Archive for the ‘Science’ category

The 116th Meeting of the Skeptics’ Circle:The Wooful ER

July 30, 2009

It’s time for your favorite blog carnival and mine, the Skeptics’ Circle!

 I had the most horrible dream the other day. After watching a Mitchell and Webb Sketch about a homeopathic ER, I had nightmares of being trapped in an ER just chock full of Woo, and other nonskeptical gibberish.

Walk with me, through the valley of woo, in the nightmare that is the wooful ER.

(more…)

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Back to Autism for a Moment.

April 28, 2009

Don’t worry, I’ll get back to telling everyone not to panic soon!

Often times people have complained that I’ve spent a lot of time covering what doesn’t cause autism, without telling people what does cause autism. I’ve said that we don’t know for sure, but most likely complex genetic causes. I promise after we discuss what ASD isn’t caused by, we’ll end the series with what science’s best information on what does cause ASD.

In the meantime, Ed Yong over at Not Exactly Rocket Science has an awesome post discussing articles from Nature that talk about genetic variants correlated with Autism.

Go! Learn! I’ll wait here. He’s an excellent writer, and his discussion is eminently understandable.

Swine flu and Woo

April 28, 2009

Continuing with the theme I’ve had on swine flu, I’ll start with this: Don’t panic.

Don’t start looking for random alternative medicine treatments and prevention for swine flu.

Don’t, for example, give yourself an enema. That may seem like it’s in bad taste, and tangential at best, but it’s exactly what Kim Evans, author of “cleaning up!” over at Huffington Post is suggesting. Her article is so ridiculously wrong that I feel the need to explore it with you.
She starts with some potentially relevant information.

1) Stay home as much as possible.
2) Avoid public places unnecessarily.
3) Wash your hands frequently, and keep your hands from your face.
4) Get some surgical face masks and wear one when you need to be in public places, even if you feel a little foolish and until others have caught on.

I agree completely with number 3. Hand washing is key. It’s a good idea to avoid smearing all the junk that is on your hands onto your face. The rest of this, is fear mongering.

Given the small number of cases, and the mildness of the cases seen in America so far, 1, 2, and 4 are overboard. They aren’t completely unreasonable, unless you’re in mexico. If you have a risk factor – you’re on chemotherapy, you’re otherwise immunosuppressed, maybe even just bad asthma, than you might consider being cautious and avoiding public places. The evidence is out on whether or not masks are that helpful right now.

Not that it matters, that’s not why she’s writing all of this though. As far as I can tell she’s really writing this to create an atmosphere of fear.

Why scare people? She has a hook. A hook that sounds crazy unless you’re scared!

The above is all pretty basic stuff, I’m going to offer more as well. But before I do, you should know that I’m a huge proponent of body cleansing, or removing the accumulated waste that most people have stored in their bodies. I’ve been a fan for years and have seen cleansing work miracles in myself and others, but in circumstances like this, I believe deep cleansing could actually save your life

I hate it when people say they can save your life. I hate it when doctors say it, and sometimes they’re right! Doctors aren’t usually the ones who say it. Liars say that. Hustlers say that. In fact, it looks like she only says that there distract from the fact that she still hasn’t given us a reason to believe cleaning out your colon would heal your lungs.

And it’s my understanding that many people who took regular enemas instead of vaccines during the 1918 pandemic made it out on the other side as well.

This is impressive. Her understanding is that people who took enemas instead of vaccines in the 1918 pandemic made it out on the other side as well. Why is this impressive? There wasn’t a flu vaccine in 1918. In 1918 we weren’t even sure of the cause of influenza, at that time some people thought it was caused by hemophilus influenza, a bacteria. We couldn’t grow influenza virus until 1931, and the first inactivated vaccine was used in World War II. Either she didn’t do her homework at all, or she thinks people used time machines to go forward in time, get a flu vaccination, then go back, and die.

