God's medicine

  I had a patient recently who suddenly developed an irregular heart beat. There are lots of things that could cause this, including many medications. I asked the patient what medications she was taking and she said none. A few minutes later, looking around her room, I saw a large tub filled with pill bottles. I pointed to them and asked her what they were. She said, "Oh, just my herbals." I told her that herbs are made of chemicals and some of them can interfere with her heart rate (or with the blood thinners and heart rhythm medications we were giving her). She said, "No, they aren't chemicals. They are natural." I explained how many of our modern medicines comes from plants. She smiled, agreed wholeheartedly and said, "Yes, plants are natural medicines." I said that she was right and she should realize that medicines, even natural medicines, can have side effects. She replied, "No, medicines you give me have side effects because they are man made. Natural medicines are made by God and He has made sure that they don't have side effects." I knew I had no chance to convince her why what she was doing was dangerous. I looked through her box of supplements and didn't recognize most of them, but there were some known to be stimulants and others known to interact with blood thinners. I told her not to take those few (5 of the more than 30). She declined saying she trust's God's medicines more than mine. I spent a few minutes explaining why we were so worried, but got no where. When I left she said "God bless you." Mixing quackery with religion makes a dangerous thing deadly.
  I'm not too surprised that quackery and religion go hand in hand. With both you are convinced that you know the truth, that whatever else is out there is a lie and if there is a conflict between the two, you are always right. With both, there is no critical thinking. With both, rather than reasoning with someone trying to convince you otherwise, you get offended. With both, you bend over backwards trying to ignore the obvious deficiencies with what you believe in.

The danger of quacks

  A major argument that supporters of alternative medicine use is that it causes no harm, so they might as well try it. Of course, that's pure crap. Alternative treatments cause harm in numerous ways: Untested drugs and techniques have side effects and interactions, they're a huge waste of money, and, most importantly, they keep patients from receiving actual treatment that works.
  Case in point is a former patient that I recently ran into in the emergency department. Nine months ago, she was a perfectly healthy mother of two that was successful in her career. One of the sweetest patients I've had all year. At that time, she was admitted for new muscle pains. We ran many tests, figured out it was an autoimmune condition, gave her steroids and connected her with a rheumatologist to make the final diagnosis and for long-term management. She improved a little and went home with a plan in hand.
  Nine months later, I find her disheveled in the emergency room's psychiatric evaluation room (where you can't hurt yourself) screaming at no one in particular. It turns out that she was eventually found to have polymyositis, an autoimmune condition that affects the muscles and can be hard to treat. She had improved with steroids when I saw her 9 months ago, but a few months afterwards had another flare and went to a holistic "doctor" instead. The quack told her that she has "chronic Lyme disease" and that the her rheumatologist was wrong. He then tricked her into trying various herbs, potions, "magnetized water treatments" and none of it worked (somehow, antibiotics never came to his mind). She went had her primary care physician test her for Lyme disease and it kept on coming back negative. But, she insisted that she had Lyme disease. She became obsessed with having Lyme disease and spent more and more money on hyperbaric oxygen chambers, toxin removers, colon cleansing, etc. She lost tens of thousands of dollars and kept on getting fleeced by the holistic "doctor". Her relationship with her family became strained and she eventually attempted to commit suicide. Hence, her arrival to the emergency room.
  I won't blame the quack for causing her to become psychotically obsessed with her medical condition. Despite having no previous psychiatric illnesses, she must have had some underlying condition. What I do blame him for is playing on these beliefs to make money off of her. I blame him for convincing her that her doctors are wrong, that the tests were wrong and that they are trying to keep the truth of his fake medicine from her. Not all quacks are out to fleece people (some of them actually believe what they're selling), but all of them, whether intentionally or not, keep people from getting the treatments that they need. Luckily, she survived her suicide attempt, but this quack nearly had blood on his hands.

