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Body Detoxification Is A Hoax

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I got this in the mail today.

screen-capture-3

The spam filter didn’t work 100%.  I know.

Why even post it?  Just to comment on a society where people ask me “is it safe?” when I prescribe a medication for them and yet value the fact that people in Hollywood do something.  Most of the people in Hollywood are idiots and are surrounded by more idiots.

Let me reassure you:

  1. Your body is not “full of toxins.”  When it is, your liver and kidneys are designed to handle those “toxins” and will do so far better than anything someone tries to sell you.
  2. Diets only work when they restrict calories.
  3. Your colon is fine and does not deserve to be regularly “cleansed.”  Colonics have been around since the early 1900’s (maybe earlier) and the fact that they are still being used is only evidence of the gullibility of humans.
  4. Never trust something that claims to “strengthen the immune system.”  It is an impossible claim to prove or disprove, and so is made with impunity.
  5. Look for the word “supports.”  Phrases such as “supports prostate health” or “supports a healthy immune system” are big signs that you are being BS’d.
  6. I never give patients medicines I would not take myself in the same circumstance.  I know no doctors who do.  It is fine to say “why do I need this medicine?” or “Is this medication really necessary?” but to ask “is it safe?” or “doesn’t this destroy the liver?” is kind of insulting.
  7. I guarantee that any plan like this one will cause significant weight loss…in your wallet.

Sorry.  Had to rant about this.  People believe many dumb things and will until the world’s end.  I feel bad for the people brought in by this and am angered at the hucksters that are fattening their wallets and misleading the uninformed.

End of Rant

*This post was originally published at Musings of a Distractible Mind.*

Scammers Alive And Well In The Health Blogosphere

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On January 28th I exposed the tactics of a certain unscrupulous company called Wellsphere. In a nutshell, they lured unsuspecting bloggers to join their network with a series of flattering emails from their Chief Medical Officer, Geoff Rutledge, M.D., Ph.D. The emails suggest that by being featured at Wellsphere, the bloggers would receive higher visibility and more traffic to their blogs. In reality, when the bloggers signed up to join, they unwittingly gave Wellsphere the right to take all of their blogs’ content, aggregate it on Wellsphere and then SELL it to Health Central (without compensating the bloggers a penny). The bloggers whom I spoke with did not notice any increase in their traffic – in fact, since their entire RSS feed was featured at Wellsphere, readers had no incentive to click back to their blogs.

Beyond the shady blog-scraping practices, Wellsphere encouraged bloggers to answer medical questions (regardless of their qualifications to do so) on their site. Health Central’s tagline, by the way, is “trusted, reliable, and up to date health information.” In return, they were offered a “Maven” badge which suggested that they had special authority to do so. One blogger pointed out how unsafe this was:

I’m supposed to be a “Health Maven” in the “General Medicine” group … and I got my qualifications from …. a Cracker Jacks box? Wellsphere made it appear as if I was someone knowledgeable in General Medicine, and no one was checking in to make sure I wasn’t killing someone with bad advice! Dude! In fact, most of the questions which were sent in weren’t being answered at all, or they were being answered by numbos like me. Answers from real medical professionals were meager. Imagine if the readers took Wellsphere seriously, and actually trusted our replies!!!

When I first posted the story, about 60 commenters relayed horror stories of how misled they were by Wellsphere, and how their content was not removed from the site in a timely manner when they asked to cease participation. Twitter lit up with more disgruntlement. I figured that Health Central would have issued an apology to the bloggers who felt betrayed, but instead Chris Schroeder, CEO
of Health Central, had this to say,

“Most bloggers are happy about Wellsphere.”

In an early announcement to the media about the acquisition of Wellsphere, Mr. Schroeder revealed that the blogger content would allow Health Central “to more effectively monetize their advertising” because bloggers tend to come back regularly to the site, thus increasing advertising page views.

