I tell ya, I go away for a few days, let the blogging slow down, decrease the usual logorrhea. Heck, I even go for the lazy blogger trick of an open thread. In the meantime, while I was busy learning about real science at the 2010 AACR Meeting, the forces of pseudoscience have not been quiet. No, they’ve been active; indeed, there is so much that requires Orac’s not-so-Respectful Insolence and so little time for me to apply it. That means that, almost certainly, “deserving” candidates will be missed. That is a shame, but even Orac needs his rest from time to time.
None of this means that I can resist (at least not easily), when everyone’s “favorite” font of burning stupid, homeopathic apologist, derailer of comment threads, and someone who has no idea when he’s not just whipped but whipped, pureed, and stomped, pops up and deposits a turd of pseudoscience on that repository of pseudoscience, quackery, and woo, The Huffington Post. And I don’t intend to, given that Dana has supplied me with–shall we say?–an exceedingly “target-rich” environment. In particular, his article could provide rich fodder for a game of “Name That Logical Fallacy,” but that alone doesn’t make it “worthy” of the loving application of a heapin’ helpin’ of not-so-Respectful Insolence. This time around, Dana, filled with the arrogance of ignorance and clearly deeply resenting the justified criticisms of his favorite form of quackery (homeopathy, for those of you not familiar with him) and his hilariously inept attempts to defend it, has apparently decided it’s time to strike back. Since he has failed miserably to provide one iota of evidence that homeopathy is anything other than magic-based medicine (to steal Jamy Ian Swiss’ line) or, as I like to put it, Dr. Strange’s medicine, Ullman has apparently decided to go on the attack against science-based medicine. The result, as usual, is hilarious, as Ullman has produced a post entitled How Scientific Is Modern Medicine Really?
I have to say this: Even if every accusation laid on science-based medicine by Dana Ulman weren’t a huge bunch of distortions and cherrypicking, modern medicine would be orders of magnitude more scientific than Dana’s preferred modality, homeopathy. But let’s move on to Dana’s woo-ful whine. The first thing I noticed is that it appears to be a rehash of a very similar article that Ullman published two and a half years ago (and which I had some fun with when he posted it), except that he appears to have found a little more recent material to throw in, some more recent anti-SBM attacks to cherry pick. Consequently, rather than taking on the whole article, I refer the reader to my old deconstruction and will concentrate mainly on what is different in the 2010 edition of Ullman’s rant about how “medical science was wrong before” and, “Oh, by the way, doctors are poopyheads.” Ullman starts out very similarly to his old article:
Doctors today commonly assert that they practice “scientific medicine,” and patients think that the medical treatments they receive are “scientifically proven.” However, this ideal is a dream, not reality, and a clever and profitable marketing ruse, not fact.
The British Medical Journal’s “Clinical Evidence” analyzed common medical treatments to evaluate which are supported by sufficient reliable evidence (BMJ, 2007). They reviewed approximately 2,500 treatments and found:
- 13 percent were found to be beneficial
- 23 percent were likely to be beneficial
- Eight percent were as likely to be harmful as beneficial
- Six percent were unlikely to be beneficial
- Four percent were likely to be harmful or ineffective.
- 46 percent were unknown whether they were efficacious or harmful
The “study” to which Ullman refers is the introduction to BMJ’s ClinicalEvidence. It sounds pretty damning, doesn’t it? Except, as many attacks on SBM are, this is an exceedingly deceptive way of presenting information. For one thing, there is no discussion of how frequent the treatments are or for what conditions. Every “treatment” is treated as a single treatment, regardless of how uncommon the disease or treatment may be. It’s quite possible, for instance, that the 13% of treatments that were found to be beneficial were beneficial for far more than 13% of patients or 13% of conditions. No mention is made of what the 46% of treatments whose efficacy is supposedly unknown are, either. They could well be treatments for uncommon conditions or experimental treatments or holdovers.
Another thing that’s rather interesting about BMJ ClinicalEvidence is that it apparently doesn’t just cover conventional medicine. It covers alternative medicine as well. For example, look at this review of therapies for tension headache. Well, actually you can’t, and neither can I, because I don’t have a subscription to BMJ ClinicalEvidence, and neither does my institution. However, it’s possible to find summaries of the reviews in the lay press sometimes, and this is one case where the evidence was summarized by the BMJ team for The Guardian. It lists treatments that work (amitriptyline, mirtazapine) and treatments that are likely to work (cognitive behavioral therapy, for instance), but what’s interesting is what BMJ lists as treatments of unknown efficacy. These include “alternative” modalities, such as acupuncture, which really should have been listed not as “needing more study but under “does not work,” based on multiple studies–which tells me right there that the reviewers for BMJ are giving too much leeway to some alternative medicine modalities. Also included was Indian head massage and biofeedback. You get the idea.