St. Jacobs Oil or Prednisone? (image from here)

Fake science legitimized

There's a lot of pseudoscientific or grossly biased "studies" out there that pretend to be actually doing real science. That really can't be stopped. Lots of organizations spend a lot of money to come up with "evidence" to back up whatever they like to promote. What upsets me is when these "studies" get published under the guise of actual scientific work. Some of theme are even peer reviewed. The great PZ brought up an example today from the Southern Medical Journal of a study that showed that prayer improves vision by recruiting subjects from a church revival, not blinding and not having a control. If the Southern Medical Journal is a legitimate medical journal, how did this study make it past the editor (let alone through peer review)? Clearly, the scientific process doesn't matter for this journal.

There are a lot of science journals that have been publishing pure crap (I suppose in order to get more readers) and it really diminishes their value. Not quite this bad, but even bigger named journals like the New England Journal of Medicine have been trending towards legitimizing pseudoscience, such as this recent review of acupuncture (discussed by Orac). A few years ago, I actually got in an argument with an editor from the American Journal of Health-System Pharmacy because they published a letter to the editor that used a posting from prolifeblogs.com to support their argument against the availability of over-the-counter emergency contraception. The response I received from the editor was that they can't be selective against the literature their contributors cite (yes you can! And, a blog post can't count as scientific literature).

So, similar to my post on companies that underhandedly promote religion, I want this post to include a (probably) growing list of scientific journals that aren't exactly scientific:

Completely Fake:
Journal of Cosmology
The Open Information Science Journal - accepted a fake paper without review from a couple of people from MIT claiming to be researchers at the "Center for Research in Applied Phrenology" (CRAP) - as long as they sent an $800 check to an address in a tax-free zone in the UAE.

Has Ulterior Motive:
Australasian Journal of Bone and Joint Medicine (sham journal for Merck provided by the supervillain of scientific journals: Elsevier).
The Journal of Global Drug Policy and Practice - funded by the Department of Justice and only publishes "research" that shows that punishing people is the only way to reduce drug use.

Ignores scientific process for publicity/money/religion:

An exhaustive list of preditory open-source journals can be found at Scholarly Open Access
American Journal of Health-Systems Pharmacy
American Journal of Surgery
British Journal of Psychiatry
Journal of Medical Hypotheses
PLoS One
Social Science Research
Southern Medical Journal
Psychology Today
Synthese

... and more coming when I get the chance to get to them.

Bad science in clinic

I was very disappointed by my recent preceptor, who's pretty good with practicing evidence-based medicine (even when it contradicts the current trends), at recommending an unproven treatment to a patient. We had a patient with reflux disease who was well-controlled with a proton-pump inhibitor (PPI). He suggested that acupuncture might be a good alternative. Then went on to describe this study, in which patients who failed standard therapy with a PPI were randomized into one group that received a double-dose of PPI and another group that received acupuncture in addition to the standard dose. Surprise, surprise, the acupuncture group got better. This is a terrible study that is doing nothing but comparing apples to oranges. First of all, if patients failed standard therapy, the chances of failing a double dose is pretty damn high. Second, where is the control for acupuncture? How do we not know that the acupuncture group is getting a placebo effect? They could have easily placed needles in the wrong places as a control. Third, this doesn't even apply to the patient we were talking to, she was responding to PPIs. Overall, terrible advice by an otherwise well-informed doctor. At least he described the methods to the patient. Luckily, the patient preferred sticking to her trusty PPI.

The one thing I learned from the paper: In the UK, GERD is called GORD (gastro-oesophageal reflux disease).

I'd rather not do that to my child

With our new baby came an instruction manual (well, maybe a book that my in-laws got us). It has some good advice, it's mostly fact-based (i.e. it does a pretty good job shutting down the anti-vacciners), but one thing caught me eye. It's about soothing a fussy baby:

Dan, a chiropractor father of a fussy baby, came up with this fuss fixer. Hold baby at his hips and swing him upside down at sixty beats per minute, like the pendulum of a grandfather clock. According to chiropractic research, upside-down swinging has a calming effect.