The Plot Thickens

So after doing my part to make bloggers aware of what was happening – and let them decide if they’d like to remain members of Wellsphere – I decided to move on. However, yesterday a member of Better Health was sent a flattering email from Dr. Geoff Rutledge inviting her to join Wellsphere. This same blogger had received similar emails over a year ago, had joined Wellsphere, figured out that there was NO value proposition for her or her blog, and requested that her content be removed.  Now many months later she receives this email:

Hi XXX,

I’m writing to give you an update on Wellsphere’s HealthBlogger Network, and tell you about the new and greatly increased benefits of participation in the network. My name is Dr. Geoff Rutledge I’m a board certified physician who practiced and taught at Stanford and Harvard medical schools before joining Wellsphere. Wellsphere is the fastest-growing online health platform and is now one of the Top 5 consumer health websites, helping nearly 5 million people each month find health and healthy-living information and support.

Several months ago, I discovered your blog while searching for the best health bloggers online. After reviewing your writing, I thought your blog would be a great addition to the network, and sent you an invitation to join in the Nursing community.  Since then, the benefits of participation have grown dramatically as the network has grown to nearly 2,000 bloggers, we’ve introduced a variety of blogger widgets and status badges, and the number of visitors has skyrocketed to 5 million per month and we are still growing fast!

Once you agree to participate, we republish the articles you have already written for your blog (with links back to your blog), so there is no extra work for you to do. Your articles will appear in the Nursing community, and on all the search results and WellPages (topic pages) where your articles match a relevant topic or search query. 

I would like to emphasize that YOU will RETAIN FULL COPYRIGHT TO YOUR WRITING <image001.png> the only right you give us is to republish your content on Wellsphere for AS LONG AS YOU CHOOSE. These terms are spelled out clearly on the Health Blogger Network Participation Agreement at http://www.wellsphere.com/bloggerSignUp.s?email=er_kim@emergiblog.com

When you participate in the HealthBlogger Network, you’ll be eligible for a variety of badges that will recognize you for your achievements and leadership in your fields, including the Top Health Blogger and Health Maven badges (we’ll send you information about how to become a Health Maven, if you choose to do so). Here are some of the options for these badges that are available to you.

<image002.jpg> <image003.jpg> <image004.png>
You will also be able to choose among a set of custom tailored widgets that you can post free of charge on your blog and provide your readers a richer experience on your site:
· Health Knowledge Finder – comprehensive health search results for your blog. See http://www.wellsphere.com/healthKnowledgeFinder.s
· Wellevation – motivational and inspirational quotes. See http://www.wellsphere.com/wellWidgets.s
· WellTips – simple, bite-sized pearls of wisdom on topics ranging from weight loss to running to yoga, and more
See http://www.wellsphere.com/wellWidgets.s
· Wellternatives – healthy menu options at your favorite restaurant! Gives your readers the nutrition information for restaurant menu items, and a Wellternative – a healthier dish that is similar, but better for you. See http://www.wellsphere.com/wellWidgets.s

Here are some examples of what your blogging colleagues have said about their experience after joining the Health Blogger Network:
Since joining Wellsphere I’ve had numerous opportunities to accomplish my goals for Mommy Motivation, not to mention that I’ve increased my traffic by at least 40%. … Thanks, Wellsphere. – Cathy Tibbles

Joining the HealthBlogger Network was a great move. I look forward to getting the great comments and feedback each time I post and knowing that there’s a growing community there all interested in the same areas. The traffic to the site has increased, too! It’s well worth getting on board if you can. Jeff A.

“My involvement in HBN has been great in that I’ve seen more traffic to my own site.” – Brett Blumenthal

“There are many benefits to becoming a health blogger. Wellsphere offers great promotion and a friendly atmosphere. It allows you to show your talents and share your insight with others. It has been a pleasure being a part of the Wellsphere community. – Lisa Robertson

Here is what some of the members have told us about the benefits of the badges and widgets:
“The badges give my blog credibility. My traffic has steadily increased since I added the awards badges from the People’s HealthBlogger Awards. I’ve also started a new related business that I’m advertising on my blog.  The increased traffic may help me make a living while I help care for my mother.” – Jacqueline Jones