This is normally the point at which I’d cite articles on why this is wrong. The problem is I can’t even find articles on this! I haven’t found one scientist who was willing to test enemas for the flu. In lieu of direct evidence, I tried to look up her basic science on this. Why would this even potentially work? Her article has some junk about taking out the trash to get rid of flies. I found it patronizing AND uninformative. I checked her website, and found it a barren wasteland of propaganda. Not a fact in sight.

Failing to find anything helpful on her website, I exercised my google-fu, which reveals: Not much. On one website, Diagnose-Me.com, I found this. That website recommends a warm, and then a cold soda enema. Why?

Most of the mucous from the respiratory tract is swallowed and waste to be expelled from this mucous makes its way to the colon. During an illness like a cold, viral particles remain in quantity in the colon. The gentle washing away of the bulk of this material allows the immune system to focus on the respiratory tract rather than maintain a second larger front in the colon. This is one reason why almost all doctors in the preantibiotic era recommended enemas, or at the least laxatives, for colds. The use of enemas gives immediate relief of symptoms and helps to concentrate the immune response where it is needed.

That almost sounds reasonable if you haven’t studied medicine. When you have influenza, you primarily have lung problems. You are not fighting a second battle in your colon. When you have something that feels like influenza, and you have diarrhea, nausea, vomiting, you might not have influenza. It’s not impossible, sometimes influenza can cause those symptoms, but there are a lot of other viruses that are more likely the culprit.

I can’t find anything anywhere saying that doctors in the pre-antibiotic era prescribed laxatives or enemas for colds… It’s not as if doctors in the antibiotic era prescribe antibiotics normally for the flu – it’s a virus, so I’m not sure where she was going with that.

The use of enemas doesn’t relieve any symptoms! If we stick a tube up your butt and clean out your colon, your lungs will still be filled with junk. Your immune response will do just fine without the enema.

This whole article is just irresponsible. Blogging may be a less formal media form, but if you have a large audience and you act like a newspaper, like HuffPo does, you’re obligated to do some fact checking. This goes double for when you’re offering medical advice. This goes triple when you’re writing about a potentially panic-causing issue like epidemic swine flu!

Shame Huffpo, shame

Why do good people use bad medicines?

April 21, 2009

ResearchBlogging.org

Hat tip goes to Epiphenom who wrote about this article on Friday. Dr David Gorski has also written a piece on this paper for Science Based Medicine here.

 

We’ve been talking a bit about evidence based medicine here at Beyond the Short Coat. In the Hard Conversation posts (1, 2, 3, 4, guidelines here), we’ve noticed a lot of dissenters bring up alternative treatments. Invariably, these treatments aren’t evidence based, and don’t work. They generally are “treatments” that seem to be “safe”, but often have no basic science basis. The classic example is homeopathic treatments – which are generally just sugar water. Sometimes people bring up more controversial, less benign things – chelation therapy comes to mind.

So why in the world would people use a treatment like that? Classically we talk about placebo effect: some people improve if you just tell them you’re giving them strong medicine. Occasionally I bring up the fact that complicated diseases have variable courses. That’s not the whole story though, and in this paper Tanaka, Kendal, and Laland, show us another side of the issue.

The authors created a simple mathematical model to simulate the spread of possible treatments in a population. This isn’t a model of doctor dispensed or recommended treatments. This model is specifically about “self medicating” – more similar to over the counter meds, and traditional therapies, things with a pretty low barrier to access. They start out with a population, everyone is either sick (“diseased state”), or healthy(“healthy state”). People who are healthy can become sick and people who are sick can become healthy. Then they introduce a “treatment”. This treatment can either be adaptive (it works), neutral (it doesn’t work), or maladaptive (it makes things worse).

