, if I analyzed every crap study done by anti-vaccine zealots to try to demonstrate that vaccines cause autism, I would have time for little else in terms of other kinds of that Insolence you all know and love. This particular study was released in late May and, at the time, I wasn't really in the mood to take it on; so I ignored it. But then wouldn't you know that the Autism Action Network would have to go and send out a press release yesterday entitled New Study Links Vaccines and Autism: Let your Representatives know about this study:

We frequently hear in the corporate media about studies that claim to show no association between autism and vaccines. But when do you ever hear about the studies that do show an association? Well, here's one that was just published.

A study in the Journal of Toxicology and Environmental Health finds a relationship between the proportion of children who received the recommended vaccines by age 2 years and the prevalence of autism or speech or language impairment. The higher the proportion of children receiving recommended vaccinations, the higher was the prevalence of AUT or SLI. The results suggest that although mercury has been removed from many vaccines, the remaining mercury as well as other culprits such as aluminum and live viruses may link vaccines to autism. Further study into the relationship between vaccines and autism is warranted.

Damn. Just when I thought I was out (at least for a while, on vacation, so to speak), they pull me back in. After all, this study, not surprisingly, is showing up in all the usual anti-vaccine locations, including the home of Olmsted's band of merry antivaxers known as Age of Autism, where the study author herself, Gayle DeLong, pimps her own study. Not a good sign. Not a good sign at all about the scientific credibility of the author Word to Gayle: If you want to keep even a semblance of scientific credibility, showing up on AoA to pimp your latest study is not a good idea. From one academic to another. Of course, not surprisingly also, DeLong is not a scientist; she is, rather, a faculty member in the Department of Economics and Finance in the Zicklin School of Business, Baruch College/City University of New York. As always, the fact that DeLong is clearly not a scientist doesn't necessarily means she is wrong. The poor study design and biased presentation are far more likely to make her wrong. That's something this study has in spades, and somehow she managed to get her paper accepted to the Journal of Toxicology and Environmental Health, a journal I had never heard of: Read the rest of this post... | Read the comments on this post...... Read more »

Delong G. (2011) A Positive Association found between Autism Prevalence and Childhood Vaccination uptake across the U.S. Population. Journal of toxicology and environmental health. Part A, 74(14), 903-16. PMID: 21623535

May 23, 2011
08:00 AM
434 views

Dr. Andrew Weil versus evidence-based medicine

by Orac in Respectful Insolence

Let's face it, Dr. Andrew Weil is a rock star in the "complementary and alternative medicine" (CAM) and "integrative medicine" (IM) movement. 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 early days of the CAM/IM movement, back before it ever managed to achieve a modicum of unearned respectability, to popularize CAM. In fact, no physician that I can think of has over the course of his lifetime done more to promote the rise of quackademic medicine than Dr. Weil. The only forces greater than Dr. Weil in promoting the infiltration of pseudoscience into academic medicine have been the Bravewell Collaborative and the National Center for Complementary and Alternative Medicine (NCCAM). Before there was Dr. Mehmet Oz, Dr. Dean Ornish, Dr. Mark Hyman, or any of the other promoters of IM, there was Dr. Weil.

And why not? Dr. Weil looks like an aging 1960s rock star, and, operating from his redoubt at the University of Arizona, is quite charismatic. For all the world Dr. Weil has the appearance of a kindly, benevolent Arizona desert Santa Claus, an ex-hippie turned respectable, dispensing advice about "natural" medicines, writing books, and making himself ubiquitous on television and radio whenever the topic of alternative medicine comes up. Before Dr. Oz told Steve Novella that "Western" science and medicine can't study woo like acupuncture, Dr. Weil was there, paving the way for such arguments, previously considered ludicrous, to achieve a patina of respectability.

In fact, he's still at it, too, doing it far better and far more subtly than the ham-handed Dr. Oz. Unfortunately, it's the same anti-science message and the same appeal to other ways of knowing built upon tearing down straw men versions of evidence-based medicine (EBM) with gusto. This was brought home last week when Dr. Weil co-authored an opinion piece with Drs. Scott Shannon and Bonnie J. Kaplan for the journal Alternative and Complementary Therapies entitled Safety and Patient Preferences, Not Just Effectiveness, Should Guide Medical Treatment Decisions, an article that was noted at the blog Booster Shots in a credulous, fawning post entitled Dr. Weil says there's a better approach to evaluating clinical drug trials. In contast, Steve Novella put it far more succinctly (and accurately) in the title of his post: Andrew Weil Attacks EBM. That's exactly what Weil and company did in this article.

While Steve is absolutely correct, I also see it more as Dr. Weil demonstrating once again that, upstarts like Dr. Oz aside, he is still the master of CAM/IM apologia, much as, even though both were Sith Lords, Emperor Palpatine remained master over Darth Vader until just before Vader turned on him and threw him down the energy shaft. You'll see why in terms of the arguments, both subtle and not-so-subtle, that Dr. Weil and his acolytes make. Moreover, even though his disciple Shannon is granted the coveted first author position, the arguments presented leave little doubt that it's Weil who's driving the bus. Read the rest of this post... | Read the comments on this post...... Read more »

Shannon, S., Weil, A., & Kaplan, B. (2011) Medical Decision Making in Integrative Medicine: Safety, Efficacy, and Patient Preference. Alternative and Complementary Therapies, 17(2), 84-91. DOI: 10.1089/act.2011.17210

May 18, 2011
08:00 AM
523 views

Still more evidence that Morgellons disease is most likely delusional parasitosis

by Orac in Respectful Insolence

One of the stranger Internet-based quackery phenomenons of the last decade is Morgellon's disease. This is a topic I haven't visited that much on this blog, its having last come up in a big way a little more than a year ago, when I discussed it in the context of Dr. Rolando Arafiles and the other quackery he was promoting. This led to extreme unhappiness on the part of self-proclaimed Morgellons disease "expert" Marc Neumann, who later bombarded me with threatening e-mail rants. In any case, whatever Morgellons disease is, its cause is almost certainly not what patients think it is, namely the presence of tiny organisms in the skin leading to a chronic itch that leads to chronic scratching. Its adherents describe it thusly:

Morgellons is a multi-symptom disease that is just now starting to be researched and understood. It has a number primary symptoms:

Physical

Sponanteously Erupting Skin lesions
Sensation of crawling, biting on and under the skin
Appearance of blue, black or red fibers and granules beneath and/or extruding from the skin
Fatigue

Mental

Short-term memory loss
Attention Deficit, Bipolar or Obsessive-Compulsive disorders
Impaired thought processing (brain fog)
Depression and feelings of isolation

It is frequently misdiagnosed as Delusional Parasitosis or an Obsessive Picking Disorder.