“Honestly, I have to say that the widgets I have (Top Health Blogger and Health Maven) help immensely in terms of credibility.  ….  I have allowed very few widgets on my blog – only the two Wellsphere ones, because it helps me, but even more important, it helps my readers find what I believe to be the BEST health site on the net.  Thanks for all that you do!” –  Lynette Sheppard

We invite you to join the HealthBlogger Network and experience these benefits for yourself. All you have to do is go to the Health Blogger Network Registration Page at http://www.wellsphere.com/bloggerSignUp.s?email=er_kim@emergiblog.com , confirm your email and blog URL, and select a password! We’ll do the work to connect your blog and begin republishing your articles for Wellsphere’s millions of visitors to read. Of course, you are also welcome to participate as a user on Wellsphere, interact with other HealthBloggers and Wellsphere members, and take advantage of the many features and functions of the site. 

If you have any questions about how this works, or would like to chat about it, please feel free to give me a call at (650) 345-2100, or send me email to Dr.Rutledge@wellsphere.com

Cheers,
Geoff

Geoffrey W. Rutledge MD, PhD
Chief Medical Information Officer
http://www.wellsphere.com
Dr.Rutledge@wellsphere.com

I am astonished that these emails are still being sent, and the bold faced lie at the beginning (“Several months ago I discovered your blog…”) is truly disturbing.

I personally feel that these emails are now bordering on harassment, and that something needs to be done to protect bloggers from continued contact with Wellsphere.

As a point of interest, I NEVER joined Wellsphere, yet here is a screen shot from their website, featuring blog posts about me, my headshot, and my YouTube videos of recent TV interviews where I was a guest.

wellspherescreenshot

What do you think should be done next?

Acupuncture Doesn’t Work, Believers Ignore Evidence

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steve_bwThe primary goal of science-based medicine (SBM) is to connect the practice of medicine to the best currently available science. This is similar to evidence-based medicine (EBM), although we quibble about the relative roles of evidence vs prior plausibility. In a recent survey 86% of Americans said they thought that science education was “absolutely essential” or “very important” to the healthcare system. So there seems to be general agreement that science is a good way to determine which treatments are safe and work and which ones are not safe or don’t work.

The need for SBM also stems from an understanding of human frailty – there are a host of psychological effects and intellectual pitfalls that tend to lead us to wrong conclusions.  Even the smartest and best-meaning among us can be lead astray by the failure to recognize a subtle error in logic or perception. In fact, coming to a reliable conclusion is hard work, and is always a work in progress.

There are also huge pressures at work that value things other than just the most effective healthcare. Industry, for example, is often motivated by profit. Institutions and health care providers may be motivated by the desire for prestige in addition to profits. Insurance companies are motivated by cost savings. Everyone is motivated by a desire to have the best health possible – we all want treatments that work safely, often more so than the desire to be logical or consistent. And often personal or institutional ideology comes into play – we want health care to validate our belief systems.

These conflicting motives create a disconnect in the minds and behaviors of many people. They pay lip service to science-based medicine, but are good at making juicy rationalizations to justify what they want to be true rather than what the science supports. We all do this to some degree – but, in my opinion, complementary and alternative medicine (CAM) is a cultural institution that is built upon these rationalizations.  It is formalized illogic and anti-science conceals as science under a mountain of rationalizations.

Some recent news items and reports dealing with acupuncture demonstrate this disconnect quite well.

The BMJ

The British Medical Journal (BMJ) recently published a review of acupuncture studies in the treatment of chronic pain. Like most other reviews of acupuncture studies, the authors were not impressed. They concluded:

A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear.

After decades of study and hundred of clinical trials, this remains the state of acupuncture research.  The best studies continue to show an unclear effect, which cannot be separated from bias – which of course is the point of clinical trials. In other words, the signal cannot be separated from the noise. The most parsimonious interpretation of this fact is that there is no significant signal – acupuncture does not work.

