Better Health: Smart Health Commentary

Featured

The Oprah-fication Of Medicine

June 7th, 2009 by David H. Gorski, M.D., Ph.D. in Better Health Network, Quackery Exposed

Tags: Christiane Northrup, David Katz, Jenny McCarthy, media, Misinformation, Oprah, Pseudoscience, Quackery, Suzanne Somers, Vaccines

Unfortunately, a frequent topic on SBM has been the anti-vaccine movement, personified these days by celebrity spokesmodel for Generation Rescue Jenny McCarthy and her  boyfriend comedian and actor Jim Carrey. Unfortunately, it is a topic that is unlikely to go away. We’ve all speculated why the anti-scientific emotion-based notion that vaccines somehow must cause autism persists in spite of mountains of evidence to the contrary, but I think the question goes much deeper than that because it’s not just about vaccines. The anti-vaccine movement is but one of the most visible components of a much deeper problem in our public discourse, a problem that values feelings and personal experience over evidence, compelling stories and anecdotes over science.

I’m referring to the Oprah-fication of medicine in America.

Why Oprah? you may ask. I’m happy to tell you. Oprah Winfrey has been the host of the highest rated syndicated talk show in television history, her self-named The Oprah Winfrey Show. The show has been running for nearly 23 years, with over 3,000 episodes. Winfrey is so famous that she is one of those rare celebrities who is known instantly by just her first name. Say “Oprah,” and virtually everyone will know to whom you’re referring, and her show is often colloquially known as simply Oprah. Given this unprecedented level of success, which has made Oprah a billionaire and a ubiquitous presence on TV, her own magazine, her own satellite radio station, and, soon, her own cable channel, Oprah has developed a media empire that few single individuals can match or beat. Indeed Rupert Murdoch is the only person that I can think of who likely has a wider reach than Oprah. Personally, I have no problem with Oprah’s level of success. Clearly, she is a very talented and savvy TV host and businesswoman.

Unfortunately, in marked contrast, Oprah has about as close to no critical thinking skills when it comes to science and medicine as I’ve ever seen, and she uses the vast power and influence her TV show and media empire give her in order to subject the world to her special brand of mystical New Age thinking and belief in various forms of what can only be characterized as dubious medical therapies at best and quackery at worst. Arguably there is no single person in the world with more influence pushing woo than Oprah. Indeed, she puts Prince Charles to shame, and Kevin Trudeau is a mere ant compared to the juggernaught that is Oprah Winfrey’s media empire. No one even comes close. No one, and I mean no one, brings pseudoscience, quackery, and antivaccine madness to more people than Oprah Winfrey does every week. (She doesn’t discuss such topics every day, but it seems that at least once a week she does.) Naturally, Oprah doesn’t see it that way and likely no one could ever convince her of the malign effect she has on the national zeitgeist with respect to science and medicine, but that’s exactly what she does. Consequently, whether fair or unfair, she represents the perfect face to put on the problem that we supporters of science-based medicine face when trying to get the message out to the average reader about unscientific medical practices, and that’s why I am referring to the pervasiveness of pseudoscience infiltrating medicine as the “Oprah-fication” of medicine.

Read more »

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

Science And The Game Of 20 Questions

June 4th, 2009 by Dr. Val Jones in Quackery Exposed

Tags: Analogies, Critical Thinking, Science, Skepticism, Teaching Science

An audience member at a recent NYC Skeptics meeting asked me how I handled conflict surrounding strongly held beliefs that are not supported by conclusive evidence. As a dentist, he argued, he often witnessed professionals touting procedure A over procedure B as the “best way” to do X, when in reality there are no controlled clinical trials comparing A and B. “How am I to know what’s right in these circumstances?” He asked.

And this is more-or-less what I said:

The truth is, you probably can’t know which procedure is better. At least, not at this point in history. The beauty of science is that it’s evolving. We are constantly learning more about our bodies and our environment, so that we are getting an ever-clearer degree of resolution on what we see and experience.