Except that delusional parasitosis is probably not a misdiagnosis. The "fibers" or "granules" found in the skin virtually always turn out to be consistent with fibers from clothing or other sources. At least, no advocate of Morgellons disease has ever demonstrated them to be anything mysterious. This concept has led to treatments for Morgellons that resemble those of chronic Lyme disease, namely chronic antibiotic use. Indeed, interestingly, Morgellons advocates frequently link Lyme disease to Morgellons, with some even asking whether Morgellons disease is the "Lyme disease of our time."

I was reminded of this frustrating (for both patient and physician) phenomenon by a couple of things recently. First, Mark Crislip wrote an excellent discussion of Morgellons disease and delusional parasitosis (which, of course, appear to be basically the more or less the same thing). The second was the publication of a study in the Archives of Dermatology by a group from the Mayo Clinic entitled Delusional Infestation, Including Delusions of Parasitosis: Results of Histologic Examination of Skin Biopsy and Patient-Provided Skin Specimens. Basically, what investigators Hylwa et al did was something very obvious. They retrospectively reviewed the pathology results of patient-provided specimens and physician-ordered skin biopsies in patients with Morgellons and diagnoses akin to Morgellons. Their search strategy was as follows: Read the rest of this post... | Read the comments on this post...... Read more »

Hylwa, S., Bury, J., Davis, M., Pittelkow, M., & Bostwick, J. (2011) Delusional Infestation, Including Delusions of Parasitosis: Results of Histologic Examination of Skin Biopsy and Patient-Provided Skin Specimens. Archives of Dermatology. DOI: 10.1001/archdermatol.2011.114

May 16, 2011
09:00 AM
723 views

Vaccines and infant mortality rates

by Orac in Respectful Insolence

The anti-vaccine movement is a frequent topic on this blog, sometimes to the point where it seems to take over the blog for days (or even weeks) at a time and I cry for respite. There are a number of reasons for this, not the least of which being that the anti-vaccine movement is one of the most dangerous forms of pseudoscience, a form of quackery that, unlike most forms of quackery, endangers those who do not partake of it by breaking down herd immunity and paving the way for the resurgence of previously vanquished diseases. However, anti-vaccine beliefs share many other aspects with other forms of quackery, including the reliance on testimonials rather than data. Even so, although the intelligentsia (and I do use the term loosely) of the anti-vaccine movement realizes and exploits the power of anecdotes and testimonials and how human beings tend to value such stories over dry scientific data, leaders of the anti-vaccine movement realize that science is overwhelmingly against them and that testimonials alone are not adequate to counter that science in the realm of public policy and relations.

That's why, over the years, various anti-vaccine "scientists" (and I use that term very loosely as well) have produced poor quality, sometimes even fraudulent studies, which are then touted as evidence that vaccines cause autism or at least as evidence that there is actually still a scientific controversy when in fact from a scientific standpoint the vaccine-autism hypothesis is pining for the fjords. Examples abound, including the work of Mark and David Geier, whose studies led the to use chemical castration to treat autistic children; Andrew Wakefield, whose small case series almost certainly included fraudulent data; a truly incompetent "phone survey" commissioned by Generation Rescue designed to compare "vaxed versus unvaxed" children; and an even more incompetent "study" in which Generation Rescue used a cherry picked group of nations to try to argue that nations that require more vaccines have higher rates of infant mortality. These efforts continue. For example, last year Generation Rescue requested $809,721 from the Airborne settlement to set up a "vaxed versus unvaxed" study, despite the known difficulties with such a study and the low likelihood of finding anything without huge numbers of children.

Earlier this month, they were at it again. Read the rest of this post... | Read the comments on this post...... Read more »

Miller, N., & Goldman, G. (2011) Infant mortality rates regressed against number of vaccine doses routinely given: Is there a biochemical or synergistic toxicity?. Human . DOI: 10.1177/0960327111407644

March 11, 2011
06:00 AM
525 views

For the anti-vaccinationists out there: The results of a real "vaxed versus unvaxed" study

by Orac in Respectful Insolence

In many ways, the anti-vaccine movement is highly mutable in many ways. However, this mutability is firmly based around keeping one thing constant. That one thing is vaccines. No matter what the evidence, no matter what the science, no matter how much observational, scientific, and epidemiological evidence is arrayed against them, to the relentlessly self-confident members of the anti-vaccine movement, it's always about the vaccines. Always. Vaccines are always the root many human health problems, be they asthma, autoimmune diseases, autism, and chronic diseases of all types. Everything else is negotiable. For instance, back when Andrew Wakefield ignited a scare about the MMR vaccine by publishing a fraudulent case series linking the MMR to a new syndrome consisting of regressive autism and enterocolitis, it was the measles vaccine that caused this syndrome. Here in the U.S., it was the mercury in the thimerosal preservative that used to be used in many childhood vaccines until 2001 that was the cause of all evil. However, as scientists did more and more studies, testing vaccines to see if they were associated with an increased risk of autism and found zero, nada, zip association with either vaccines or the thimerosal preservative in vaccines, the anti-vaccine movement was nothing if not mutable. Before long, Jenny McCarthy was declaring that it was the "toxins" in vaccines that were causing autism, and Generation Rescue was asserting that children were getting "too many too soon." Of course, as far as the anti-vaccine movement was concerned, the beauty of these ideas was (and is) that they are much harder to falsify scientifically because they are so much more vague.