But supporters of acupuncture prefer to go through a litany of rationalizations rather than acknowledge that simple fact (more on this later).

It was also recently announced that the BMJ group will be adding a new journal: BMJ Acupuncture. That’s right, an entire journal dedicated to studying (read “promoting”) acupuncture.  The press release notes:

Acupuncture in Medicine is a quarterly title, which aims to build the evidence base for acupuncture.

I thought the purpose of research was to discover if a treatment works, not to build a case for it.

BMJ is a strange journal – it is generally of high quality but seems to have a blind spot for certain CAM modalities, like acupuncture. While it will publish critical reviews, like the one above, it also has published some low quality positive reviews – such as this one of acupuncture and IVF (in vitro fertilization).  The review glosses over the disparity in study quality and location. Other reviews published around the same time showed no effect from acupuncture in IVF.

And the best individual studies to date show no effect. In fact, the most recent study showed that the placebo acupuncture group had slightly higher pregnancy rates by some measures than the acupuncture group (while other measures showed no difference). Again – the most parsimonious interpretation of this study is the null hypothesis – acupuncture does not work in IVF. But proponents twisted themselves into logical pretzels and offered up the astounding rationalization that placebo acupuncture must have some real effect.

To be clear, I am not against journals that specialize in one area, or practitioners that specialize in one form of treatment. Specialization is essential to deal with the modern complexity of medicine. However, we must recognize the significant risk of specialization – and that is the fallacy that is often summarized as follows: if your only tool is a hammer then every problem will look like a nail. It is unlikely that a journal or practitioner dedicated to acupuncture will ever reach the conclusion that acupuncture is a dead end and science-based medicine should move on. As an extension of this, specialty journals and specialist should follow well-established modalities. Forming a specialty journal dedicated to an unproven and dubious modality is problematic, to say the least.

More Rationalizations

A recent Washington Post article observes in its headline: “Millions embrace acupuncture, despite thin evidence.” It seems this reporter, Ellen Edwards, has grasped the essential disconnect, although she does not sufficiently explore an answer to the implied question – why? Why do so many accept acupuncture despite an enduring absence of scientific evidence? Ironically, the press has much to do with it. They are often complicit in misrepresenting the facts, and abetting the rationalizations that are necessary for those who should know better to continue to promote acupuncture despite the lack of evidence.

Some professional organizations are also complicit. The article notes, for example:

The American Medical Association takes no position specifically on acupuncture; the AMA groups it with other alternative treatments, saying “there is little evidence to confirm the safety or efficacy of most alternative therapies.” It says “well-designed, stringently controlled research” is needed to evaluate its efficacy.

Now, the AMA is not the best place to go for position papers on specific scientific questions in medicine. But if they are going to bother having any position, it should be better informed. They say that research is needed, giving the impression that there isn’t already a large body of research to inform out opinion about whether acupuncture works or not.

The notion that more research is needed is one of the most common rationalizations. That allows someone to put off forever concluding that their pet modality does not work – simply make the case for more research, which is easy to make sound like it’s a good idea. And of course anyone against more research must be closed-minded.  For example, the story relates (standard disclaimer – I am aware that experts are often quoted out of context by journalists, so keep that in mind, but for the purposes of this post I will take the quotes at face value):

In 2007, NCCAM spent about $9.1 million on acupuncture research. While more is planned, Brent Bauer, an internist at the Mayo Clinic and director of its complementary and alternative medicine program, said the research is in its “toddlerhood.”

Nice touch – “toddlerhood.”  That’s just a cute way of saying that more research is needed and you can comfortably ignore any current negative research. If the assessment were fair, then it could be justified. But we have already had several fairly sophisticated placebo-acupuncture controlled trials. This represents reasonably mature clinical research. I suspect
Bauer just does not like the fact that these best studies (like the IVF study above) are generally negative. I wonder – if these studies were positive would he still think they were imature and could be ignored?