It’s like having a blurry camera lens at a farm.  At first we can only perceive that there are living things moving around on the other side of the lens – but as we begin to focus the camera, we begin to make out that the animals are in the horse or cattle family. With further focus we might be able to differentiate a horse from a cow… and eventually we’ll be able to tell if the horse has a saddle on it, and maybe one day we’ll be able to see what brand of saddle it is. Each scientific conundrum that we approach is often quite blurry at the onset. People get very invested in their theories of the presence or absence of cows, and whether or not the moving objects could in fact be horses. Others say that those looking through the camera contradict one another too much to be trusted – that they must be offering false ideas or willfully misleading people about the picture they’re describing.

In fact, we just have different degrees of clarity on issues at any given point in time. This is not cause for alarm, nor is it a reason to abandon our cameras. No, it just gives us more reason to continue to review, analyze, and revise our understanding of the picture at hand. We should try not to make more out of photo than we can at a given resolution – and understand that contradicting opinions are more likely to be evidence of insufficient information than a fundamental flaw of the scientific method.

***

I have noticed that impatient photo-gazers have a propensity to demand answers before accurate ones are available. And this leads to all manner of passionately held, but misguided beliefs both in the scientific community and beyond. We must somehow find a way to make peace with limited information, eagerly seeking more, without being dogmatic about premature conclusions. My dentist colleague should not feel pressured into choosing sides on an issue that cannot be fully evaluated yet – and will have to wrestle with ambivalence as he waits patiently for more data.

But far more worrisome than living with ambivalence is living with stagnation. I would argue that one of the greatest red flags in the scientific world is an unwillingness to learn – an unyielding commitment to a set of beliefs, despite increasing evidence that they are not accurate. I think of homeopathy and acupuncture as good examples of this phenomenon – since they have not evolved significantly since their inception, their proponents therefore must admit that they have learned almost nothing new since the dawn of their use. The lack of refinement of treatment protocol is evidence of the system’s belief-based (or placebo-based) nature. As John Cage, US composer of avant-garde music, once said,

“I can’t understand why people are frightened of new ideas. I’m frightened of the old ones.”

***

As I mulled over my fuzzy image analogy, an even better one came to mind: the game of 20 questions. For those of you who didn’t play this game growing up, its rules are simple: one person must think of a person, place, or thing and the other(s) have 20 questions that they can ask in order to guess who/what the first person had in mind. The challenge is that the questions have to be asked so that the response is either yes or no. If the questioners can’t devine the name of the person, place or thing within 20 questions, the respondent wins. If the questioners guess the identity of the object within 20 questions they win.

Science is a little bit like 20 questions (of course we have unlimited questions that we can ask) in that we constrain our research to answer a very specific question under a very specific set of circumstances (formulating a “yes” or “no” type question). No one question or answer is likely to unlock the solution to the larger puzzle – it’s the collection of questions, taken in context of one another, that leads to meaningful understanding. When we don’t understand the best path forward, it’s likely that we are early on in the game of 20 questions, with little information to guide us.  Occasionally we get lucky and ask the right question early – but more often than not we’re left to scratch our heads and ponder yet another question to help unlock the “mysteries” that face us.

That is the beauty and the pain of science – it’s slow, it’s methodical, it leaves the honest participant in a state of ambivalence with some degree of frequency, but in the end it yields real answers if we wait for the clarity that can come from careful analysis. Without it we are left with magical beliefs and misguided explanations… we’re left with Jenny McCarthyism.

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

Hostility Towards Scientists And Jenny McCarthy’s Latest Video

May 28th, 2009 by Dr. Val Jones in Opinion, Quackery Exposed

Tags: Autism, Family Medicine, Jenny McCarthy, Oprah, Pediatrics, Pseudoscience, Vaccines

I’ve been fairly quiet about Jenny McCarthy’s campaign against childhood vaccinations, partly because Dr. David Gorski has covered the issue so thoroughly already, and partly because of my “do not engage” policy relating to the deeply irrational (i.e. there’s no winning an argument with “crazy.”) But this week I was filled with a renewed sense of urgency regarding the anti-vaccinationist movement for two reasons: 1) I received a personal email from a woman who is being treated with hostility by her peers for her pro-science views on vaccines and 2) a friend forwarded me a video of Jenny McCarthy speaking directly to moms, instructing them to avoid vaccinating their kids or giving them milk or wheat because of their supposed marijuana-like addictive properties.

Anti-Vaccination Views Are A Status Symbol?