Of late, the anti-vaccine movement has hit upon a new strategy. Specifically, they are demanding what they like to call a "vaxed versus unvaxed" study. Basically, their claim is that unvaccinated children are so much healthier than vaccinated children, and they think that such a study would prove it. Of course, they only hit on this message after making some rather embarrassing missteps. In particular, they didn't seem to realize that a randomized, double blind study of vaccination according to the currently recommended schedule versus unvaccinated children was totally unethical. So, they figured out another angle. They acknowledge that a randomized trial of unvaccinated versus vaccinated children would not be feasible (although they appear not to be able to admit just how unethical it would be), and blithely suggest instead an epidemiological study of the vaccinated versus the unvaccinated without realizing just how horrendously difficult it would be to overcome the confounders that would plague such a study or that ethical considerations still require sound scientific justification for such a study. That's why it's so cute to see anti-vaccine loons trying to justify such a study.

All of which is why it's pretty amusing that just such a study was recently reported in Germany. Can you guess what it found? Let's just say that, to those of us who accept the science showing that vaccines do not cause autism, autoimmune diseases, asthma, and the like, the results were utterly unsurprising: Read the rest of this post... | Read the comments on this post...... Read more »

Schmitz, R; Poethko-Müller, C; Reiter, S; Schlaud, M. (2011) Vaccination Status and Health in Children and Adolescents: Findings of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Dtsch Arztebl Int, 108(7), 99-104. info:/

Medicine

February 21, 2011
11:30 AM
798 views

If we can put a man on the moon, why can't we cure cancer?

by Orac in Respectful Insolence

Why haven't we cured cancer yet?

If we can put a man on the moon, why can't we cure cancer?

If we can harness the atom, why can't we cure cancer?

How many times have you heard these questions, or variants thereof? How many times have you asked this question yourself? Sometimes, I even ask this question myself. Saturday was the two year anniversary of the death of my mother-in-law from a particularly nasty form of breast cancer, and, even though I am a breast cancer surgeon, I still wonder why there was nothing in the armamentarium of science-based medicine that could save her from a several month decline followed by an unpleasant death. That's why, to me at least, the timing of the publication of a study examining the genome of prostate cancer that was published in Nature a week and a half ago and summarized in this Science Daily news story was particularly apt. Performed as part of the National Cancer Institute's Cancer Genome Project, the study undertook complete genome sequencing of seven advanced and aggressive prostate cancers. The results, as ERV put it, revealed what can be describe as a "train wreck."

Personally, I'd describe it as looking as though someone threw a miniature grenade into the nucleus of a prostate epithelial cell. You'll see what I mean shortly.

Of course, although that image does give you an idea of the chromosomal chaos in the heart of prostate cancer cells, it is inaccurate in that it implies a sudden explosion, after which the damage is done, and if there's one thing we know about cancer it's that in most cases it takes many years for a normal cell to progress to a cancer cell fully capable of metastasizing and killing its host. Cancer is really, really, really complex, of course, and have even pointed out before that when President Nixon launched the "war on cancer" 40 years ago scientists had no idea how complex or difficult cancer would turn out to be. Indeed, before I discuss the current study, it's probably useful to reiterate a bit why, in order to put the study in context. Read the rest of this post... | Read the comments on this post...... Read more »

Berger, M., Lawrence, M., Demichelis, F., Drier, Y., Cibulskis, K., Sivachenko, A., Sboner, A., Esgueva, R., Pflueger, D., Sougnez, C.... (2011) The genomic complexity of primary human prostate cancer. Nature, 470(7333), 214-220. DOI: 10.1038/nature09744

October 29, 2010
08:31 AM
719 views

What's in a placebo? Mike Adams certainly doesn't know.

by Orac in Respectful Insolence

If there's one thing that confounds advocates of so-called "complementary and alternative medicine" (CAM), it's the placebo effect. That's because, whenever most such remedies are studied using rigorous clinical trial design using properly constituted placebo controls, they almost always end up showing effects no greater than placebo effects. That's the main reason why they frequently suggest that, you know, all those rigorous, carefully constructed randomized placebo-controlled clinical trials aren't really the best way to investigate their woo after all. To them, it's much better to do "pragmatic" trials, which are not even always randomized and often don't control for placebo effects, mainly because they're more likely to produce false-positive effects due to biases and placebo effects. Of course, part of the reason for this dislike of placebos among CAMsters is because recently some very good placebo controls have been developed for modalities thought not to be amenable to placebo-controlled trials. Foremost among these modalities undoubtedly acupuncture, for which placebos in the form of sham needles that do not actually penetrate the skin but are able to reliably prevent the patient (and sometimes even the practitioner) from knowing which treatment is being administered. Studies such as these have demonstrated quite conclusively that acupuncture effects are placebo effects.

What brought these thoughts to mind is a study that I recall seeing a few days ago in the Annals of Internal Medicine on placebos in randomized clinical trials coming out of the University of California San Diego and the University of Oxford. The study is entitled, provocatively enough, What's in Placebos: Who Knows? Analysis of Randomized, Controlled Trials. Basically what Golomb et et al did in this study was something incredibly simple. They simply asked: How often did published randomized clinical trials (RCTs) provide sufficient detail about the composition of the placebo used that another investigator could replicated them? The answer was, in essence: Disturbingly less often than I would have expected. I filed the article away as something I should consider blogging about. Then I filed it away and, thanks to the other things going on this week, forgot about it.

