February 13, 2012
Category: Clinical trials • Medicine
If there's one form of so-called "complementary and alternative medicine" (CAM) that I find more tolerable than most, it's massage therapy. The reason, of course, is that, whatever else anyone claims about massage, there's no doubt that it feels good.
All too often, however, massage therapists ruin a perfectly good massage by imposing pseudoscientific and quack claims on it, such as claims that they are stimulating acupressure points or their adoption of the language of "energy healing." So it was with a bit of trepidation (but also more than a bit of interest) that I took a look at some links that readers sent me about a week ago (too late, alas, for me to write about this last Monday). These links were to news stories with titles like Scientists Uncover Why Massage Heals Sore Muscles and Massage Reduces Inflammation And Promotes Growth Of New Mitochondria Following Strenuous Exercise, Study Finds. My first impression, actually, was that this was somewhat counterintuitive in that one might predict that deep kneading of muscles might actually cause a bit of inflammation and that it's the counterirritation effect that leads to the perceived reduction in the amount of pain. Yet, according to the press release issued by McMasters University, whose contents were mirrored in many news stories, a study claiming state-of-the-art methods is concluding that massage is reducing inflammation:
Most athletes can testify to the pain-relieving, recovery-promoting effects of massage. Now there's a scientific basis that supports booking a session with a massage therapist: On the cellular level massage reduces inflammation and promotes the growth of new mitochondria in skeletal muscle. The research, involving scientists from the Buck Institute for Research on Aging and McMaster University in Hamilton Ontario appears in the February 1st online edition of Science Translational Medicine.
The study involved the genetic analysis of muscle biopsies taken from the quadriceps of eleven young males after they had exercised to exhaustion on a stationary bicycle. One of their legs was randomly chosen to be massaged. Biopsies were taken from both legs prior to the exercise, immediately after 10 minutes of massage treatment and after a 2.5 hour period of recovery.
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Posted by Orac at 3:01 AM • 1 Comments
February 10, 2012
Category: Medicine • Religion
Work called last night. (It happens.) Basically, I had two deadlines for two big things (finishing reviewing the grants assigned to me for study section and a major writeup for a project for my job). Unfortunately, both of them were today. I realized as I perused old posts that I hadn't reposted this one in over five years. So, unless you're a long time reader, it's definitely new to you. More importantly, it reminds me that I don't write about thins like this much anymore. Certainly I rarely do personal anecdotes or straight medical blogging much anymore. Maybe I should do more.
[NOTE: This story is loosely based on a real patient encounter from several years ago, but some details have been changed.]
The patient list for the day had simply the words "abnormal mammogram" next to her name. That used to be the most common reason that of breast patients came to see me. They have their regular mammogram and are told by their primary care physician that it is abnormal. The next thing they know, they're sitting in one of my examining rooms. However, the patient list is quite brief. It's just meant to be a quick capsule of what patient has what basic complaint. These days, because at my current institution so many more practitioners order breast biopsies, most of the patients I see are already pre-diagnosed with breast cancer. Be that as it may, nothing on the list prepared me for the woman I greeted when I walked in the examination room.
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Posted by Orac at 8:00 AM • 44 Comments
February 9, 2012
Category: Antivaccination lunacy • Autism • Medicine
There are times when I want to fall down on my knees and give thanks for certain cranks. I mean, where would my blogging material come from, were it not for antivaccine loons, quacks, cranks, creationists, and animal rights terrorists providing me with an unending stream of blog fodder? Were they all to disappear, I'd be reduced to blogging about puppies or music or something, and, trust me, you wouldn't want that. Of course, my readership would flee me faster than a advocates of gay marriage flee the Republican Party; so I guess it wouldn't matter. I know which side my bread is buttered on; you come for the Insolence, both Respectful and not-so-Respectful, and hopefully you get some education about science, medicine, and critical thinking as a byproduct. Fortunately, my blogging proclivities based on what I like to write about line up rather well with what my readers seem to like read. I suppose there's some circular logic in there somewhere.
Be that as it may, today I'm giving thanks for the antivaccine propaganda blog Age of Autism and one of its bloggers, Julie Obradovic for giving me an utterly irresistable bit of material that I rather suspect you'll find just as amusing as I did. Of course, what made her post so irresistible to me is the very reason she's not going to be very happy with me if she sees this post. Not that I care much, I just find it amusing. You see, Julie Obradovic really, really, really doesn't like being called "antivaccine," as in hates it so much that she wrote a post bout how much she hates it and considers it a horrific injustice and wants to convince you that she and the merry band of antivaccine propagandists over at AoA aren't anti-vaccine after all. Yes, it's the old antivaccine trope, "I'm not 'antivaccine'; I'm a vaccine safety advocate," and it comes in the form of a post entitled The Trouble with the ANTI "Anti-Vaccine" Movement: How They Hijack the Issue; Distort the Facts; and Totally Miss the Point. Not content to turn the antivaccine whining up to "10," Obradovic turns it up to "11" with 11 things she finds really, really wrong with those of us who stand up for vaccine science against the likes of AoA.
