Posted by Scott Gavura on September 24, 2015

Low dose aspirin is now recommended to prevent heart disease and cancer.

Despite the remarkable advances in medicine over the past 20 years, cardiovascular disease and cancer will still kill half of us. Beyond the deaths, millions survive heart attacks, strokes and cancer, but many are left with disability and a reduced quality of life. While lifestyle changes can improve our odds of avoiding these diseases, they do not eliminate our risk. Finding ways to medically prevent these diseases before they occur, a term called primary prevention, is a holy grail in medicine. Primary prevention can be a tough sell, personally and medically. It means taking medicine (which may cause side effects) when youre well, with the hope of preventing a disease before it occurs.

The US Preventative Services Task Force (USPSTF) released draft guidelines on the primary prevention of cardiovascular disease and colorectal cancer last week. The USPSTF is now recommending daily aspirin use in those at average risk of cardiovascular disease. This isnt the first guideline thats recommended aspirin for primary prevention of cardiovascular disease, but it is the first major guideline to endorse aspirin to prevent colorectal cancer. Given these recommendations will apply to millions of people, they have attracted considerable controversy. Is this strategy going to reduce deaths and disability? Or are we about to start medicalizing healthy people inappropriately? (more)

A recent segment on NPR is an excellent representation of some of the mischief that promotion of unscientific medical treatments can create. The title is a good summary of the problem: To Curb Pain Without Opioids, Oregon Looks To Alternative Treatments.

The entire segment is premised around a false dichotomy, between excess use of opioids and unproven alternative treatments. It is clear that the reporters didnt even speak to a pain specialist who relies upon science-based treatments, or if they did the specialist was completely ignored because a SBM approach did not fit into the narrative of the report.

The problem addressed by the segment is real the current technology of pain control is limited. I dont want to sell pain management short, we have an array of powerful and effective treatments. There are limitations, however, and many patients are inadequately treated.

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Lets not change the eagle into a duck

AMVETS has joined with The American Association of Naturopathic Physicians in seeking to promote natural, non-pharmacological approaches to treating patients suffering from chronic pain. They are petitioning Congress and the VA to authorize bringing licensed NDs into the VA system. As a veteran myself, a retired Air Force Colonel and an MD, I find this appalling. During my twenty years service in the U.S. Air Force as a family physician and flight surgeon, I took pride in the high-quality science-based medical care my colleagues and I were able to provide. This proposal would jeopardize the welfare of our veterans by exposing them to substandard care with irrational, untested, and potentially harmful treatments. Letting naturopaths into the VA would be a grave mistake. (more)

Republican candidates Ben Carson and Donald Trump during the CNN Republican presidential debate at the Ronald Reagan Presidential Library and Museum on Wednesday, Sept. 16, 2015

Ive been writing about vaccines and the antivaccine movement since the turn of the millennium, first in discussion forums on Usenet, then, beginning in 2004, on my first blog (a.k.a. the still existing not-so-super-secret other blog), and finally right here on Science-Based Medicine (SBM) since 2008. Vaccines are one of the most important, if not the most important, topics on a blog like this because (1) arguably no medical intervention has prevented more deaths and suffering throughout history than vaccines; (2) few medical interventions are as safe and effective as vaccines; and (3) there is a vocal and sometimes effective contingent of people who dont believe (1) and (2), blaming vaccines for all sorts of diseases and conditions to which science, despite many years of study, has failed to link them. The most prominent condition falsely linked to vaccines is, of course, autism, but over the years Ive written about a host of others, including sudden infant death syndrome, shaken baby syndrome, autoimmune diseases, and even cancer. In a similar vein, antivaccine activists will try to claim that vaccines are loaded with toxins or even tainted with fetal parts or cells because some vaccines manufacturing process involves growing virus in two cell lines that were derived from aborted fetuses many decades ago. Even the Catholic Church doesnt say that Catholics shouldnt use these vaccines, but that doesnt prevent some antivaccine groups from portraying vaccines as virtually being made by scientists cackling evilly as they grind up aborted fetuses to make vaccines. (I exaggerate, but not by much.)

On a strictly scientific, medical level, antivaccine claims such as the ones described above are fringe, crank viewpoints. There is no serious scientific support for any of them and lots of scientific evidence against them, particularly the most persistent myth, namely that vaccines cause autism. It also used to be the case that, politically, antivaccine views tended to be those of the fringe. Unfortunately, in the current election cycle, those fringe views seem to be coming to the fore among prominent candidates for the Republican Presidential nomination. This was most evident at the second Republican Presidential debate last week, where Donald Trump spewed antivaccine tropes and neither of the two physicians also running for the Republican nomination mounted a vigorous defense of vaccines. Even candidates who have previously issued strong statements defending vaccines (Senator Marco Rubio and Louisiana Governor Bobby Jindal) remained silent.