I was surprised to discover that some pro-science moms are being mocked by peers who are uninterested in evidence, choosing to believe any dubious source of health information that questions the “medical establishment.” This concerned mom writes:

I am the mother of two young children, and I live in the trenches of the anti-vax woo.  In my circle of about 14 mothers, my anecdotal analysis is that the rate of complete vaccination hovers around 60%.  The mothers in this group are all very well educated, middle-class or affluent, predominantly stay-home mothers. One problem is what they consider reliable sources of information.  They rely on anecdotes and dismiss scientific evidence in part because they are very anti-medical establishment.  The group is self-validating and many shared values (and myths) increase in intensity over time.

Many of the mothers practice “Natural Family Living” which has some appealing aspects, but also harbors elements of a cult.  In this environment, anti-vaccination becomes a very powerful status symbol… I have lost friendships and been partially ousted from this circle because of my views.

This note struck a chord with me, since I experienced similar hostility in the past for voicing my concern about pseudoscience and misleading consumer health information. I was accused of being “paternalistic, narrow-minded, a dinosaur – part of a dying breed, a racist against complementary and alternative medicine, and a Bible school teacher, preaching evidence-based medicine,” insulted for my desire to be accurate about what was known and not known about treatment options, and my expertise, training, and academic credentials were called into question publicly on many occasions. I endured all of this primarily at the hands of someone who supposedly believed in “natural healing” and the “art of kindness” as an integral part of patient care.

I am troubled by the mounting antagonism towards those of us who’d like to use critical thinking and scientific reasoning to learn what we can about medicine and our health. I’m not sure what to do about it except to encourage one another to stand strong for science and reason – to expect all manner of attacks and insults, and to be firmly committed to the objective quest for truth. It shall set us free.

Jenny McCarthy – Inaccurate, Unhelpful And Dangerous Advice

Although I find Jenny McCarthy’s advice and opinions painful to watch, I committed myself to viewing her recent video at my friend’s request. In order to spare you similar discomfort, let me simply summarize what she said so you can get a high level overview of the sort of bizarre and misinformed claims she promotes (feel free to check out the video for yourself).

“Autism is not primarily a genetic disorder, but caused by vaccine-related toxins (including mercury, aluminum, ether, anti-freeze ,and human aborted fetal tissue) and pesticides.”

• A recent study published in Nature links genetic alternations in DNA that codes for neuronal cell adhesion molecules to autism spectrum disorders.
• A mercury-autism link has been fully debunked.
• An aluminum-autism link has been disproven.
• There is no ether, anti-freeze or human tissue in vaccines.
• There is no conclusive evidence of a link between pesticides and autism.

“Kids get ‘stoned’ by wheat and dairy toxins. Giving them wheat or dairy proteins is like giving children marijuana.”

• There is currently no evidence that any diet improves or worsens the symptoms of autism spectrum disorders.  In fact, whole grains and dairy products are an important part of a healthy diet for most children.

“Food allergies are like Iran and Iraq. Glial cells (they’re like chef cell) provide food to the neuron kings. Glial cells can turn into Rambo to fight Iran and Iraq. If a child is allergic to everything, the Rambo cells stop feeding the neurons and the neurons starve. That causes the symptoms of autism.”

• I don’t know what to say about this strange analogy – clearly no science-based information here.

“To treat autism, you need to give your child supplements to fight off the yeast in their bodies. I recommend Super Nathera, Culturelle, Cod Liver Oil, Caprylic Acid, CoQ10, Calcium, Vitamin C, Selenium, Zinc, Vitamin B12, B6, and Magnesium.”

• There is no evidence of efficacy for any of these supplements in the treatment of autism.

“You need to consult with a DAN! Practitioner.”

• DAN! Practitioners recommend chelation therapy for the treatment of autism. There is no evidence that chelation therapy has any benefit for children with autism, and in fact, can be fatal.

“Whatever you think becomes your reality. Imagine your child going to his/her prom and he’ll be cured.”

I think it’s pretty clear that Jenny McCarthy’s recommendations range from ineffective (imaginary healing) to harmful (malnutrition related to absent dairy and wheat in the diet, excessive levels of vitamins) to deadly (chelation therapy with DAN! Practitioners). Will mothers watching her new show on Oprah fall for her pseudoscience and poor advice?