It's truly hilarious reading. Well, hilarious and sad at the same time.
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Posted by Orac at 3:00 AM • 147 Comments
February 8, 2012
Category: Medicine • Pseudoscience • Skepticism/critical thinking
I was going to write about that article about massage therapy and the gene expression changes it causes, but when I went to look up the actual paper and found out, to my great disappointment, that our institution still doesn't have a subscription to the journal in which it was published. So, while I'm waiting for a friend to send me a copy, I can't help but do a quick and uncharacteristically short posts (for me) discussing a tidbits of information that I found quite heartening. Unfortunately, it involves a person every bit as vile as the antivaccine activists who so hate vaccines that they're willing to make excuses for the death of a baby that involve claiming that the shaken baby syndrome doesn't exist and trying to exonerate baby killers by claiming that shaken baby syndrome is due to vaccines.
I'm referring to a woman named Camille Marino, a woman who is every bit as despicable--more so, even--than the most die-hard antivaccinationist pushing the idea that vaccines can replicate the triad of findings in shaken baby syndrome. Remember Camille Marino? She's the animal rights "activist" in Florida responsible for a website and blog known as Negotiation Is Over, which can best be described as pure crazy on megadoses of steroids. With her spiritual soulmate Steven Best, Marino has created a paean to self-righteously overwrought pontificating sprinkled with the fetishization of violence. To her, threats against children are not considered beyond the pale, nor is justifying it by saying things like:
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Posted by Orac at 3:00 AM • 225 Comments
February 7, 2012
Category: Antivaccination lunacy • Medicine • Quackery
Way back in the day, when I first encountered antivaccine views in that wretched Usenet swamp of pseudoscience, antiscience, and quackery known as misc.health.alternative, there was one particular antivaccine lie that disturbed me more than just about any other. No, it wasn't the claim that vaccines cause autism, the central dogma of the antivaccine movement. Even ten years ago, that wasn't a particularly difficult myth to refute, and, with the continuing torrent of negative studies failing to find even a whiff of a hint of a whisper of a correlation between vaccination and autism, refuting that myth has only gotten easier over the years. Indeed, I know it's gotten pretty easy when even the mainstream media start to accept that the claim that vaccines cause autism is a myth and report matter-of-factly on issues such as Andrew Wakefield's fraud and don't give nearly as much copious and prominent media time to the likes of Jenny McCarthy. No, what I've found to be one of the most disturbing antivaccine claims of all is the assertion that shaken baby syndrome is a "misdiagnosis for vaccine injury."
I first learned of this vile concept when I learned of the case of Alan Yurko. Yurko gained "fame" (if you can call it that) when he was sentenced to life in prison without parole for the murder of his 10-week-old son, who was shaken to death. Somehow, Yurko became the centerpiece of a campaign (Free Yurko) that featured as the centerpiece of its argument for Yurko's innocence the claim that shaken baby syndrome (SBS) is in realty "vaccine injury." Unfortunately, ultimately Yurko was released early, not because the courts agreed with the lie that it was vaccine injury, not SBS, that killed Yurko's son. Rather, it was because apparently the coroner's office where the autopsy was done on the dead baby was the most shoddily run morgue ever and incompetent coroner ever.
If you ever wanted to know how low antivaccine zealots can sink, let Australian skeptic Peter Bowditch describe it:
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Posted by Orac at 3:00 AM • 95 Comments
February 6, 2012
Category: Alternative medicine • Medicine • Pseudoscience • Quackery • Religion • Skepticism/critical thinking
It's amazing how fast six months can pass, isn't it? Well, almost six months, anyway, as it was five and a half months ago that I wrote about a particularly execrable example of quackademic medicine in the form of a study that actually looked at an "energy healing" modality known as "energy chelation" as a treatment for cancer chemotherapy-induced fatigue. Actually, the study design itself wasn't so bad, leaving aside the utter ludicrousness of the concept of "energy chelation." Rather, it was how the authors spun interpreted their results that set my head spinning. Surprisingly, a letter to the editor was accepted for publication describing exactly why this study was a pair of fetid dingo's kidneys. The letter itself and the authors' response to it are quite instructive, which is why I decided to revisit this study.