They assume that sick people will expose others to this treatment, and that people adopt the treatment at a constant rate of the time they “see” the treatment. Notice, I said nothing about the treatment working or not. The authors assumed people had no way of telling if a treatment works or not. Don’t be insulted, it’s a pretty reasonable assumption. In fact that’s the reason we have to do evidence based medicine – people generally can’t tell if something actually worked, or if they just got better anyway. They also assume that the longer a treatment doesn’t work, the more likely a sick person is to abandon the treatment.

This model in hand, the authors can ask a lot of questions. They can test a variety of situations. What if the disease is short lived, and rapidly gets better on its own? What if it never gets better? How about if people can catch the disease multiple times? What if the treatment works really well? What if it makes things worse? What if people only expose others to the treatment when they’re sick? What if they expose others to the treatment forever? How fast do people abandon a treatment that doesn’t work?

Their results are interesting to say the least. By their model If people can only get the disease once, the disease is relatively short lived, and only show people the treatment to others when sick, then treatments that don’t work, or hurt you, spread better than effective treatments! Why? Bad treatments give longer “exposure times”, which lets more people pick up on the treatment.

Now if you flip it – if the disease is long lived, and if people spread treatments all the time instead of just when sick, this model tends to select effective treatments as more dominant.

If you can get sick more than once – that too trends towards effective treatments over the long haul.

Interestingly, their model shows that prophylactic treatments spread badly, because they don’t offer a lot of opportunity to get “converts.”

So how much stock can we put in this model? How closely does it resemble real life? Across the board, it’s limited. Not enough of medicine fits in with their initial assumptions. While they discuss CAM in the paper, this model seems to resemble a lower tech, more “traditional medicine” approach. So it may model the spread of modalities in the past better than in the age of the internet.

One situation that does seem to work is flu season – it’s an illness that resolves quickly, and generally the flu “cures” are only used when you have the flu. Admittedly, one can get the flu every year since there are different strains every year. The situation fits the model pretty well actually – there are all manner of non-efficacious flu treatments out there!

How about our topic of choice recently – vaccines? Vaccines are generally pretty easy to come by – yes technically a doctor should be involved, but outreach is pretty high, and the barrier to vaccination is low. It’s a prophylactic treatment, so once you’ve gotten vaccinated you aren’t showing the whole world the joy of vaccination while you’re sick – because you don’t get sick! Well that actually fits the model pretty well, we have to do all kinds of things to get people vaccinated, and it’s not easy!

Where does this model breakdown? The easy one is chronic disease. This model predicts that long duration of disease leans away from bad treatments. Yet those patients who have chronic diseases will often try a wide variety of non-efficacious treatments. I think the inherent assumptions don’t fit chronic disease well though. In chronic disease, rather than pick therapies based on time exposure, one is more likely to actively seek out therapies. Additionally I think there are psychological components that are a little too subtle for this model to take into account.

One obvious issue is that this model doesn’t take into account the ways doctors can spread good practices. Nor does it give us a model through which other “thought leaders” can spread practices. I’m thinking of course of the celebrities – Like She Who Shall Not Be Named of the vaccine denialists. These are powerful forces today.

I think this model is an interesting counterpoint to our regular ongoing discussion here. Regularly commenters bring up “treatments” that have “helped children recover”, in an effort to spread their particular brand of “medicine”. They never cite evidence, they never see the need for it. I find it comforting to think that a model assuming patients know nothing about treatments can lead to this behavior. In my mind that means that maybe, just maybe, science based medicine can make a dent in this situation through the appropriate education.

Tanaka, M., Kendal, J., & Laland, K. (2009). From Traditional Medicine to Witchcraft: Why Medical Treatments Are Not Always Efficacious PLoS ONE, 4 (4) DOI: 10.1371/journal.pone.0005192

The Relativity of Wrong Writ Large

April 13, 2009

All the way back in Part 1 of Vaccines and Autism, I touched on the relativity of wrong.

Either I didn’t do a good job describing it then, or people didn’t read whatI wrote before posting.

The basic question is this: “Does science really teach us anything? If science isn’t objectively right, then aren’t we all just wrong?”