Linda Lee, a gastroenterologist who is director of Johns Hopkins’s new Integrative Medicine and Digestive Center, is quoted as saying:

“We have this double standard. We are completely comfortable using pharmacological therapies that have not been subjected to clinical trials for the purposes we use them, but we are super suspicious of alternative therapies that haven’t been tested with randomized placebo trials. From a research point of view, I understand the criticism. But we physicians are in the healing business, and we have to go beyond the pharmacological solutions to understand the whole person,” she said. “Acupuncturists start with the whole person.”

Ah – the “holistic” gambit.  This is just another rationalization to distract people from the uncomfortable fact, that she acknowledged. From a “research point of view” means “I understand that the best quality scientific evidence is negative.” And “we..are in the healing business” means “but I want to believe in this anyway.”

The double standard is also an incredible claim, because the opposite is true. SBM advocates want a single standard. What Dr. Lee is actually referring to is prior plausibility – scientific practitioners are more accepting of treatments that are biologically plausible, and are appropriately skeptical of treatments that are extremely implausible.  It is also a tu quoque fallacy – we advocate high standards of science for all treatments, even plausible ones. If some doctors uses drugs unscientifically, that does not justify chucking science whenever it conflicts with our beliefs and desires.

It is, in fact, the CAM proponents who want a double standard. Imagine if after hundreds of studies the best a drug could do for any indication is a weak effect that is likely just placebo – the signal cannot be separated from the noise. Imagine  a pharmaceutical company making the exact same rationalizations to put its failed drug on the market anyway that acupuncture proponents make for acupuncture.

The article concludes, as most do, with a positive anecdote from a believer – Elise Feingold:

“I decided to leave my science brain aside,” she said. “I felt it had helped other people, and it might help me. I don’t know how it works, but it’s got 4,000 years of Chinese medicine behind it.”

She begins with what amounts to saying that anecdotal evidence is more compelling that rigorous science. This, of course, makes no sense. The whole point of scientific rigor is for evidence to be more objective and reliable – to control for any many variables as possible. Anecdotes are unreliable because they do not control for any variables. Proponents of acupuncture are happy to cite scientific evidence when they think it supports their beliefs, but then will chuck science in favor of low quality anecdotes as needed.

Feingold finishes with the commonplace appeal to antiquity.  The premise of this argument is that a treatment that has no real effect could not survive for thousands of years. History proves that this premise is false (see blood letting), and it also profoundly underestimates the human capacity for self-deception and therefore the need for scientific controls.

Conclusion

There is still no compelling evidence that there is any real effect to acupuncture.  It didn’t have to turn out that way, but that is the way the scientific chips fell. The treatment also lacks plausibility (although I usually point out that something is happening, unlike homeopathy, and so there is the physical possibility of an effect), and in medicine you only get two strikes. No evidence and no plausibility means that you’re out.

But the disconnect continues. Proponents keep pretending that there is compelling evidence, or it has not been properly studied yet, or it does not have to be studied because historical anecdotes are enough – whichever argument suits the moment. Meanwhile the media keep breathlessly telling us that acupuncture is gaining ground, while the evidence is standing still.

The premise of SBM is that support and resources should follow scientific support. In the world of CAM, however, support follows belief, and the science seems to be an afterthought or, worse, an obstacle.

**This post was originally published at Science Based Medicine.**

Announcing The Science-Based Medicine Conference

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My colleagues and I will be holding a Science-Based Medicine conference on Thursday, July 9th. This is an all-day conference covering topics of science and medicine. The conference is designed for both a professional and general audience.

The conference will be at the Southpoint Casino and Hotel in Las Vegas, Nevada. It is also part of The Amazing Meeting 7 (TAM7) which is run by the James Randi Educational Foundation (JREF). You can register for the conference either separately or packaged with TAM7.  You can register for both here.

Physicians can earn 6 hours of category 1 CME credits for attending the conference.

Below is the list of speakers and the titles of their talks, and below that is the bio for each speaker.

