February 5th, 2008 by Dr. Val Jones in Quackery Exposed
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So my last post stimulated some interesting discussion amongst friends and colleagues. Some applauded the late night supplement “smack down,” and others felt it was too harsh. Still others who don’t read my blog regularly complained that it was unfair to pick on the supplement industry without also pointing out the flaws of Big Pharma. Well, here’s to equal opportunity smack downs – where things “applied directly to the forehead” are as fair game as anti-psychotics, IT mishaps, healthcare professional SNAFUs, and misguided policies resulting in unanticipated harm to patients.
But let’s not forget the happy stories, the unlikely triumphs, and the snatching of victory from the jaws of defeat. We can laugh at ourselves, cry with our friends, and mourn the loss of the lonely. Medicine is full of a broad array of emotions and perspectives, captured here for you in this blog.
And now, back to bunnies and puppies…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 5th, 2008 by Dr. Val Jones in Quackery Exposed
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The financial burden of snake oil
Prickly snake oil seeds are taking root in the soil of our broken healthcare system. Consumer discontent and feelings of helplessness are the manna of charlatans – and they are growing fat in our lean times. Unprecedented opportunity for promotion via the Internet, coupled with chronically short audience attention spans and generalized patient exhaustion (from the treadmill of life) are creating the perfect climate for the spread of pseudoscience.
I must admit that I had turned a blind eye to the whole pseudoscience movement until fairly recently. I figured it was harmless enough – placebos that might engage peoples’ minds in a more optimistic view of disease. But little did I realize that this tumor on the face of medicine would become life threatening to the advancement of science and truth.
Take for example the money that Americans spend on weight loss supplements – 1.3 billion dollars per year, and yet the American Academy of Family Physicians has found no evidence to support the use of a single one. That’s more money than the World Health Organization’s annual budget, and more than Great Britain spends on cancer research in a year. The supplement industry in general rakes in 20 billion dollars a year, which is more than the total amount spent by the US government in the wake of hurricane Katrina.
And what do snake oil salesmen think of this colossal waste of resources? Why, they’re touting it as a new era of enlightenment of course. They weave in “all natural” products, “mindfulness” practices, and “detoxification” programs into a comprehensive feel-good message that is a soothing balm to anxious souls. In reality they are leading the public down a garden path towards a false wellness nirvana, fleecing them as they go, and sowing seeds of mistrust for science-based medicine.
The rise of snake oil salesmen
The strongest potion in the snake oil salesman’s repertoire is the placebo. Placebos are treatments that work based solely on the power of suggestion. A so-called placebo effect occurs when a patient’s symptoms are altered in some way (i.e., alleviated or exacerbated) by an otherwise inert treatment, due to the individual expecting or believing that it will work. If a snake oil salesman is to become truly successful, he must build a case for his wares through anecdotes and testimonials. To obtain these, he must be a master of the power of suggestion, cultivating a small number of “true believers” from which to conjure evidence for the effectiveness of his oil. He need not convince the majority, a small minority of passionate believers will do. As Mark Twain writes, “The most outrageous lies that can be invented will find believers if a man only tells them with all his might.” Therefore, a common denominator with many snake oil salesmen is charisma and charm.
Once the charlatan has developed his small but passionate following, and some miracle cure anecdotes, he will then start playing the role of a victim. He will look for individuals who are willing to challenge his pseudoscientific claims, and then cry out to his loyal followers that he is being persecuted. He will use racism imagery to describe an illusionary bias against himself and the “good” that he is trying to do for those who are open-minded and willing to forsake “paternalistic” science. His followers will be further emboldened to carry the banner of this “downtrodden hero” as they continue to fall for his under-dog psychology.
The snake oil salesman, of course, will not gain traction with key opinion leaders in medicine, so he is left to draw from the Hollywood celebrity pool to further evangelize the masses. Medical leaders will roll their eyes and ignore his obvious pseudoscience, much to the detriment of the general public who have a hard time discerning science from pseudoscience. The charlatan then points to the medical profession’s silence as “proof” that they cannot deny his claims, further convincing susceptible listeners.