In Asimov’s essay, the answer to the former question is “Yes”, and the answer to the latter is “Yes, but not all of us are as wrong as you!”.

For example. We once said the earth was flat. The earth is not flat. Science later said the earth was spherical. The earth is not spherical. More scence tells us that the earth is an oblate spheroid – that means it’s ‘width’ at the equator is bigger than it’s ‘hieght’ through the poles.  Even later, more ridiculous science with satellites shows that the earth isn’t even an oblate spheroid, it’s also a little pear shaped – a little bulgier on the southern half.

So are the people who said the earth is flat just as wrong as the people who said the earth is spherical? Did science teach us anything? Absolutely! As a culture we still mock the flat-earthers. Why? Because they’re REALLLY wrong. Spherical is wrong, but much less wrong.

So lets put this idea into practice. Suppose we ask two chldren to spell “quantum” – . If they answer “kwontum”, and  “noidea”, they’re both wrong, but “kwontum” is alot closer. Noidea boy has no understanding of how to spell, at least as far as we can tell. Kwontum boy may not know about the sound “qu” makes, but he knows some phonetics, it’s a start.  If noidea boy said he was equally wrong, rather than more wrong, most people would disagree, and it’s easy to see why. This is the relativity of wrong in action.

Now that you know this, you too can refute half of the pseudoscientists on this very blog. Generally our aspiring pseudoscientist will couch this declaration in word salad to make it more inconspicuous, but the gist is the same. The latest, and most egregious example of this is Chuck.

There are many problems that evidence based sciences cannot currently address and may never be able to address. Not all sciences are evidenced based due to subjectivity. Evidence based sciences may never be able to answer many problems because reality is often very unethical.

The subjectivity of reality handicaps a great many possibilities for evidence based sciences. (emphasis mine)

Chuck’s entire comment is written in what seems like really smart important words. Subjectivity, ethics, we must be on to something here! Unfortunately, that entire first paragraph reduces down to “everything is subjective, and science can’t learn about anything unethical”. 

First lets dispatch that whole “ethics hinders science” gibberish. I disagree. Our adversaries here seem to only understand the most direct of trials – “well if we want to test vaccines, we must have a group of people unvaccinated! Thats unethical so we can never know if vaccines work!”

I’ve already covered the evidence on how we can show that vaccines aren’t connected to autism without directly putting childrens lives at risk. You can see that it is alot more subtle than Chuck’s understanding. Science doesn’t depend on the direct test. Science depends on a working hypothesis. Once you have a hypothesis, you can find a question to test. It doesn’t need to be the direct question!

What I really love though, is what I’ve emphasized in bold print. This is an amazing piece of work. Chuck makes the blanket claim that reality is subjective. Reality is not subjective. Reality is real.

Many people may make subjective interpretations about reality. Heck, you could even reasonably say everyone makes subjective interpretations about reality. That doesn’t make reality subjective. This is beyond an epic fail. This is a fractal fail.

What’s Chuck saying when he says “everything is subjective”? He’s really saying “we’re all equally wrong.” He had a bunch of big words around it, but his comment comes right back to the relativity of wrong.

The entire point of science is to reduce the subjective interpretations we all make. It may not always suceed right away. Thats we rely on levels of evidence, and why science produces better answers over time.

So why would Chuck and all of the other pseudoscience crew would have you believe that because “reality is subjective”? Once you believe that drivel,  his answers to lifes questions, devoid of any data, become just as valid as Science’s.

However you know better than that now! We may be wrong today. We may be wrong tomorrow. But we will always less wrong than Chuck.

Science Based Medicine, and Hard Conversations

April 10, 2009

Before I disappear for the holiday weekend, I wanted to put out one last post.

Firstly, go check out Science Based Medicine – a blog about the battle against pseudoscience. Go check it out! I’ll wait right here. I promise it’s relevant to the rest of this post.