But here’s something more interesting. Look at what therapies are listed as harmful. It is argued that taking over the counter painkillers is potentially harmful, but this is probably only true if headaches are frequent. If a person is not getting a headache every other day, if a person is, for instance, getting a headache only once or twice a month, it is unlikely to be harmful to take Tylenol or ibuprofen. Although pointing out that taking such drugs for headaches that occur 15 times a month may be harmful is probably true, when a bunch of such reviews are lumped together, a lot of therapies get thrown into the “harmful” or “unknown” categories. More importantly, it appears that the BMJ doesn’t just confine itself to “conventional” or “science-based medicine.” It appears to include all sorts of alternative therapies in its list. So Ullman is–surprise! surprise!–being either clueless (if he didn’t bother to look at a few reviews) or intellectually dishonest (if he did) by implying that the overall summary by BMJ represents the percentage of conventional therapies that don’t work. In fact, it looks at conventional medicine and various “alternative” modalities, like herbal remedies, acupuncture, etc.
In fact, lumping together all these therapies as a huge list is, in essence, meaningless other than a couple of things. First, I’m heartened at the low percentage of treatments that are likely to be harmful. Second, given that BMJ apparently includes a whole bunch of “alternative” therapies in its reviews, it’s actually not so bad that only 46% of treatments are of unknown effectiveness. In any case, as a commenter pointed out, for individual conditions, SBM does quite well–asthma, for instance, where 67% of treatments are beneficial or likely beneficial;
24% of treatments are of unknown effectiveness; 9% of treatments are unlikely to be beneficial. And, depending on the disease or condition, even conventional medicine’s efficacy can vary wildly.
Of course, homeopathy’s efficacy remains very constant, no matter what the condition. Homeopathy doesn’t work and would thus fall into “unlikely to be beneficial,” but only if you can say wildly, extravagantly, ridiculously unlikely to be beneficial. After all, it’s just water.
Another new bit that Ullman grafted onto his 2007 article is this:
Today in America, every man, woman, and child is prescribed around 13 prescription drugs per year (and this doesn’t count the many over-the-counter drugs that doctors prescribe and that patients take on their own) (Kaiser, 2006). Just 12 years earlier, Americans were on average prescribed less than eight drugs per person, a 62 percent increase! The fact of the matter is that drugs are not tested for approval in conjunction with other drugs, and the safety and efficacy of the use of multiple drugs together remains totally unknown.
This practice of “polypharmacy” is increasing substantially, and Big Pharma is pushing it hard and benefiting from it in a big big way.
According to a 2008 nationwide survey, 29 percent of Americans used at least five prescription medications concurrently (Qato, Alexander, Conti, 2008), while just three years previously, 17 percent took three or more prescription drugs (Medscape, 2005). Even conservative publications such as Scientific American can no longer deny the increasing serious problems from pharmaceuticals. A recent article highlighted the fact that there has been a 65 percent increase in drug overdoses leading to hospitalization or death just in the past seven years (Harmon, 2010).
One notes that, while it’s clear that polypharmacy is a problem, one can’t help but note that the very same source that Ullman cites also points out that the percent of the population with a prescription drug expense in 2003 was 61% (for those under age 65) and 91% (for those 65 and older), which has changed little since 1996, when they were 62% and 88%, respectively. One possible implication is that people who are on a prescription drug are now more likely to be on more prescription drugs than they were in the past. One thing that bugs me about these number, though, is that it is not clear whether these prescriptions represent new prescriptions or refills or both. My guess is that it’s both. In any case, Ullman clearly chose the number that sounds the worst, given the rate of increase in prescription drug spending is decreasing, from 4.5% in 2007 to 3.2% in 2008, although projections are that this spending will increase by 6% every year for the next decade, which is not suprising or out of the ordinary given that the Baby Boomer generation is heading into retirement and that senior citizens tend to use far more prescription drugs than do younger people. It just sounds scarier to make it sound as though every American is on at least 13 prescription drugs. Again, I’m not saying that polypharmacy and arguably too much spending on prescription drugs are not problems. However, practitioners of science-based medicine are aware of these problems and are trying to do something about them. In marked contrast, Ullman remains blissfully unaware or unwilling to admit that homeopathy is nothing more than water.
Similar comparisons can be made to the observation that there has been an increase in prescription drug overdoses over the last seven years. What Ullman neglects to mention is that the vast majority of this increase is due to prescription opoids and tranquilizers:
The biggest percent increase in hospitalizations for poisoning for a specific drug was a quintupling for methadone, according to the team’s report published in the American Journal of Preventive Medicine. This may be due to the more than 10-fold increase in overall retail sales of this drug from 1997 to 2006, they state.