Then years later as snake oil salesmen realize that there is further strength in numbers, they gather together to form the first snake oil union. They create a continuum of oily treatments, gathering anecdotes and testimonials from one another in pseudoscientific “meta-analyses” to further strengthen their assault on science and reason. They find wealthy donors and benefactors who are impressed by their growing numbers, and match them with cash-strapped academic centers who will desperately accept funds for any vaguely scientific purpose. The snake oil team now has won a respectable platform from which to grossly inflate statistics about public use of “alternative medicine” (lumping “prayer” into the list of therapies which, combined together, would have you believe that over 60% of Americans are using alternative therapies like homeopathy).
Snake oil goes mainstream
Now that the very same snake oil that medical experts didn’t wish to dignify with a response is being promoted by academic centers, we are obligated to fund research into the potential therapeutic uses of these placebos, wasting countless millions in government funding to study implausible therapies. With a critical mass of snake oil believers, few dare to challenge the wisdom of this approach, and have become passive observers in a downward spiral that is harming the credibility of the very centers founded to promote objective scientific inquiry.
Can good science separate the wheat from the alternative chaff? Yes, but the problem is that few people seem to care about truth any more. While the American Academy of Family Physicians demonstrates that no single weight loss supplement is recommended for public use, the public is spending 1.3 billion dollars per year on these very supplements. Why? Maybe the AAFP is not reaching the public with their message, or maybe people are simply unable to resist the sweet lure of false promises?
Nonetheless, there is a growing movement in medicine to reclaim scientific territory stolen while we shrugged passively at the snake oil lobby. Blogs like Science-Based Medicine and Respectful Insolence are uniting physicians who believe in the importance of objective scientific inquiry as the foundation for the best therapeutic decision-making.
As the healthcare budget crunch looms, further pressure will be placed on providers and pharmaceutical companies to demonstrate the efficacy of their treatments in order to be eligible for coverage. This will be a boon to scientific medicine, as therapies that actually work will (by budgetary necessity) be preferentially selected for reimbursement. While Big Pharma undergoes further scrutiny, they will also turn to science to demonstrate the utility (or lack thereof) of their drugs. Therefore, those in search of truth will not be completely thwarted by pseudoscience.
Yet patients are free to pay out-of-pocket for any number of alternatives to scientifically proven medicine. I predict that further healthcare access limitations will drive more people to look for placebos than ever before, much to the detriment of those who have diseases that are treatable or curable through proven therapies. I worry far more about missed therapeutic opportunities than the dangers of the snake oil itself.
So my final advice is this: eat a well-balanced, calorie controlled diet, engage in regular exercise, stay within a healthy weight range, sleep well, participate in loving relationships, don’t smoke, do drugs, or drink in excess. At least 60% of your medical problems will be prevented if you do these things. You do not need to waste your money on supplements and snake oil – put that money into a savings account that you can access in case you become seriously ill and your insurance doesn’t cover all the best, evidence based care that you need.
Do not tithe to the snake oil salesman. Resist the dulcet tones of the false promises. Save your money to do good, and listen to your own voice of reason.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 4th, 2008 by Dr. Val Jones in Medblogger Shout Outs, News
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I learned something interesting today from Dr. Benabio’s Derm Blog: bacteria love to grow in skin cream. He said that it was kind of like cream cheese – leaving it out at room temperature would cause it to go bad pretty quickly, were it not for the usual preservatives. He described an outbreak of a deadly bacterial infection in a hospital ICU – caused by nurses using “all natural” European (preservative-free) skin cream on their patients.
So there you have it folks – deadly bacteria are indeed “all natural.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 24th, 2008 by Dr. Val Jones in Health Tips
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I loved yogurt when yogurt wasn’t cool.
In fact, I grew up on a small dairy farm in Canada where our sole product was yogurt. My parents bought a cow (Daisy) “in an unguarded moment” and ended up having to get creative to get rid of all the extra milk that she produced for our family. One thing led to another – and I wound up as the VP of Sales and Marketing for a growing yogurt company taking Canada by storm. So when I saw today’s news release about Dannon being sued for exaggerated health claims for their yogurt, my dairy ears perked up.