Yikes... how did that research get IRB approval?

Chiroquackery #1?

I love Consumers Union and their magazine Consumer Reports. They are a great, not-for-profit, unbiased organization fighting for consumer protection and they independently test the quality of various merchandise. But, they have a terrible habit of using surveys to rate things that cannot be directly tested in their labs. So, the results come up completely misleading. In this month's issue they made the claim that the best treatment for back pain was going to a chiropractor (59% were happy), followed by going to a physical therapist, in third place was acupuncture and way down in the bottom was going to a physician (a mere 34% happy). They sent surveys to a lot of people, but with a vague topic like back pain, basing your ratings by only asking "How satisfied were you with your treatment?" can only result in a meaningless outcome. They have no controls about severity of pain, underlying disease, number of visits or compliance with the prescribed treatment. Also, maybe people who have already made the decision to go to an acupuncturist or chiropractor are more likely to report having a satisfactory experience no matter what the outcome. Maybe people who see anyone once a week for a year will feel better than someone who, at most, sees someone a few times a year for their pain. The efficacy of pain treatment is extraordinarily difficult to measure. A simple survey is far from adequate. Consumers Union should know better (after all, they've got a team of statisticians). They are a very influential organization and this report is giving undeserving ammo to quacks (who are already pimping it) and terribly misleading their readers. Stick with crashing cars and breaking washing machines!

Badmouthing the Med School

Over at Science-Based Medicine (great site), there is a post by a medical student about his/her concern with a mandatory assignment to a clinic that promotes alternative medicine (things like acupuncture to "control post-partum bleeding" and cupping). This is an unfortunate situation that is creeping into many medical schools (including mine). Dr. Gorski has a great response to the student (document everything, find other students/faculty members who feel the same, then make a formal complaint to the dean). One thing, though, that caught my eye was the following:

Unfortunately, Student X informs me that the dean censors anything said by medical students on blogs or online forums that might bring the medical school into disrepute. Were I to name his medical school and it ever became known who had complained to me, the consequences are likely to be unpleasant.

Is this legal? From the terrible experiences several med students I know have had, my plan, after returning to med school, is to document my experiences (good and bad) here, on this blog. If there's anything that the medical school does that may give it a bad reputation, they should fix it, rather than threaten their students and attempt to hide it from the public. I don't know what the official stance of my medical school is (and I don't plan on asking either), but I don't intend on holding much back.

Oh no... quackery counts as medical education

Here's a recent "opportunity" from our medical school:

Traditional Chinese Medicine Rotation—Preliminary Announcement



I am pleased to announce that we are again able to offer a rotation in traditional Chinese Medicine (TCM) during the Spring of 2010. This month-long rotation is possible through the exchange program between the Department of Family Medicine and FuXing Hospital in Beijing. In addition to didactic instruction in the principles and techniques of TCM (acupuncture, massage, herbal treatment), students will observe how TCM is practiced in Chinese community health centers and hospitals. Limited hands-on training in acupuncture and/or massage may also be provided.

Now that (yet another) scientific review says that acupuncture is nothing but a glorified placebo effect (and I won't even bother with the rest), aren't there more important (more proven) medical techniques that medical students should be educated in? Does the medical school really think that spending an entire month (of the mere 18 months of clinical rotations that makes up an MD) on traditional (i.e. fake) medicine will really add to their students' educations? Come on medical educators... you can't teach your students about evidence-based medicine and then allow this to count as a month's worth of credit at the same time.