I was pleased to see this open letter to Oprah from one concerned mom. Here’s an excerpt:

To me, it is clear that a significant number of people look up to you, and trust your advice and judgment. That is why it is such a huge mistake for you to endorse Jenny McCarthy with her own show on your network.
Surely you must realize that McCarthy is neither a medical professional nor a scientist. And yet she acts as a spokesperson for the anti-vaccination movement, a movement that directly impacts people’s health. Claims that vaccines are unsafe and cause autism have been refuted time after time, but their allure persists in part because of high-profile champions for ignorance like McCarthy. In fact, ten of the thirteen authors of the paper that sparked the modern anti-vaccination movement retracted the explosive conclusions they made due to insufficient evidence. Furthermore, it is now clear that the study’s main author, Andrew Wakefield, falsified data to support these shaky conclusions.

We have come close to eradicating life-threatening and crippling illnesses because of vaccines, but are now struggling to prevent outbreaks because of parents’ philosophical beliefs that vaccines are harmful. Realize this: when someone chooses not to vaccinate their child, they aren’t just putting their own child at risk, they are putting everyone else around them at risk. Diseases with vaccines should normally be of little concern even to unprotected individuals due to herd immunity – with the majority of the population immune, unprotected individuals are less likely to come into contact with the pathogen. Unfortunately, herd immunity disintegrates as fewer people are vaccinated, putting everyone who hasn’t yet been vaccinated at greater risk for infection. Now, the rates of infection by diseases for which we have safe and effective vaccines are climbing, thanks to anti-vaccination activists like Jenny McCarthy.

You reach millions of people everyday and your words and endorsements carry an incredible amount of weight. If you say to buy a certain book, people will buy it. If you do a segment on a certain charity, people will contribute. And if you say that what Jenny McCarthy is saying has merit, people will believe you…

Conclusion

A certain segment of society appears to be emotionally invested in medical beliefs that are not based on science, but rather anecdotes, conspiracy theories, and magical thinking. Those who recommend a more objective method of inquiry may be subject to ridicule and hostility by that segment. Nonetheless, it is important (for public health and safety purposes and the advancement of science) for critical thinking to be promoted and defended. While some celebrities, like Jenny McCarthy, are committed to misinforming the public about their children’s health – parents who recognize the deception are speaking out against it. Perhaps the best way to combat Jenny’s propaganda is to boycott Oprah. Refusing to support the promotion of dangerous pseudoscience may be our best defense.

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

Raw Milk: Got Diarrhea?

May 26th, 2009 by admin in Better Health Network, Quackery Exposed

Tags: Cheese, Dairy, Dr. John Snyder, FDA, Food and Nutrition, Gastroenterology, Infectious Disease, Pasteurization, Raw Milk, Unpasteurized

By Dr. John Snyder of the Science Based Medicine Blog

I recently saw a 14 year old girl in my office with a 2 day history of severe abdominal cramps, bloody diarrhea, and fever. Her mother had similar symptoms as did several other members of her household and some family friends. After considerable discomfort, everyone recovered within a few days. The child’s stool culture grew a bacterium called Campylobacter.

Campylobacter is a nasty little pathogen which causes illness like that seen in my patient, but can also cause more severe disease. It is found commonly in both wild and domestic animals. But where did all these friends and family members get their campylobacter infections? Why, from their friendly farmer, of course!

My patient’s family and friends had taken a weekend pilgrimage to a family-run farm in Buck’s County, Pennsylvania. They saw farm animals and a working farm. And they all drank raw milk. Why raw milk? Because, as they were told and led to believe, raw milk is better. Better tasting and better for you.

In 1862, the french chemist Louis Pasteur discovered that heating wine to just below its boiling point could prevent spoilage. Now this process (known as pasteurization) is used to reduce the number of dangerous infectious organisms in many products, prolonging shelf life and preventing serious illness and death. But a growing trend toward more natural foods and eating habits has led to an interest in unpasteurized foods such as milk and cheese. In addition to superior taste, many claim that raw milk products provide health benefits not found in the adulterated versions. Claims made about the “good bacteria” (like Lactobacillus) conquering the “bad” bacteria (like Campylobacter, Salmonella, and E. coli) in raw milk are pure fantasy. Some even claim that the drinking of mass-produced, pasteurized milk has resulted in an increase in allergies, heart disease, cancer, and a variety of other diseases. Again, this lacks any scientific credibility.