Topics:
Introduction to Science-Based Medicine (Steven Novella, MD)
Case studies in cancer quackery: Testimonials, anecdotes, and pseudoscience (David H. Gorski, MD. PhD)
A Scientific Critique of Chiropractic (Harriet Hall, MD)
Why Evidence-Based Medicine is not yet Science-Based Medicine (Kimball Atwood, MD)
Lyme: From the IDSA to the ILAD to the ABA (Mark Crislip, MD)
Online Health & Social Media: The Good, The Bad, and The Ugly (Val Jones, MD)
Conclusion (Steven Novella, MD)

Speakers:

Steven Novella, MD
Dr. Novella is an academic clinical neurologist at Yale University School of Medicine. He is the president and co-founder of the New England Skeptical Society. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe. He authors NeuroLogicaBlog and contributes to several other science blogs: The Rogues Gallery, SkepticBlog, and Science-Based Medicine, of which he is also the founding editor.

David H. Gorski, MD, PhD
Dr. Gorski is an Associate Professor of Surgery Division of Surgical Oncology, Wayne State University School of Medicine, Detroit, MI. He is also the Program Leader, Breast Cancer Biology Program, Barbara Ann Karmanos Cancer Institute. His cancer research has been funded by the NIH, ASCO, and the Breast Cancer Research Foundation. He is a long-time science blogger who regularly tackles issues related to science and medicine. He is the associated editor of Science-Based Medicine.

Harriet Hall, MD
Dr. Hall is a retired family physician. She spent 20 years in the Air Force as a flight surgeon and family physician and retired as a full colonel. Also known as “The SkepDoc” from her column in Skeptic magazine, she has written extensively about alternative medicine. She is an editor of The Scientific Review of Alternative Medicine and the Science-Based Medicine blog, is an advisor to Quackwatch, and is a contributing editor to both Skeptic and Skeptical Inquirer magazines. Her website is www.skepdoc.info.

Kimball Atwood, MD
Dr. Atwood is a practicing anesthesiologist who is also board-certified in internal medicine. He has been interested in pseudoscience for years. He was a member of the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners, and subsequently wrote its Minority Report opposing licensure for naturopaths. He is an associate editor of the Scientific Review of Alternative Medicine and co-editor of Naturowatch. He is particularly concerned with implausible claims being promoted, tacitly or otherwise, by medical schools and government. He is also dubious about the ethics of human trials of such claims.

Mark Crislip, MD
Dr. Crislip has been a practicing Infectious Disease specialist in Portland, Oregon since 1990. He is Chief of Infectious Diseases for Legacy Health System.
He is responsible for the Quackcast, a skeptical review of Supplements, Complementary and Alternative Medicine, The Persilflagers Annotated Compendium of Infectious Disease Facts, Dogma and Opinion a guide to Infectious Diseases, the Persifalgers Puscast, a podcast review of Infectious Diseases, and Rubor, Dolor, Calor, Tumor, an infectious disease blog.

Val Jones, MD
Dr. Jones is the CEO of Better Health, LLC, a medical blogging network, and VP of Strategic Partnerships at MedPage Today, an online health news source for healthcare professionals. She has been the Senior Medical Director for Revolution Health, and the founding editor of Clinical Nutrition & Obesity, a peer-reviewed e-section of the online Medscape medical journal. Dr. Jones volunteers once a week as a rehabilitation medicine physician at Walter Reed Army Medical Center.

Quote Of The Month: The Dean Ornish Debate

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Dean Ornish writes:

…let’s use science to evaluate ideas that might seem a little weird or offbeat, but deciding a priori that an idea is stupid or worthless just because it doesn’t fit the conventional paradigm is, in my humble opinion, the epitome of being unscientific.

Dr. Benway responds:

There’s weird and then there is weird.

Diet and excercise affecting cancer? Plausible.

Naturopathy? Weird.

Subluxations? Homeopathy? Delusional.

MDs selling self-branded supplements? Embarrassing.

Chelation and coffee enemas for kids with autism? Evil.

I believe you are the plausible wrapping paper surrounding a coalition of crazy, weird, embarrasing, and evil ideas that some want to “integrate” into the universal health care bill.

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