Until, that is, I saw Mike Adams at that even more wretched hive of scum and quackery than The Huffington Post, NaturalNews.com, decide to argue on the basis of this study that the entire scientific basis of science-based medicine is now in doubt. I kid you not. That's what he is arguing in an article he entitled Placebo fraud rocks the very foundation of modern medical science; thousands of clinical trials invalidated. It's a screed of flaming stupid so over the top that only Mike Adams could have produced it, firing napalm into the sky to form the words, "I'm an idiot" in letters big enough for the state of Texas to see. Read the rest of this post... | Read the comments on this post...... Read more »

Golomb BA, Erickson LC, Koperski S, Sack D, Enkin M, & Howick J. (2010) What's in placebos: who knows? Analysis of randomized, controlled trials. Annals of internal medicine, 153(8), 532-5. PMID: 20956710

October 7, 2010
08:31 AM
858 views

Better late than never: The Swedish mammography study and screening for women under 50

by Orac in Respectful Insolence

Last week blew by me in a blur. Because I was in full grant writing frenzy to get an R01 in the can by Friday, pretty much anything that wasn't totally urgent got shoved aside, at least after Wednesday. Of course, it was last Wednesday that yet another mammography study was being touted as a "landmark" study. I had just enough time to look it over briefly and decide that I really should blog about it, particularly given that it came hot on the heels of a Norwegian study less than a week before that found the benefits of mammography to be less than previously believed and even more particularly because this study apparently showed that mammography was much more beneficial to women between the ages of 40-49 than previously thought. Given the kerfuffle over the USPSTF update of its guidelines for mammography last fall, where the USPSTF recommended starting regular mammography at the age of 50 rather than 40 and ran into a buzzsaw of criticism, both honest, dishonest, and from those who were protecting their turf. Naturally, with that background, the question is: Does this study help to clarify the question of assessing the benefits versus the risks of screening mammography? Or does it complicate things even more?

Perhaps a little of both.

As I've written about over the last couple of years, evidence has been accumulating that is muddying the picture regarding the benefits of screening mammography, So, before I move on to the study, let's be absolutely clear on what it is that we are discussing here. Screening mammography is different from diagnostic mammography in that it is performed at regular intervals in asymptomatic women in order to detect cancer at an earlier stage and thereby allow earlier intervention, resulting in the saving of more lives than if we waited until breast cancer produces symptoms (such as a lump) that lead to diagnosis. If a woman feels a lump or some change in her breast and undergoes mammography, that is not screening. In that case, mammography is being done for diagnostic purposes. We are not discussing diagnostic mammography. We are discussing screening mammography. I can't emphasize that distinction enough.

The study that was reported last week was performed in Sweden and reported under such headlines as New mammogram study stirs debate for women in 40s; Mammogram Benefit Seen for Women in Their 40s; and Swedish mammography study sows more confusion about screening for breast cancer. I found radiologists I know circulating the study as though it were vindication, and Dr. Len of the American Cancer Society touted it as being very important, while Dr. Daniel B. Kopans (whom we've met before crudely and blatantly defending his turf over the USPSTF guidelines) declared that the study "should end any debate and end the use of age 50 as a threshold for screening."

Not so fast there, pardner. Read the rest of this post... | Read the comments on this post...... Read more »

Hellquist, B., Duffy, S., Abdsaleh, S., Björneld, L., Bordás, P., Tabár, L., Viták, B., Zackrisson, S., Nyström, L., & Jonsson, H. (2010) Effectiveness of population-based service screening with mammography for women ages 40 to 49 years. Cancer. DOI: 10.1002/cncr.25650

September 10, 2010
10:00 AM
1,022 views

More acupuncture quackademic medicine infiltrates PLoS ONE

by Orac in Respectful Insolence

I hate to do this to Bora again. I really do. I'm also getting tired of blogging all these crappy acupuncture studies. I really am. However, sometimes a skeptic's gotta do what a skeptic's gotta do, and this is one of those times.

As you may recall, a mere week ago I was disturbed to have discovered the publication of a truly horrifically bad acupuncture study in PLoS ONE. It had all the hallmarks of quackademic medicine: an implausible hypothesis, trying to correlate mystical concepts of meridians and qi to anatomy and failing miserably, and dubious statistical modeling. That PLoS ONE actually published this tripe shows me that, for all its claims of being scientifically rigorous, PLoS ONE has a serious problem when it comes to so-called "complementary and alternative medicine" (sCAM or, if you're a fan, CAM). In fact, PLoS ONE has as its tagline "accelerating the publication of peer-reviewed science." Sadly, the acupuncture study published there a month or two ago made me think that going a bit slower wouldn't necessarily be such a bad thing.

So does this latest atrocity, which comes from the University of New South Wales, and the Prince of Wales Hospital and is entitled The Brain Effects of Laser Acupuncture in Healthy Individuals: An fMRI Investigation. I'll give Im Quah-Smith and crew some credit. Unlike a recent acupuncture study from a month ago, where the authors explicitly tried to hide that they were not actually doing acupuncture at all but rather were running electrical current thorough the needles, at least Smith et al admit up front that they are using "laser acupuncture." Of course, "laser acupuncture" is no more acupuncture than is "electroacpuncture"--unless, of course, the Chinese were more techologically advanced than anyone had previously suspected, having developed electricity and having understood quantum mechanics a couple of millennia before we backward "Western" scientists did. Either that, or the first incarnation of Deepak Chopra was alive and active back then.

Yes, it's just that ridiculous. Before I even discuss the study, I just want to reiterate and reemphasize that "laser" acupuncture is not acupuncture. It is lasers zapping the skin. True, "laser acupuncture" is a much cooler term than "lasers zapping the skin," but that does not make it any more accurate or correct. What is it with woo-meisters and their propensity to take modern technology, graft it onto treatment based on prescientific notions of disease and how the body works, and then "rebrand" it (to put it kindly) into something that sounds cool but goes woo. That's all the "electroacupuncture" study was done, and it's how this "laser acupuncture" study was done.

Smith et al begin: Read the rest of this post... | Read the comments on this post...... Read more »

Quah-Smith, I., Sachdev, P., Wen, W., Chen, X., & Williams, M. (2010) The Brain Effects of Laser Acupuncture in Healthy Individuals: An fMRI Investigation. PLoS ONE, 5(9). DOI: 10.1371/journal.pone.0012619

August 19, 2010
09:00 AM
846 views

Another pointless "acupuncture" study misinterpreted

by Orac in Respectful Insolence

At the risk of once again irritating long time readers who've hear me say this before, I can't resist pointing out that, of all the various forms of "alternative medicine" other than herbal medicines (many of which are drugs, just adulterated, impure drugs), acupuncture was the one treatment that, or so I thought, might actually have a real therapeutic effect. Don't get me wrong; I never bought magical mystical mumbo-jumbo about "meridians" and "unblocking the flow of qi" (that magical mystical life energy that can't be detected by scientists but that practitioners of woo claim to be able to manipulate for therapeutic intent). The point is (sorry, couldn't resist) that acupuncture actually involves doing something physicial to the body, namely inserting thin needles into it. Shorn of its trappings of prescientific Eastern mysticism, acupuncture struck me as something that might have something to it.

