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Do You Have “Low T?”

If you google “low testosterone” you’ll see lots of ads for testosterone replacement. Some are from pharmaceutical companies that sell testosterone, others from obvious snake-oil salesmen.

Both types of ads list vague sets of symptoms, encourage you to believe that they are pathologic, and want to sell you something to make you better. For example, the pharmaceutical company Solvay gives you a handy guide for speaking to your doctor, and a quiz to see if you have “low T.” The quiz asks some questions that may be useful, but also asks very general questions about your sense of well being. Read more »

*This blog post was originally published at Science-Based Medicine*

Andrew Weil Sent Warning Letter By FDA For Selling Snake Oil Flu Remedies

Dr. Weil is often seen as the smiling “mainstream” of alternative medicine. He’s a real doctor (unlike, say, Gary Null), and much of what he advocates is standard and uncontroversial nutritional advice. But Weil illustrates the two biggest problems with so-called alternative medicne: once you’ve decided science is dispensible, the door is open to anything, no matter how insane; and no matter how altruistic you may start, sooner or later you start selling snake oil. Most doctors out there are working hard to help their patients prevent and overcome disease use the available evidence.  Others decide that science is too constraining and start practicing at the periphery of knowledge, throwing plausibility and ethics to the wind.

The fact that Weil claims to donate to charity all of his ill-gotten gains does not mitigate the harm he causes. Read more »

*This blog post was originally published at Science-Based Medicine*

Alternative Treatments For Fibromyalgia: A Critical Analysis

One of the common themes regarding alternative medicine is the reversal of normal scientific thinking. In science, we must generally accept that we will fail to validate many of our hypotheses. Each of these failures moves us closer to the truth. In alternative medicine, hypotheses function more as fixed beliefs, and there is no study that can invalidate them. No matter how many times a hypothesis fails, the worst that happens is a call for more research.

Sometimes this is the sinister and cynical intent of an alternative practitioner—refuse to let go of a belief or risk having to learn real medicine. Often, though, there are flaws in our way of thinking about data that interfere with our ability to understand them.
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Magical Thinking Of The Week: The Anti-Inflammation Diet

Alternative medicine practitioners love to coin magic words, but really, how can you blame them? Real medicine has a Clarkeian quality to it*; it’s so successful, it seems like magic. But real doctors know that there is nothing magic about it. The “magic” is based on hard work, sound scientific principles, and years of study.

Magic words are great. Terms like mindfulness, functional medicine, or endocrine disruptors take a complicated problem and create a simple but false answer with no real data to back it up. More often than not, the magic word is the invention of a single person who had a really interesting idea, but lacked the intellectual capacity or honesty to flesh it out. Magic is, ultimately, a lie of sorts. As TAM 7 demonstrates, many magicians are skeptics, and vice versa. In interviews, magicians will often say that they came to skepticism when the learned just how easy it is to deceive people. Magic words in alternative medicine aren’t sleight-of-hand, but sleight-of-mind, playing on people’s hopes and fears.

A reader has turned me on to another magic word I hadn’t known about. It’s called the “Inflammation Factor”, and is the invention of a nutritionist named Monica Reinagel. Like most good lies, this one builds on a nidus of truth.

Inflammation is a medical term that refers to a host of complex physiologic processes mediated by the immune system. Inflammation gets its ancient name from the obvious physical signs of inflammation: rubor, calor, dolor, tumor, or redness, heat, pain, and swelling. As the vitalistic ancient medical beliefs bowed to modern science, inflammation was recognized to be far more complex than just these four external characteristics. In addition to being a response to injury and disease, the cellular and chemical responses of inflammation can cause disease. For example, in asthma and food allergies, a type of immune reaction called type I hypersensitivity elicits a harmful type of inflammation. Coronary heart disease, the biggest killer of Americans, is believed to have a significant inflammatory component.

But nothing in medicine is perfectly simple. For example, corticosteroids, which can be used effectively to treat the inflammation in asthma are not effective against the inflammation in cororary heart disease. It’s just not that simple.

But while inflammation may not be that simple, people can be. People want easy answers, and quacks are happy to step in to provide them.

So Ms Reinagel has invented a diet, available for sale in a book called The Inflammation Free Diet Plan. Her premise is that inflammation is at the root of all major diseases, and that your diet can affect inflammation, thereby improving your health.