Secondly, through the short lifetime of this blog my goal has been to educate people about science and evidence based medicine. This has proved more difficult than I initially hoped.

In my initial posts I at least try to keep the language understandable to the generic educated lay person. Sadly by about comment 3, a pseudoscience advocate cites 3-10 articles that they don’t understand, or that are thoroughly out of date. Then by comment 10, multiple scientists have appropriately responded, but the thread is no  longer in reach for the very people I was hoping to reach with this blog.

Unfortunately, journal articles are just as easy to manipulate into pseudoscience as any other resource. Google-fu now makes it easy to put multiple citations and some 10 dollar words between a loving family and the appropriate evidence.

I’m going to try to make some changes going forward to make this blog still more accessible, and hopefully keep the discussion more relevant and understandable. Unfortunately, to do so I’m having to make some hard decisions. I banned my first poster last night, which greatly disappointed me. I was hoping by keeping a respectful tone I’d be able to have an open engaging discussion with both sides of the aisle.

I was warned before I started that affording respect to those who will abuse it would burn me. Some sites don’t have this problem – without the courteous tone I’ve encouraged, it’s very easy to burn the pseudo-scientific offenders out. Sadly, until now it’s been very easy for someone to just keep citing random articles and throw out a few “I don’t understand”‘s to sound reasonable enough, yet derail any progress.

Now after the holiday weekend – I’ll be swearing off the Internet from when this post comes up on line until Monday – I will post updated guidelines for the Hard Conversations series, and for this posting on this blog in general. I’ll continue to be soft on patients, but I will be much Harder on Woo. I apologize if that makes this blog feel less open, less free of speech, but I now think it’s necessary to ensure we are not hijacked by the unscrupulous minions of ignorance.  

So how does this connect to the Science Based Medicine blog? The post series in particular is by the wonderful Kimball Atwood, “Harvard Medical School: Veritas for Sale” . I have linked to the first post in that series. It may not be entirely appropriate reading for one segment of my audience – the parents/patients  among you will find it dry. The scientists and doctors may find it an entertaining, and disturbing look at the big business of medicine. I find this relevant because if Harvard can’t get it’s business in order on science based medicine, how in the world can you?!

The reality is that, it’s a complicated task to keep up with what is science and what is pseudoscience. I will endeavour to cover and explain science based medicine to the best of my ability. Please continue to let me know where I can improve guys, I really appreciate your input.

For now, enjoy!

-Whitecoat Tales

Blogging vs Mainstream Media and Other Digressions.

April 9, 2009

I’m sad to announce that my life is getting pretty busy from now through the end of the month. I’ll still be posting pretty regularly. Howeveras the Hard Conversations posts require a lot more time to write, a good bit of research, and some time moderating or participating in discussion, I’ll be interspersing some other posts along the way.

As I’ve written elsewhere on this blog, part of my interest in blogging stems from the opportunity to respond to the mainstream media. In my meager experience, medical journalists in the mainstream media are journalists first, and vaguely medical second. The writing is often excellent – crisp, succinct, and well presented, far better than my admittedly amateurish style here. Sadly the science and medicine are often misstated, or distorted to have more shock value, or “pop”. I’d like to think that despite my stylistic demerits I make up some ground on accuracy.

Lately parts of the blogosphere have been a twitter with responses to a review of Openlab 2008 published by New Scientist. The general discussion is on the merits of the blogosphere vs the main stream media. Personally I think they both have their place.

It’s far too easy to use the blogosphere to confirm all of your own viewpoints rather than learn anything – something we’ve seen quite regularly in the comments on this blog! I think of the blogosphere as a whole as a supplement to the mainstream media, rather than it’s replacement.

In roughly that vein, today I’d like to direct your attention to an interesting post at Not Exactly Rocket Science. Ed Yong has a great perspective on this, since he writes both in the mainstream media and on his blog. I think he presents a balanced, accurate, and succinct view on the subject.

For now, enjoy!

-Whitecoat Tales