Five years ago.

Since I started actually studying acupuncture and acupuncture studies, I've become acutely aware that my previous assessment was incorrect, and my pointing that out from time to time sometimes results in comments along the lines of, "We don't need to hear this again." Tough. For the benefit of new readers and readers who might not have read some of my previous posts on acupuncture before, I consider it important to reinforce that I have, in fact, undergone a bit of a change of heart. I have reviewed studies that showed that sham acupuncture works as well or even better than "true" acupuncture, with the needles placed right where those fancy acupuncture charts say they should be placed and that you don't even need needles. Toothpicks with their points twirled against the skin will do. I've also come to realize that many of the explanations postulated by acupuncturists and doctors who believe in acupuncture are actually far less interesting than actual scientific results that they produce in their search for "proof" that "acupuncture works." Sometimes, acupuncturists substitute active sorts of treatment for acupuncture and call it something else, like "electroacupuncture, which involves hooking up a weak electrical current to acupuncture needles. Electroacupuncture is in essence nothing more than transcutaneous electrical nerve stimulation (TENS), an accepted modality to treat pain.

Add to the evidence pile yet another study demonstrating that acupuncture is placebo medicine, reported in Arthritis Care & Research by a team of investigators based primarily at the M.D. Anderson Cancer Center that I heard about via the TIME Magazine Wellness Blog. The study, entitled A Randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication, demonstrates about as unequivocally as one can imagine that one form of so-called "acupuncture" is, as far as can be detected, virtually all placebo. What is surprising about this study is not so much that it shows that acupuncture doesn't work. In fact, it doesn't actually show that, because what is being used is not acupuncture. What is being used is "electroacupuncture, which is in essence nothing more than TENS! More amazingly, no one whom I've yet seen seems to be mentioning this. In essence, the results of this study are entirely consistent with the hypothesis that it doesn't matter whether you place TENS needles on acupuncture points or not. Will wonders never cease? Actually, that's not quite the right interpretation, as we shall soon see. Read the rest of this post... | Read the comments on this post...... Read more »

Suarez-Almazor, M., Looney, C., Liu, Y., Cox, V., Pietz, K., Marcus, D., & Street, R. (2010) A Randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication. Arthritis Care . DOI: 10.1002/acr.20225

August 5, 2010
10:00 AM
995 views

Fructose and pancreatic cancer

by Orac in Respectful Insolence

I hate science press releases.

Well, not exactly. I hate science press releases that hype a study beyond its importance. I hate it even more when the investigators who published the study make statements not justified by the study and use the study as a jumping off point to speculate wildly. True, it's not always the fault of the investigators, particularly if they don't have much experience dealing with the press, but all too often scientists fall prey to the tendency to gab glibly and give the reporter what he or she wants: Pithy, juicy quotes that relate the results to what the reporter wants them related to. It's irritating as hell, not so much because it's pure self-promotion. (After all, self-promotion is not in and of itself a bad thing) but rather because it's almost inevitably an excuse for the investigators to say what they want without peer pesky peer reviewers telling them that they should keep their remarks focused on what the evidence will support. Often these press releases lead to credulous news stories that make conclusions that aren't justified from the actual study. Sometimes an investigators' comments are taken out of context. Sometimes the investigator says something dumb. Sometimes it's all three.

There's a certain Reuters story entitled Cancer cells slurp up fructose, U.S. study finds making the rounds, and it's being represented as yet more evidence about the evils of high fructose corn syrup. That it might be viewed as a few years in the future, after followup studies have been done, but for right now all it is is an intriguing study being used to serve an agenda that it doesn't serve well: Read the rest of this post... | Read the comments on this post...... Read more »

Liu, H., Huang, D., McArthur, D., Boros, L., Nissen, N., & Heaney, A. (2010) Fructose Induces Transketolase Flux to Promote Pancreatic Cancer Growth. Cancer Research, 70(15), 6368-6376. DOI: 10.1158/0008-5472.CAN-09-4615

June 23, 2010
09:00 AM
933 views

Don't get sick in July? (Revisited)

by Orac in Respectful Insolence

June is almost over. If you work in an academic medical center, as I do, that can mean only one thing.

The new interns are coming, and existing residents will soon be advancing to the next level. The joy! The excitement! The trepidation! And it's not all just the senior residents and the faculty feeling these emotions. It's the patients too. At least, it's the patients feeling the trepidation. The reason is the longstanding belief in academic medical centers, a belief that has diffused out of them and into "common wisdom," that you really, really don't want to get sick in July?

But is there any truth to this common wisdom, passed down from hoary emeritus faculty to professor to assistant professor to resident to medical student every year? Is there any truth to the belief commonly held by the public that care deteriorates in July? It turns out that a recent study published in the Journal of General Internal Medicine has tried once again to answer this question and come to a rather disturbing answer.

Imagine, if you will, that you want to determine whether there really is a "July effect," that quality of care really does plummet precipitously as common wisdom claims. How would you approach it? Mortality rates? That's actually fairly hard, because mortality rates fluctuate according to the time of year. For example, trauma admissions tend to spike in the summer. Well do I remember during my residency the fear of the fourth of July weekend, because it was usually the busiest trauma weekend of the year--and we had new residents to have to deal with it all. It was an attending's and senior resident's worst nightmare. In any case, if a hospital has an active trauma program it would naturally be expected that it would have more deaths during the summer regardless of resident status, quite simply because there is more trauma. Complication rates? That might also be a useful thing to look at, but that's actually not as easy as it seems either. How about comparing morbidity and mortality rates between teaching hospitals and community hospitals throughout the year and test whether mortality rates increase in academic hospitals relative to community hospitals. That won't work very well, either, mainly because there tends to be a huge difference in case mix and severity between academic institutions and community hospitals. Community hospitals tend to see more routine cases of lower severity than teaching hospitals do. Read the rest of this post... | Read the comments on this post...... Read more »

Phillips, D., & Barker, G. (2010) A July Spike in Fatal Medication Errors: A Possible Effect of New Medical Residents. Journal of General Internal Medicine. DOI: 10.1007/s11606-010-1356-3

Medicine

June 11, 2010
09:00 AM
787 views

More evidence for a genetic basis for most autism

by Orac in Respectful Insolence

I wonder what the loons at Age of Autism will say about this.