(Video of the exchange can be found here.)

How did we get to this point? And why is it that antivaccine views, which in the past were stereotypically associated with crunchy lefties in the mind of the public, seem now to have found another comfortable home among small government conservatives, including the man who currently appears to be the frontrunner for the Republican nomination? In the days that followed the debate, there have been many discussions of Donald Trumps antivaccine views, but none that take the long view. All seem to flow from the idea that its mainly just Donald Trump and his wacky views, rather than Trump being part of a more widespread phenomenon. Ive frequently said that antivaccine beliefs tend to be the pseudoscience that knows no political boundaries, occurring with roughly equal frequency on the left and the right. However, its virtually inarguable that right now, in 2015, the loudest political voices expressing antivaccine views (or at least antivaccine-sympathetic views) are in the Republican Party. Yes, Robert F. Kennedy, Jr. is back in a big way, partying like its 1999 with Bill Maher over thimerosal-containing vaccines and autism, but neither he nor Bill Maher holds public office or is currently running for office. The ber-liberal website The Huffington Post might have been promoting antivaccine propaganda since its inception, but its writers are not running for office, either, and of late it seems to be much less antivaccine than before. (more)

Tags: AB 2109, antivaccine, Autism, Ben Carson, Bobby Jindal, Carly Fiorina, CNN, Donald Trump, Jake Tapper, Marco Rubio, Patrick Colbeck, Rand Paul, Republican debate, Republican Party, SB 277, Scott Walker, Ted Cruz, Vaccines

Posted in: Neuroscience/Mental Health, Politics and Regulation, Vaccines

A rare double-face palm, so you cant see the tears

I run across a lot of information in my feeds that I need to save for further evaluation. The study Does additional antimicrobial treatment have a better effect on URTI cough resolution than homeopathic symptomatic therapy alone? A real-life preliminary observational study in a pediatric population, I saved with the file name, jaw droppingly stupid.

The worst homeopathy clinical trial ever doesnt spring full formed like Athena from the head of Zeus. No. The worst homeopathy clinical trial ever started with a seed. The seed is Homeopathic medicine for acute cough in upper respiratory tract infections and acute bronchitis: A randomized, double-blind, placebo-controlled trial, which is a standard lousy homeopathic study. (more)

Massage therapy? Pranic healing? Polarity therapy? Zero balancing?

Back in my days of practicing law, one of my escapes from reality was a good massage. It was a great treat, exchanging the high-octane atmosphere of the law office for the soothing music, subdued voices and pastel tones of the treatment room. I could have stayed on that table for hours.

Little did I know just how much an escape from reality massage therapy would soon become.

About 15 years ago, when I called to book an appointment with my favorite therapist, a recorded message offered something called ray-kee at least, that is how it was pronounced. I assumed it was just a form of massage and didnt think anything about it. Then, at one session, while my feet were being rubbed, my massage therapist an RN, no less suggested I would be surprised at how often a sore spot actually correlated with a medical problem. She was talking about reflexology, of course.

Fast forward a few years. A new massage therapist and a new location, this time a health center (actually, a gym) owned by a local hospital. The massage therapist inquired whether Id like to try cranial sacral therapy. Whats that? I asked. Oh, she said, it would be hard to explain. (She got that right.) She then proceeded to inform me that she had actually used it in one of our sessions. This alerted me to the possibility that informed consent was not part of the massage therapy protocol.

A few more years went by. Another therapist (also an RN), another location. I was pleased with her because I thought she did a good job and she also taught me some simple stretching exercises. To my surprise, in one session, she started pressing on the space between my toes because, she said, it corresponded with the (something, something I didnt get this part) of my neck. Reflexology again. (Are they now teaching reflexology in nursing school? I am beginning to wonder.) (more)

Tags: Energy Medicine, massage, polarity therapy, pranic healing, Reflexology, regulation, vitalism, zero balancing

Posted in: Acupuncture, Energy Medicine, Health Fraud, Politics and Regulation

You read that headline correctly.

Stephanie Seneff first came to skeptical attention when she published a study claiming that vaccines were linked to autism. She trolled through the VAERS database and, as David Gorski noted, tortured the data until it confessed. Last year she published a paper in which she claimed glyphosate caused autism, claims which I addressed almost a year ago. Gorski also deconstructed this paper, noting, In fact, if you look at the slides for Seneffs talks (e.g., this one, available at her MIT web page), youll find a tour de force of confusing correlation with causation

Seneff is a computer scientist who apparently is anti-vaccine and anti-GMO. In a stunning example of the Dunning-Kruger effect, she feels she can take her computer expertise and export it to biology. She nicely demonstrates that expertise is not so easily transferable.