While the hypothesis is intriguing, each step of the argument has problems, leading to an invalid conclusion.

Inflammation is the root of all disease

No, it’s not. “Inflammation”, which is actually refers to a lot of different processes, plays an important role in many diseases. But not all inflammation is the same.

The most important factor in fighting inflammation is the food you eat every day.

Um, no. If you have a staph infection on your arm, your eating habits will not change the amount of heat, pain, swelling, or redness. The kernel of truth here is that diet can affect various measures of inflammation, such as C-reactive protein (here is one of many examples). There’s a long leap between this fact and the conclusion that diet can “stop inflammation”.

The benefits of reducing inflammation are immediate as well as long term. You’ll notice that your skin looks younger, your joints feel better, and your allergy symptoms improve. At the same time, when you reduce inflammation, you also reduce your risk of heart disease, Alzheimer’s disease, cancer, osteoporosis, diabetes, and other complications of aging.

It’s a very long walk from the claim that reducing inflammation is “a good thing” to proving that your particular diet reduces inflammation and thereby improves health . A hypothesis is not true simply because it sounds pretty.

Who wouldn’t love a magic book that would prevent and cure all illness? Perhaps you’ve noticed that these books come along every few months. None of them ever has the one true answer. Life is much more complicated and beautiful than any magic book. It may be a lot more difficult to commit science than to commit quackery, but in the end it’s a lot more satisfying and a lot more useful.

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*”Any sufficiently advanced technology is indistinguishable from magic.” –Arthur C. Clarke’s Third Law

*This blog post was originally published at Science-Based Medicine*

Science Is Hard, And Best Left To Professionals (The Same May Be Said For Journalism)

It might seem a bit undemocratic, but science, like medicine or dentistry, is a profession. One doesn’t become a scientist by fiat but by education and training. I am not a scientist. I apply science. My colleague Dr. Gorski is a scientist (as well as physician). He understands in a way that I never will the practical process of science—funding, experimental design, statistics. While I can read and understand scientific studies in my field, I cannot design and run them (but I probably could in a limited way with some additional training). Even reading and understanding journal articles is difficult, and actually takes training (which can be terribly boring, but I sometimes teach it anyway).

So when I read a newspaper article about science or medicine, I usually end up disappointed—sometimes with the science, and sometimes with the reporting. A recent newspaper article made me weep for both. Local newspapers serve an important role in covering news in smaller communities, and are often jumping off points for young, talented journalists. Or sometimes, not so much.

The article was in the Darien (CT) Times. The headline reads, in part, “surveys refute national Lyme disease findings.” Epidemiologic studies, such as surveys, are very tricky. They require a firm grounding in statistics, among other things. You must know what kind of question to ask, how many people to ask, how to choose these people, etc, etc, etc. So what institution conducted this groundbreaking survey on Lyme disease?

Actually, they are quoting the famous work of one Kent Haydock, chairman of the Deer Management Committee. But I’m sure he outlined his methods carefully. Or not.

Haydock conducted:

[T]wo surveys — which polled 41 Darien households after a showing of the Lyme Disease film, Under Our Skin, at the Darien Library last month… . In the 41 households that completed the questionnaire, 47 total Lyme disease cases were reported. In 64 percent of those cases, the patient had relapses after an initial Lyme treatment, which required additional treatment for a chronic or long-term conditions.

So, Haydock showed the agitprop chronic Lyme advocacy film Under Our Skin to local families, presumably not selected at random, and then asked them if they had signs of Lyme disease and if it was ruining their lives. Not surprisingly, the answers to both questions were “yes” a remarkably high percentage of the time.

His conclusion: the surveys “show that Lyme not only exists in great numbers, but also in debilitating, chronic and long-term cases.”

This is not epidemiology. This is not science. This is an uninformed opinion dressed up with meaningless numbers. If you get together a group of people who are interested in Lyme disease, show them a propaganda film, and query them about it, the only thing you’ve “measured” is your ability to count people who come to a movie and hold a certain belief. If there were any valid conclusions to be drawn (and with these numbers, there probably aren’t) it’s that many people in this small group think they have Lyme disease—and even that’s over-reaching.

It’s bad enough that the deer commissioner did this. But arguably, it’s much worse that the reporter and editor published it. The only thing this accomplishes is fanning the fears of the readers.

*This blog post was originally published at Science-Based Medicine*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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