Before I do, let's just briefly provide the CliffsNotes version why I wasn't impressed with the original study. (If you want the gory details, feel free to go back to my original post to refresh your memory.) First, none of the primary outcomes showed statistically significant differences between placebo control and treatment groups. Unfortunately, that didn't stop the authors from mining their dataset for secondary outcomes. Not surprisingly, they found barely statistically significant differences between the control and treatment arms in a couple of these secondary endpoints plus a surrogate endpoint that they proposed as a biomarker (cortisol slope) even though it's never been validated as a measure of chemotherapy-induced fatigue. These deficiencies in the study interpretation led me to ask this question six months ago: What do we normally call it when there is no difference between the real treatment and a sham treatment in a clinical trial testing a drug or device? That's right. We say there's no effect greater than that of a placebo and that the trial is negative; i.e., the tested experimental intervention doesn't work.
Let me remind you that that is not what the authors concluded. Here's a snippet from the conclusion of the paper:
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Posted by Orac at 3:00 AM • 22 Comments
February 3, 2012
Category: Alternative medicine • Medicine • Pseudoscience • Quackery • Religion • Science • Skepticism/critical thinking
A couple of weeks ago, I made the observation that there seems to have been a--shall we say?--realignment in one of the central arguments that proponents of "complementary and alternative medicine" (CAM) and "integrative medicine" (IM) make. Back in the day (say, a few years ago), such CAM practitioners and apologists used to try very, very hard to argue that their modalities had actual efficacy, that they had actual, measurable effects that made them medicine rather than woo. Never mind that even back then they had been trying for at least a couple of decades to come up with preclinical and clinical evidence that various magical CAM modalities worked, without any appreciable success. Worse for them, it's only gotten worse over the last few years. As I've documented here and elsewhere, the larger and better-designed the scientific study, the more likely it is that a CAM modality will show no efficacy detectably different than placebo effects. When we test a drug or medical device, finding no difference between the treatment arm and placebo arm leads us to conclude that the drug or device (or whatever intervention) does not work; i.e., does not have effects detectably different from nonspecific effects. When CAM practitioners find no difference between the treatment arm and placebo arm, they conclude that their treatment has promise. I love the double standard, don't you?
In any case, as more and more evidence comes in failing to find CAM modalities to be any more efficacious than placebo, the inevitable conclusion is that most of CAM is placebo medicine. Given that placebo effects have not been shown to have any detectable effect on the actual pathophysiology of disease, that they are variable, unreliable, and generally weak, and that invoking them requires deceiving the patient, it is considered at best ethically dubious and at worst completely unethical to treat patients with placeboes. They are not particularly effective, and a practitioner must, in essence, lie to his or her patient. Paternalism, although by no means gone in medicine, is soooo 1950s; it's slowly disappearing, and the disapproval of using placebo medicine is one part of that decline--except in CAM, apparently.
In any case, as I pointed out a couple of weeks ago, when faced with more and more evidence that the vast majority of CAM is placebo medicine, what do CAM pracitioners do? Do they do what a science-based practitioner would do, at least eventually, and give it up? Of course not! Instead, they double down and embrace the "placeboness" of their treatments by invoking the "powerful placebo" and claiming that they are "harnessing the power of placebo" to produce "powerful mind-body healing," of course!
I thought I was done with this topic, at least for a while, but then I found a post in--where else?--that wretched hive of scum and quackery, The Huffington Post by someone named Robert Schiffman, who is apparently a journalist and wants to tell us How the Placebo Effect Proves That God Exists.
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Posted by Orac at 9:00 AM • 90 Comments
February 2, 2012
Category: Antivaccination lunacy • Medicine
Since I wrote about a man who is arguably the biggest seller of quackery on the Internet, namely Joe Mercola, yesterday, I thought I'd turn my attention to someone who is arguably another of the biggest promoters of quackery on the Internet, namely Mike Adams of NaturalNews.com. If Joe Mercola is proof positive that quackery sells, Mike Adams is proof positive that there are conspiracy theorists out there who are so reality-challenged that they'll believe virtually anything. Whether it's his despicable assaults on dead celebrities as having been "killed by modern medicine," his constant stream of antivaccine fear mongering, or his hilariously inept attempt to out-Chopra Deepak Chopra while mixing in liberal helpings of pure unadulterated fevered conspiracy mongering, truly no one brings home the crazy about alternative medicine the way that Mike Adams does. As a result, he's a major force on the Internet, at least in the realm of quackery and attacking science=-based medicine. True, he doesn't appear to be nearly as good at marketing wares for huge profits, but he sure does appear to be good at marketing himself. While Mercola is cold and calculating about how to make money; Mike Adams appears to be just as calculating, but he's more about stirring up emotion and conspiracy theories. Unfortunately, he seems to be pretty good at it.