Poisoning by benzodiazepines such as Xanax and Ativan — drugs that possess sedative, hypnotic, anti-anxiety, anticonvulsant and muscle relaxant activities — rose 39 percent over the study period.
Poisoning by barbiturates, which also have sedative, hypnotic and anti-anxiety actions, actually fell 41 percent, as did hospitalizations for poisoning by antidepressants (a decrease of 13 percent).
One also notes that there is a thriving black market for illegally selling many of these prescription drugs, as well as overprescription and wider availability of much drugs of a potency that could until recently only be obtained through intravenous injection. In any case, Ullman, not surprising, disingenuously makes it sound as though it’s all prescription drugs, not primarily drugs from one category, that are responsible for this increase in hospitalization. Once again, no one is arguing that unintentional overdoses of opiods and tranquilizers are not a problem. Once again, it is the medical profession, not homeopaths, who are sounding the alarm. Ullman is just cribbing reports done not by homeopaths or “alternative medicine” practitioners but by practitioners of science-based medicine and scientists. Once again, it is useful to point out that an overdose of any homeopathic remedy–true homeopathic remedy, that is, not homeopathic remedies that contain actual drugs or herbs in pharmacologically active concentrations–is nearly impossible to achieve, aside from drowning or water intoxication.
Ullman also can’t resist adding a different take to his attacks on big pharma, other than the pharma shill gambit and conspiracy mongering:
An even stronger case can be made for the epidemic of “elder medical abuse” due to the much larger number of drugs prescribed to and for our senior citizens. It is no wonder that so many of them have become mental zombies, while Big Pharma profits big time and insurance companies simply raise their rates.
If we were living a lot longer and the quality of our lives was improved by medical care, one could make a case for why today’s medical care is providing more benefits than problems, but this is simply not true.
Although we are commonly told that we are living longer than ever now, this is simply a clever, even tricky, use of statistics. The fact of the matter is that there has been a considerable reduction in deaths during the first five years of life … and this reduction in deaths has resulted primarily from a medicinal agent called “soap,” not from the use of any specific conventional pharmaceutical agent.
Ultimately, an American who was 40 years old in 1900 and an American who was 40 years old in 2000 has a similar chance of living to 80 years old today.
Ullman is just plain wrong here. As these life tables from the Department of Health and Human Services, National Center for Health Statistics; National Vital Statistics Reports, vol 54., no. 19, June 28, 2006. show, in 1900, life expectancy at age 40 was 27.74 years for white males and 29.17 years for white females. In 2000, the same numbers were 37.1 years and and 41.3 years, respectively, impressive increases. For age 60 over the same period life expectancy in men has increased from 14.35 years to 20 years; women from 15.23 years to 23.2 years. Ullman’s either mistaken or lying, take your pick. Or perhaps Ullman considers a 33% increase in life expectancy in men and a 42% increase for women from age 40 over the last century to be “similar.”
The bottom line is that we are living longer than ever and staying active longer than ever, and it sure isn’t homeopathy that is making that possible. In light of the flowing swaths of burning stupid that Dana laid down in his article, I can’t help but point out that Dana promises a part 2. I also can’t wait, as I’m sure it will be as entertaining as this rehash of his 2007 article, which, by the way, I did deconstruct back in 2007, which is the main reason I didn’t rehash the not-so-Respectful Insolence that I laid down on the parts of Ullman’s latest HuffPo travesty that are more or less identical (or at least very similar) to his 2007 piece.
Finally, I will close by citing what is perhaps the most disingenuous bit that Ullman included in his post:
NOTE: This article focuses on the issue of the amount of “science” in medical care today. I predict that many commenters below will choose to attack me or the subject of homeopathy, even though THIS is not the subject of this article. I sincerely hope that commenters will stick to the subject at hand. For those of you who wish to comment on homeopathic medicine research, I urge you to do so at articles on that subject.
Unfortunately for Dana, the one part he did keep from the older article is his rant against the AMA for having tried to suppress homeopathy back in the 1800s. In essence, Ullman is doing what apologists for homeopathy and various forms of alt-med have done for decades, if not centuries. Because they can’t present any convincing positive evidence for the efficacy of their favorite woo, they point out–and exaggerate, if necessary–the problems of science-based medicine. Unfortunately, these problems do not invalidate science-based medicine, nor do they validate homeopathy. Ullman means to imply that they do, because he really can’t do anything else. That’s why I did two things: I addressed the distortions in Ullman’s distortion-packed article, and I contrasted science-based medicine with homeopathy. In the end, even if everything Ullman said were utterly true and completely unexaggerated or cherry picked, science-based medicine would still be effective, and homeopathy would still be water.