Actually, I know what they'll say. Whenever a scientific study like the one just published earlier this week the top tier journal Nature, which examines genetic variations (CNVs) associated with autism and autism spectrum disorders (ASDs), comes out, they have a standard reply. Even though, as of this writing, I haven't seen yet seen a reply on the anti-vaccine crank blog Age of Autism to the study I'm about to describe, I'm sure it's coming and I'm sure it will look something like this article from a year ago by Mark "Not A Scientist Not a Doctor" Blaxill entitled Latest Autism Gene Studies Find....Not Very Much:

There's a familiar rhythm to the most prominent autism gene hunt publications. Their authors hype their newly minted study aggressively in the media. The prestigious journals that publish them lend their imprimatur to press releases that say, "this study is a big deal." The findings sound impressive in the press release (and the authors get plenty of time on camera and in leading newspapers to tell us how truly impressive they are). In the meantime--in papers that are so densely written that making sense of what they really say requires far more reflection than the media hype cycle permits--skillfully concealed evidence reveals the truly important news in the findings: the authors whisper quietly (if at all) that the new analysis negates the most important findings of some of the most prominent previous gene hunts, while crucial detail on their new findings is often relegated to "supplementary material" that's not available on the publication date.

Such a declaration is then almost inevitably followed by rants against scientists for concentrating on genes rather than vaccines as a cause of autism, claims of "conflicts of interest," and an "analysis" of the findings of the study that betray an incredible lack of understanding of molecular biology, genetics, and developmental biology. I expect that the response to this study will be no different and may well appear on AoA by tomorrow morning, quite possibly written by Mark "Not a Scientist Not a Doctor" Blaxill. The study by Pinto et al, looks at the functional impact of global rare copy number variation in autism spectrum disorders. Read the rest of this post... | Read the comments on this post...... Read more »

Pinto, D., Pagnamenta, A., Klei, L., Anney, R., Merico, D., Regan, R., Conroy, J., Magalhaes, T., Correia, C., Abrahams, B.... (2010) Functional impact of global rare copy number variation in autism spectrum disorders. Nature. DOI: 10.1038/nature09146

June 10, 2010
09:04 AM
997 views

NaturalNews.com slimes breast cancer research again

by Orac in Respectful Insolence

Let's see. Now that I'm back from Chicago, having recently attended a major cancer meeting, not to mention having already blogged about the meeting, what to do next? Sure, the whole thing about Andrew Wakefield finding himself just one step away from appearing on Jeff Rense's or Alex Jones's radio show was amusing in the extreme to me, and no doubt there will be much more blogging material to mine in that vein, but if you really want to bring home the crazy there's only one place shy of Whale.to to visit.

That's right, I'm talking about that wretched hive of medical scum and villainy, Mike Adams' NaturalNews.com. Now, usually it's the Grand Master of Woo and Quackery himself, Mike Adams, who really knows how to deliver the crazy quacky goods. Usually. This time, it's one of Mike's minions doing the duty, and addressing the nonsense in her post is a perfect post-ASCO thing for a surgical oncologist to do. The minion of woo is S. L. Baker, and the post is entitled Study shows how radiation causes breast cancer.

The first thing you need to remember about NaturalNews.com is that Mike Adams has a deep and abiding hatred of scientific medicine. One manifestation of this hatred is that, when it comes to breast cancer, to Adams surgery, chemotherapy, and radiation kill, not the cancer; "natural" therapies like vitamin D can prevent cancer with near 100% certainty and cure it with near 100% certainty if you happen to be someone who didn't listen to Adams; and that early detection tests like mammography are always bad, although, ironically enough, a modality that claims to do the same thing as mammography without radiation (thermography, an unvalidated and not particularly useful old technology that, for reasons that I've never been able to understand, "alternative" medicine practitioners love) is the greatest thing ever. I've written about NaturalNews.com and its hatred of conventional therapy for breast cancer before. For instance, seven months ago, Mike Adams himself mined similar territory that his apparent acolyte has done, while earlier he abused Breast Cancer Awareness month to castigate the "breast cancer industry." This time around his flunky Baker is doing the castigating: Read the rest of this post... | Read the comments on this post...... Read more »

Rituparna Mukhopadhyay, Sylvain V Costes, Alexey V Bazarov, William C Hines, Mary Helen Barcellos-Hoff, & Paul Yaswen. (2010) Promotion of variant human mammary epithelial cell outgrowth by ionizing radiation: an agent-based model supported by in vitro studies. Breast Cancer Research, 12(1). info:/10.1186/bcr2477

June 1, 2010
09:00 AM
904 views

When what an acupuncture study shows is much more interesting than what acupuncture believers think it shows

by Orac in Respectful Insolence

Of all the "alternative" therapies out there, arguably the most studied is the modality known as acupuncture. Perhaps the reason is that, unlike homeopathy, which based on physics, chemistry, and biology alone is so implausible that, for it to "work," huge swaths of well-established physics and chemistry would have to be shown to be not just wrong but extravagantly and outrageously wrong (making homeopathy far more akin to magic than science), or reiki, which, when you come right down to it, is nothing more than faith healing based on Eastern mysticism rather than Christianity, acupuncture actually involves doing something physical. Indeed, at the risk of annoying or boring long time readers, who have seen me write this many times before, even I used to think that there might be something to acupuncture. Certainly, I recognized that the concepts of meridians along which life energy (qi) flows and how sticking needles into just the right locations on these meridians somehow "unblocks" the flow of qi and thereby relieves pain and heals disease was prescientific nonsense on the order of thinking that evil spirits cause disease. Such ideas may have made sense hundreds of years ago, before scientists developed an understanding of how the body works, but now, in 2010, they are vestiges of a time when medicine really had close to no idea how the body works and when medicine was more often worse than the disease being treated.