I must admit that I have a bit of a fascination for Mike Adams. I have a rational mind (or, at least, I try to have a rational mind); so it's really hard to wrap my brain around the sheer lunacy that is Mike Adams. There appears to be no conspiracy theory too outlandish for him to buy into uncritically, no charge against big pharma too unbelievable. In fact, I have a hard time deciding whether Adams is a true believer who really lives his paranoid world view or a scammer with a talent for tapping into the paranoia of the more gullible. I suspect it's a little of both but leaning towards the former. After all, a man who can produce a video in which science is portrayed as an unrelenting force for evil probably must at some level believe that science is an unrelenting force for evil. Either that, or he's extremely good at lying and mimicking paranoia.
Whatever Adams' motivation, his penchant for bringing home the crazy was on full display last night in an article entitled Microsoft buys eugenics technology from Merck, becomes drug development partner with top global vaccine manufacturer. Somehow I ended up on Adams' NaturalNews.com mailing list a while back. Actually, I ended up on it twice, once per my two main blogging e-mail addresses, meaning that I get a double dose of crazy delivered to my in box every morning; so when this gem popped up I just couldn't resist. One of these days, fascination with this much concentrated misinformation might suck me past the event horizon of the black hole of crazy that is Mike Adams' website. Not today. Today, I take my amusement (and hopefully produce yours).
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Posted by Orac at 9:00 AM • 71 Comments
February 1, 2012
Category: Alternative medicine • Medicine • Quackery
For as many benefits as the Internet and the web have brought us in the last two decades, there are also significant downsides. I could go into all the societal changes brought about by the proliferation of this new technology, not the least of which (to me, at least) is the newfound ability of someone like me to find an audience. After all, pre-Internet and pre-blog, I could try to write books, or I could try to get onto TV and radio, but those are very difficult things to do. Over the last seven years, steadily blogging, I've built up an audience. True, compared to the "old media" and the more popular examples of the new media, this blog is the proverbial tiny voice in the wilderness. Normally, I have to actively think about people such as Dr. Oz, Oprah Winfrey, The Doctors, and that wretched hive of scum and quackery, The Huffingto Post, just to remind me how small my influence is when compared to the forces arrayed against science-based medicine.
It's rather depressing, though, to have it rubbed in my face from a source I didn't expect.
I'm referring to an article that appeared yesterday in Chicago Magazine entitled Dr. Mercola: Visionary or Quack? Although I agreed with much of what was in the article, which featured some familiar people trying to provide balance to Mercola's pseudoscience, I must admit that I couldn't help but find the very title of the article is annoying. Putting the word "visionary" in the same title with the word "Dr. Mercola" is profoundly offensive to anyone who values reason, science, and science-based medicine. I realize the reporter was doing nothing more than being provocative, but it sets the tone in a way that makes it sound as though there is even a controversy over what the answer to such a question is. That answer, of course, is, in my not-so-humble opinion, that Dr. Mercola is a quack. Many are the posts I've written right here on this very blog spelling out in painful detail exactly why it is that I think this is so. For one thing, Dr. Mercola is antivaccine to the core, even going so far as to team up with the antivaccine group the National Vaccine Information Center (NVIC) to spread its propaganda. This article actually provides a tidbit of information that I didn't know about. In fact, it's a tidbit so juicy that I'm going to mention it now, even though it doesn't show up until late in the article:
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Posted by Orac at 11:45 AM • 51 Comments
Category: Antivaccination lunacy • Medicine • Politics
Here's a rare bit of good news on the regulatory front. It turns out that Representative Dan Burton (R-IN) has finally decided to retire:
So Rep. Dan Burton (R-Ind.) is finally retiring, after two decades in Congress. He's got a notable record of craziness, having doggedly pursued President Bill Clinton during the Monica Lewinsky scandal while knowing full well he'd had an affair himself and even fathered a child out of wedlock. He famously claimed to have shot up a "head-like object" (likely a melon or a pumpkin) to try to re-create the alleged "murder" of former Clinton deputy White House counsel Vince Foster, who committed suicide. But Burton doesn't get enough credit for what may be his lasting legacy: helping turn Americans away from life-saving childhood vaccines.
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Posted by Orac at 12:00 AM • 38 Comments
Orac is the nom de blog of a (not so) humble pseudonymous surgeon/scientist with an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his miscellaneous verbal meanderings, but just barely small enough to admit to himself that few will. (Continued 