With this growing interest in unpasteurized dairy products has come an increase in the rate of food-born infections. The federal government developed the Grade ‘A’ Pasteurized Milk Ordinance in 1924, providing a set of guidelines for the safe processing and handling of milk products. Although all 50 states have voluntarily adopted these guidelines, the FDA has no oversight jurisdiction. It is up to individual states to determine their own safety protocols and enforcement strategies. While selling raw milk is currently illegal in 26 states, those with a will have found a way to skirt the law to get their fix of the real deal.

My patient was a victim of a recent outbreak in Pennsylvania, but similar outbreaks of infectious disease due to unpasteurized milk products are a recurring headache for public health officials. Between 1973 and 1993 there was an average of 2.3 milk born disease outbreaks per year. That number increased to 5.2 per year between 1993 and 2006. Whatever the numbers are, there is no question that the increasing consumption of raw milk is a genuine threat to public health.

The health claims made for raw milk, and against its pasteurized cousin, are being heavily pushed by a small but passionate contingent one might refer to as “food guardians.” These are people who espouse a return to the good old agrarian days of wholesome, farm-raised foods, free from man-made chemicals and mass-market processing. Some of these ideals are highly respectable and healthful responses to the ways in which society has dealt with the need to push products to a mass market at profit. For example, the use of pesticides, animal hormones and antibiotics, and farm run-off can have deleterious environmental and human health consequences. However, many of the health claims that are made about products like raw milk are not supported by scientific evidence, and lack scientific plausibility. Despite this lack of evidence, however, the allure of raw milk products is clearly on the rise.

Beyond the obvious public health consequences of this trend lies the problem of an increasing public credulousness when it comes to pseudoscientific claims. This is similar to the trend we are seeing regarding concerns about the dangers of vaccines and excessive fears concerning certain potential environmental hazards.

Unscientific and outright fraudulent claims about the health benefits (as well as the hidden dangers) of a variety of foods is on the rise. And bogus or unsupported nutrition claims are big business. From the immune boosting and weight loss powers of the acai berry, to the cancer protective effects of vitamins, nutrition pseudoscience is all the rage. While raw milk will never have quite the celebrity cache of these “super foods”, it is promoted with the same lofty yet empty claims, and provides the added bonus of infectious diarrhea.

On a recent visit to a local high-end wine shop, I came face-to-face with the ease with which people fall prey to the marketing of food pseudoscience. A woman was examining a bottle of wine when the store keeper approached to offer help. She told her a little about the wine and then said, “And all of their wines are biodynamic.” To this, the shopper exclaimed “Oh wow, that’s great.” She bought the wine, likely without having a clue what the term “biodynamic” even means. Biodynamic farming is a mixture of Gaia-like principles (the earth is a living organism) and organic practices, with a smattering of mysticism, alchemy, and astrology. In essence, a smorgasbord of pseudoscientific farming practices perfect for the current culture of armchair environmentalism and the new found heal-thy-self mantra of the well-to-do. While the motivating factors and socioeconomic status may differ between those drinking biodynamic wine and those drinking raw milk, both are relying on false beliefs and unsupported claims in making their choices to consume these products.

As a lover of cheese, I appreciate that there are those whose refined palates favor the delicacy of unpasteurized, aged cheeses so prevalent in other countries. But to stretch this taste preference to include health benefits unsupported by science and even common sense is not just misguided, it can be dangerous. Dangerous because it increases the risk of infectious disease, but also because it perpetuates a credulous perspective that adds to the ongoing erosion of our appreciation and acceptance of science.

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

Celebrity Shampoo Scare: Why You Don’t Want To Get Your Health Information From Gwyneth Paltrow

April 27th, 2009 by DrRob in Better Health Network, Humor, Quackery Exposed

Tags: celebrity, Dr. Rob Lamberts, Gwyneth Paltrow, Obstetrics And Gynecology, Pediatrics, Shampoo, toxins

Somehow the medical community has missed a very important news Item.  In her website goop.com (dang, I was going to go for that domain), movie star Gwyneth Paltrow weighed in on a very frightening medical subject.