Last year she also published a paper, which escaped my attention until it was recently pointed out to me, claiming that glyphosate, GMOs, and other modern lifestyle factors are responsible for the recent increase in concussions. Her co-author on the paper is Wendy Morely, who is a Registered Holistic Nutritionist specializing in the nutrition of concussion. Neither author has any neuroscience background.

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Its not clear who first quipped Id rather have a bottle in front of me than a frontal lobotomy, but its not just a joke. Almost anything would be preferable to a frontal lobotomy. It was a barbarous procedure with catastrophic consequences, and yet it was once widely accepted and even earned a Portuguese doctor a Nobel Prize. In the annals of medical history, it stands out as one of medicines biggest mistakes and an example of how disastrously things can go wrong when a treatment is put into widespread use before it has been adequately tested.

A new book by Janet Sternburg, White Matter: A Memoir of Family and Medicine, puts a human face on the suffering of mentally ill patients and their families, and helps us understand why they agreed to lobotomies. It is the affecting story of how her relatives made the difficult but misinformed decision to lobotomize two of her mothers five siblings, one for schizophrenia and the other for depression, and the consequences of that decision. (more)

FTC vs. homeopathy: Cage match?

Well, Im back.

OK, returning from London isnt nearly as epic as Sam Gamgees final words in The Lord of the Rings returning to his wife and daughter after having accompanied Frodo, Gandalf, Bilbo, and key elves of Middle-Earth to the Grey Havens, there to say goodbye to them as they boarded a ship to the undying lands. I just love the quote. It says something to me returning home after a long journey, even if it was just a vacation to J.R.R. Tolkiens native land. It also suggests a bit of the exhaustion after a long day of traveling, complete with a long-delayed flight, a late arrival, and a state of utter exhaustion that accompanied it, plus an unfortunate lower gastrointestinal issue.

All of this is a way of saying that this post might actually be relatively brief for a post by meno epics this week. [Addendum: Nope. Even lower GI annoyances and exhaustion couldnt keep me from going over 2,000 words. At least I didnt hit 3,000.] In its nearly eight year history, Ive never missed more than one week at SBM, and I dont intend to start now. Specifically, with the FTC workshop on homeopathy rapidly approaching, one week from today, I couldnt resist adding my 2 pence to the mix, now that the agenda and list of participants have been announced. (more)

As a pediatrician working in a relatively sCAM-inclined region, it is not uncommon to find myself taking care of patients who are also being followed by so-called alternative medicine practitioners. This often creates a major obstacle to providing appropriate care and establishing an atmosphere of mutual trust in the provider-patient/parent relationship. It usually makes me feel like Im battling invisible serpents in a sea of sCAM.

While these double-dipping parents utilize a variety of sCAM providers, including naturopaths, homeopaths, chiropractors, and a smattering of holistic healers, most are taking their children to one of a few wellness centers near my practice where they are seen by actual medical doctors practicing so-called integrative medicine. Many of these children have vague, chronic, usually non-specific complaints that are difficult to explain and thus to treat. Some have behavioral and mental health problems, or neurodevelopmental conditions such as autism for which parents are seeking explanations and treatments.

What I find to be a common theme with these patients is that they and their parents are summarily taken advantage of by their alternative care providers when they are given a fictitious diagnosis and treated with a variety of useless potions, elixers, and false hopes. Often, parents bring their children to these providers because they are frustrated by their childs chronic complaints of fatigue, pain, or other somatic issues that have eluded a satisfactory diagnosis or treatment. Invariably, the diagnosis that has remained so elusive to me is quickly found and treated by these much more holistic and open-minded providers. In fact, I have never seen a consultation note from one of these providers indicating any uncertainty as to diagnosis or treatment regimen. Typically a large battery of expensive, inappropriate, and sometimes outright fraudulent lab tests is ordered, often from equally questionable laboratories. Again, there are invariably interesting findings prompting tailored and bizarre treatments. In typical red-flag sCAM fashion, some of these providers have their own supplement store, available online only to their patients, prominently displayed on their website. These providers are perceived as being more holistically informed about health and wellness then conventional doctors like myself, as if there are two distinct ways of treating illness and maintaining healthas if there is truly such a thing as alternative medicine.

It can be very difficult to manage patients who are being simultaneously treated by such providers. Sometimes the treatments complicate or confuse the picture, but it always indicates a failure of trust in the conventional method of practice, which is science and evidence based, and in science itself.

Below are a few examples of patients cared for by my practice and simultaneously followed by alternative medicine practitioners. They provide a good picture of just how problematic these co-practitioners can be. No names or identifying information are revealed. (more)

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