Yet the fascination with acupuncture remains, so much so that an inordinate amount of research dollars are spent on studying it. Of course, as Steve Novella has pointed out, in general in medicine (at least these days), the trajectory of research is from bench research to animal models to small scale, less rigorous, pilot studies in humans to large scale, rigorously designed studies using many subjects. True, this order doesn't always hold. For instance, if physicians make a compelling observation "at the bedside" of response to therapy or how a disease progresses, frequently, after making closer observations to confirm the initial observation, researchers will jump back to animal models and bench top research to try to figure out what's going on. For such a progression to be useful, though, scientists have to be sure that the phenomenon in human patients under study actually exists. Unfortunately, such is not the case for acupuncture. As larger, more well designed studies using real placebo or sham acupuncture techniques, have increasingly shown that acupuncture does not function any better than placebo in human beings (and sometimes even worse), acupuncturists and acupuncture believers have been reversing the usual order of things, doing smaller studies and "pragmatic" (i.e., uncontrolled) clinical trials, where the placebo effect is not controlled for. Never mind that it doesn't matter where the needles are placed (thus blowing the whole "meridian" idea out of the water) or even if the needles puncture the skin. Toothpicks work just as well as needles. Also never mind that the mythology of acupuncture as having been routinely practiced for over two thousand years (or, sometimes, four thousand years, is largely a creation of Chairman Mao, who elevated what was a marginal practice at the time to a modality that the state supported and promoted (1,2,3,4). Unfortunately, even the National Center for Complementary and Alternative Medicine (NCCAM) falls for this mythology.

Sometimes, acupuncture studies even end up in high impact journals like Nature Neuroscience. Of course, what is being studied is not really "acupuncture" per se, but rather sticking needles into either people or animals. Since a bunch of you have deluged my mail box with this particular study, I felt obligated to have a look at it. Before I get to the study itself, though, let's take a look at the press release: Read the rest of this post... | Read the comments on this post...... Read more »

Goldman, N., Chen, M., Fujita, T., Xu, Q., Peng, W., Liu, W., Jensen, T., Pei, Y., Wang, F., Han, X.... (2010) Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neuroscience. DOI: 10.1038/nn.2562

May 25, 2010
03:58 AM
688 views

No difference between "too many too soon" and "too few too late" when it comes to vaccines

by Orac in Respectful Insolence

Regular readers know that I have a tendency every so often to whine about when writing about the antics of the anti-vaccine movement seems to engulf this blog. Yes, it's true. Every so often I get really, really tired of the bad science, pseudoscience, magical thinking, misinformation, and even outright lies that emanate from various anti-vaccine websites and blogs. This week, I promised myself I would try not to do it. There are times when duty calls, and this is one of those times. For better or for worse, as hard as I still find it to believe, somehow I've become one of the top bloggers defending vaccines, and there are times when I have to stop whining and just embrace this role. Given the one-two-three triple whammy of the start of the anti-vaccine autism quackfest Autism One, Andrew Wakefield having had his license to practice medicine in the U.K. yanked, and the hilariously insane anti-vaccine rally to take place in Grant Park in Chicago tomorrow, it's time just to go with the flow and do what needs to be done.

Today this is something I'm more than happy to do, at least today.

If there's one thing about the anti-vaccine movement that I've learned over the last several years, it's that it's nothing if not, for lack of a better word, nearly infinitely pliable. To put it more simply, anti-vaccine activists are experts at throwing out as much stuff as they can and seeing if anything sticks, adjusting their stories, and moving the goalposts every time each of their successive demands for more evidence are met by scientists. Although there has always been an anti-vaccine movement, its most recent incarnation is built primarily around the idea that vaccines cause autism somehow. First it was Andrew Wakefield presenting dubious, trial lawyer-funded "research" purporting to show that the MMR vaccine causes "autistic enterocolitis" and even autism itself. Then, not long after that, the U.S. version of this manufactrovery showed up in the form of the concept that mercury in the thimerosal preservative that used to be in vaccines cause autism, promoted initially by David Kirby and Robert F. Kennedy, Jr. Fortunately, more than a decade's worth of research consisting of large epidemiological studies has utterly failed to find even a whiff of a hint of a link between either the MMR vaccine or thimerosal-containing vaccines and autism. Unfortunately, the anti-vaccine movement simply moved the goalposts to the "toxins" gambit, in which it is claimed that vaccines are laced with "toxins" such as formaldehyde, antifreeze, and tissue from aborted fetuses. Never mind that there are no parts from aborted fetuses or antifreeze in vaccines, and scary-sounding chemicals like formaldehyde are present in concentrations far too low to be a problem. Even so, "Green our Vaccines" sure sounds like a slogan that means something, even though it doesn't.

The latest gambit, and arguably one of the most successful because it's the most vague and difficult to falsify, is the "Too Many Too Soon" slogan. Under this idea, anti-vaccine propagandists claim that infants are getting too many vaccines too soon (hence the slogan) and that all those nasty vaccines being given to such young infants is somehow messing up their immune system, attacking their brains, and giving them autism. This is a tough one to combat because the only definitive way to refute it would involve studying unvaccinated versus vaccinated children (which, not surprisingly, is the latest demand of the anti-vaccine movement). Doing such a study in a rigorous prospective randomized fashion would be completely unethical because it would leave the control group unprotected, while retrospective studies would be prone to a lot of confounders, given that there are likely to be other factors besides vaccination status that make populations who aren't vaccinated different from those who are.