Magnetic Quackery

I was browsing through a book store a few days ago and I came across Kevin Trudeau's line of Natural Cure's They Don't Want You to Know About books (I must have been in the convicted fraudsters section). I usually see Kevin Trudeau on late night TV raving about the benefits of some untested treatment or another that "they" (hey that's me) are hiding from you. He's made millions and the gullibility of the American public is demonstrated by the fact that his books are always on a best seller list. Anyway, I thought I might get a laugh if I saw what's inside. I turn to a random page and what do I see? Magnetic therapy!!! Being an expert in training in real magnetic therapy, I started reading. Alas, it wasn't the 2 Tesla focused rapid brain stimulator that I work with. He was talking about wearing a small magnetic bracelet around your wrist for treating pain (and if I had read further I'm sure he would have said it will cure your heartburn, get rid of that tumor that's been bothering you and make you have a better sex life). This isn't the first time that I've encountered this form of "therapy." Several times when I've told people that I research magnetic brain stimulation, the response has been, "Oh, I know. It's like those magnetic bracelets!"

Well, I'm here to say that this:

does not work.

Let me quickly tell you why. Although our bodies have molecules that could potentially be affected by magnetic fields, biological tissue is amazingly unresponsive to static magnetic fields. The device pictured above (which you could have for a mere $17.95+sh) according to the manufacturer (if we actually believe them) contains 2 x 1000 Gauss static magnets. Magnetic fields aren't additive so let's say we're working with 1000 Gauss (or 0.1 Tesla) - though a JAMA article actually measured their surface field strengths and found them to be more like 30 to 250 Gauss. The problem is that a 0.1 Tesla static magnet (about the strength of the magnet in a small speaker) doesn't do anything to tissue. The magnetic therapy proponents say things like it affects your circulation by interacting with hemoglobin or it stimulates nerves (if they don't first say it aligns your chi). But nonetheless, valuable tax dollars were spent to test the claim that magnetic therapy is a natural cure that we don't want you to know and several studies (here are 4: 1 2 3 4) have found that it's no better than placebo at treating pain (their main use). The reason why magnetic brain stimulation works is that a very large magnetic field (around 2 T) is being delivered over a very short period of time (<250 microseconds). It's this rapidly changing magnetic field that affects biological tissue (induces current). Even then, unless you get it at the right intensity, frequency, target, angle, duration, etc, it has very subtle effects. So, unless the magnet on the bracelet produces a rapidly changing magnetic field (and if it did it would cost way more than $17.95 and would probably not be so portable), it won't do anything to nerves and it won't treat pain.

FTC regulating drugs?

Well, actually, they're regulating fake drugs (i.e. untested herbal supplements). I saw this on Terra Sigillata at Scienceblogs and I must say, I applaud their efforts. The FDA regulates real drugs, but "supplements" are not under their jurisdiction. It's a multibillion dollar industry that (with a few exceptions) at best only wastes peoples money. But companies claiming that their extracts can cure cancer or treat diabetes are putting people's lives in danger. It looks like the federal trade commission has stepped in to stop the worst offenders. Hopefully this trend continues and "supplements" end up getting some real regulation.

Skies are falling in Canada

The god of science is mad at Canada for picking a quack for Minister of Science & Technology. What's with conservatives everywhere always appointing utterly unqualified people to high positions?



It turns out that Canada's conservative prime minister picked a chiropractor and acupuncturist for the Minister of Science & Technology. Now, I'm sure that some of what acupuncturists and chiropractors do is helpful and may relieve pain (and there is some scientific evidence for it), but for the most part it is NOT medicine and it is NOT science. Both these fields tend to avoid evidence-based practice and essentially claim that their technique treats everything. It's dangerous not so much because of possible side effects, but because it keeps people with diseases that can otherwise be easily treated from seeing a real physician. So to all you new-agey people: Most of you are (otherwise) pretty intelligent. So, next time you are skeptical of western medicine go to pubmed and do a quick search to see if your skepticism is warranted. And next time you want to treat your kid's Lyme disease or broken femur with the extract of some plant or acupuncture, again, check the literature to see if there isn't a better way.

... and Canadians, please don't try to become like the US. This meteor was just a warning.