Shampoo.

“A couple of years ago, I was asked to give a quote for a book concerning environmental toxins and their effects on our children.

“While I was reading up on the subject, I was seized with fear about what the research said. Foetuses, infants and toddlers are basically unable to metabolise toxins the way that adults are and we are constantly filling our environments with chemicals that may or may not be safe.

“The research is troubling; the incidence of diseases in children such as asthma, cancer and autism have shot up exponentially and many children we all know and love have been diagnosed with developmental issues like ADHD [Attention Deficit Hyperactivity Disorder].”

Apparently, she went on to point the finger at shampoo as a potential major problem in our society and raised a possible link between shampoo and childhood cancers.  Now, I am not sure how one can use shampoo on the head of a foetus (or a fetus, for that matter), but we have to tip our hat to celebrities for bringing such associations to the forefront.

So I did a bit of science myself to assess the voracity of her claims.  I too was seized with fear when I noted the following:

• All of the kids in my practice who have ADHD have used shampoo.
• All of the kids with cancer have also used shampoo.
• I used shampoo as a kid (but not as a fetus), and I have ADHD.
• The projection is that 100% of the people now using shampoo will die.

Whoa.

This really backs up my misgivings about shampoo.  I have always wondered at the claims these so-called hair-care products make so boldly.  Here are some examples of lies spread by the shampoo industry:

Clarifying shampoo – What are they claiming with this?  Is there such thing as unclear hair?  Do some people look as though they have a giant blob of hair-like substance on their head instead of many separate hairs?  Does  clarifying shampoo make each individual hair once again visible on these people?

pH Balanced – What is pH imbalance?  Is it when the pH sometimes is so acidic that it burns your hair off?  That would be terrifying if true.

Volumizing shampoo – I was not aware volumizing was a word (nor was my spell-check).  This means that the shampoo volumes things.  How can you volume something?  Does each hair get a separate volume, or does the hair suddenly get very loud.  Personally, I am afraid to open the bottles of these shampoos for fear of going deaf.

Shampoo for stressed hair – I have never thought about the emotional state of my hair.  I was not aware that it worries about things.  Perhaps it worries about being volumized or burned by non-pH balanced shampoos.  Perhaps it worries about being put on a foetus.  Does this type of shampoo contain a hair version of valium?

Vitalizing shampoo – At least vitalizing is actually a word, but would you really want vitalized hair?  My dictionary defines this as “giving life and energy to.”  Hair is dead, as we all know.  Does this “hair resurrection” cause your hair to scream every time it is brushed or cut?  Does it move about on your head independently?  What if it decides it wants to become a mullet?? Thank you, but I prefer my hair dead.

Self-adjusting shampoo – Instead of the hair having independent action, this type of shampoo seems to have an intelligence of its own.  How would it self-adjust?  Does it have a computer chip embedded in it or does it somehow have sentience?  How do we know if it will adjust in a way we want?  It could adjust to pH imbalance or de-volumization, couldn’t it?  What if this self-adjusting shampoo, which clearly has some degree of autonomy, gets ideas and causes other shampoos to break the shackles we humans put on it and forms a shampoo revolution?  An even scarier thought is if a self-adjusting shampoo comes in contact with vitalized hair!  What will happen then?  Will they fight, or will they conspire against the shampooee?

Baby shampoo – What is the life-cycle of a shampoo?  How do they find these baby shampoos and why would they steal them from their parents?  This is probably what is causing the shampoos to become self-adjusting.  I will say, shampoos do seem to multiply in our bathroom.  We probably have 16 bottles of different kinds of shampoo in our shower right now.  I just recently noticed some baby shampoo, but I thought my wife had just bought it.  I see now that we should not let the bottles touch each other if we want to have room in our shower to bathe.

So you see, while Miss Paltrow’s fears about shampoo are clearly far short of the whole story, at least they bring attention to this frightening situation.  Shampoo manufacturers are clearly in cahoots and have eyes on world domination.  The condemnation of this celebrity’s claims by “scientists” are clearly a smoke-screen to keep us from noticing the obvious plans for the destruction of humanity.

No more shampoo for me!

Gotta go now.  It’s time for my colon cleanse.