That's why a study hot off the presses yesterday (well, hot off the web, as it were, given that it's an E-pub ahead of print) is so well timed. Released right as Autism One starts and Andrew Wakefield tanks, what better time for a study to look right at the very question that anti-vaccinationists seem to want answered? The title of the article is even an arrow aimed right at the heart of the "too many too soon" mantra, namely On-time Vaccine Receipt in the First Year Does Not
Adversely Affect Neuropsychological Outcomes. Read the rest of this post... | Read the comments on this post...... Read more »

Michael J. Smith, MD, MSCE, Charles R. Woods, MD, MS. (2010) On-time Vaccine Receipt in the First Year Does Not Adversely Affect Neuropsychological Outcomes. Pediatrics. info:/

May 19, 2010
10:37 AM
848 views

Oh no! My cell phone's going to kill me! (The revenge)

by Orac in Respectful Insolence

Here we go again.

I've written a few times before about the controversy over whether cell phones (a.k.a. mobile phones in most of the rest of the world) cause brain cancer, concluding on more than one occasion that the evidence does not support a link. For example, there has not been a large increase in brain cancer or other cancers claimed to be due to cell phone radiation in the 15 to 20 years since the use of cell phones took off back in the 1990s, nor has any study shown a convincing correlation between cell phone use and brain cancer.

Of course, one would not expect a priori, based on what is known about basic science, that cell phone radiation would cause cancer. After all, the development of cancer in general ultimately requires mutations in critical genes regulating cell growth and development. For an outside treatment to cause such mutations, as far as we know, requires the ability to cause DNA damage through the breaking of chemical bonds. Ionizing radiation can do this, as can certain cehmicals and chemotherapeutic agents. Indeed, that's how these agents work against cancer because cancer cells tend to be more sensitive to DNA damaging agents than normal cells due to defective DNA repair mechanisms. Thus, it is highly implausible based on basic science that cell phone radiation could cause cancer. It's not homeopathy level-implausible, but it's pretty implausible. Nor is it impossible, as has been claimed, because there may be biological mechanisms behind cancer that we do not yet understand, and it's almost always physicists with little knowledge of epigenetics and other mechanisms of cancer development who make such dogmatic claims. Still, such physicists are not too far off; if cell phones could cause cancer, it would have to be through a previously unknown physiological or genetic mechanism. Absent compelling evidence of a link between cell phones and cancer, then, it is not unreasonable to rely on the basic science and consider the possibility of such a link to be remote. Read the rest of this post... | Read the comments on this post...... Read more »

, . (2010) Brain tumour risk in relation to mobile telephone use: results of the INTERPHONE international case-control study. International Journal of Epidemiology. DOI: 10.1093/ije/dyq079

May 17, 2010
04:00 AM
838 views

Dichloroacetate (DCA) and cancer: Déjà vu all over again

by Orac in Respectful Insolence

Late last week, a crank I hadn't heard from in a while showed up in my comments. I'm referring to DaveScot, who normally was known for promoting anti-evolution rhetoric in the service of the pseudoscience known as "intelligent design" creationism. This is what he said:

Hi Orac,

terrasig suggested you do a followup article on dichloroacetate (DCA) given the paper just published on the phase 1 trial in Edmonton.

Three years have passed and countless cancer patients were denied this drug. Now at the end of its first phase one trial we know exactly what we did from the reports of people self-medicating in 2007 before the FDA forced it off the market - it shows great promise.

Explain to me again how these controlled trials are oh-so-much better than the ad hoc trial of self-organized self-medicants? Lay that old woo stick on me again, buddy.

How can I refuse such a heartfelt request for a loving application the clue by four (a.k.a. the cluestick). Apparently DaveScot forgot the last time I laid it on him. Oddly enough, it was not over evolution or creationism, and the loving application occurred over three years ago. Specifically, it was about a topic that I hvaen't written about for about a year and a half now, mainly because there wasn't any real news to write about, namely (as I've put it) the "cancer cure that big pharma doesn't want you to know about," dichloroacetate (DCA for short).

Actually, DaveScot wasn't the first this week. Over the last several days, I've received a trickle of e-mails about DCA. These generally fell into two categories. One category was simply asking me to update the story; the other category was of the type demonstrated by DaveScott, gloating that I was wrong when I threw cold water on the ridiculous level of hype over this drug on the basis of a single paper reporting that DCA showed significant efficacy against various cancers in cell culture and rodent models of cancer.

I suppose I shouldn't be too hard on DaveScot. After all, when the DCA saga began in January 2007, I started noticing a bunch of posts by various bloggers as well as news stories that all had similar titles, such as Cheap, safe drug kills most cancers, Objectively pro-cancer, Gotta pay, When promising cures are ignored, and, my personal favorite, Potential cheap, safe cure for cancer: Will Big Pharma Allow It?

Note that there were two assumptions about the study three years ago. First, these bloggers and pundits assumed that the cell culture and animal work were definitive evidence that DCA might be a "cure" for cancer. Second, the assumption was that, because the drug was out of patent and very cheap to make, neither the government nor pharmaceutical companies would be interested in funding it, thus condemning thousands, maybe millions, of people to die of cancer unnecessarily. Unfortunately, the New Scientist article and articles in the Edmonton Sun featured headlines to that effect and quotes by the investigator Evangelos Michelakis lamenting how he had had difficulties finding funding to do the next step, clinical trials in cancer. As a result of these sensationalistic stories, unscrupulous "businessmen" sought to bring DCA to the masses. A frenzy of sorts was unleashed, with desperate cancer patients scrambling to find DCA. If you're interested in the details, scroll to the end of this post for a list of the numerous blog posts that I did on the topic as the story was evolving. That's the past, and all the "Insolence" and science are there for you if you want to read it. I'm concerned with today (well, last week), when apparently DCA bubbled to the surface in news reports such as this, which were apparently what "inspired" DaveScot's and some e-mails challenging me. For example: Read the rest of this post... | Read the comments on this post...... Read more »

Michelakis, E., Sutendra, G., Dromparis, P., Webster, L., Haromy, A., Niven, E., Maguire, C., Gammer, T., Mackey, J., Fulton, D.... (2010) Metabolic Modulation of Glioblastoma with Dichloroacetate. Science Translational Medicine, 2(31), 31-31. DOI: 10.1126/scitranslmed.3000677

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