First of all, if it’s true that Dannon is claiming that their yogurt has greater health benefits than other yogurts with active cultures, that’s false advertising.
I also think it’s pretty sneaky that they (allegedly) ran ad campaigns exaggerating the health benefits of yogurt, and then marked up their product by 30% to make consumers feel that they were getting added value from what was there all along. Typical big business move, right?
Secondly, yogurt bacteria do have beneficial uses (eating yogurt may decrease colon infection rates in hospitals, and can reduce the chance of vaginal yeast infections after antibiotic use). There is no conclusive evidence that yogurt treats or prevents diarrhea. However, it’s silly to extrapolate that these friendly bacteria will improve the health of your entire immune system – so you’ll never be sick – or that they will perfectly regulate your bowels – regardless of your underlying disease. As with many foods that have been shown to have some specific health benefits (green tea, blueberries, flax seeds) the media tends to blow them out of proportion.
And finally, what should you know about yogurt? Know that for those who are not allergic to milk products, it is a healthy nutritional option (especially the low fat variety without too much sugar) that may be especially important if you’re in the hospital or have received any antibiotics recently. Yogurt contains protein and calcium, which are important components of a healthy diet. But beyond this nutritional benefit (and the infection reduction in at-risk populations), I wouldn’t ascribe any particular magic powers to this tasty treat – as much as I’d like to.
1. Look for the “active cultures” sign on yogurt containers. The National Yogurt Association (NYA) established its own criteria for live and active culture yogurt in conjunction with its Live & Active Culture seal program. In order for manufacturers to carry the seal, refrigerated yogurt products must contain at least 100 million cultures per gram at the time of manufacture. Don’t pay extra for a yogurt because they have live cultures. The majority of them do!
2. Yogurt bacteria don’t live forever in your gut, so you’ll need to eat yogurt (or take active cultures) regularly to repopulate the colonies. I can’t find any data to support an exact consumption frequency. I guess it also depends on how many bacteria are contained in the yogurt or supplement you’re taking.
3. Acidophilus pills (one of the most popular yogurt bacterial strains) are available at health food stores for those who’d rather not eat yogurt but still want the benefits of the culture. These pills must be refrigerated to keep the culture alive (kind of like keeping milk cool) – and make sure you check the expiration date too. For more information on acidophilus, check out this supplement database.
4. The most common side effect of eating live yogurt cultures (in pill form or in yogurt form) is bloating and gas.
So don’t be surprised if you encounter it!
And I think that’s a nice thought to end on.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 27th, 2007 by Dr. Val Jones in Book Reviews
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This is my final post in a series inspired by Dr. Barker Bausell’s recent book, “Snake Oil Science: The Truth About Complementary and Alternative Medicine.” Since I began this series, the New York Times has published a rave review of Bausell’s book, which only further confirms the importance of Bausell’s contributions.
Although Bausell’s main thesis is that there are currently no large, randomized controlled trials (published in leading medical journals) demonstrating the effect of any CAM therapy beyond placebo, I have chosen to highlight some of his thinking about research methodology as it applies to the medical literature in general.
So far I have explained why most research (if not carefully designed) will lead to a false positive result. This inherent bias is responsible for many of the illusionary treatment benefits that we hear about so commonly through the media (whether they’re reporting about CAM or Western medicine), because it is their job to relay information in an entertaining way more so than an accurate manner (i.e. good science makes bad television).Then I explained a three step process for determining the trustworthiness of health news and research. We can remember these steps with a simple mnemonic: C-P-R.
The C stands for credibility– in other words, “consider the source” – is the research published in a top tier medical journal with a scientifically rigorous review process?
The P stands for plausibility– is the proposed finding consistent with known principles of physics, chemistry, and physiology or would accepting the result require us to suspend belief in everything we’ve learned about science to date?
And finally we arrive at R – reproducibility. If the research study were repeated, would similar results be obtained?
This third and final pillar of trustworthy science is a simple, but sometimes forgotten, principle. If there is a true cause and effect relationship observed by the researcher, then surely that cause and effect can be demonstrated again and again under the same conditions. Touching a hot stove burner always results in a burned hand. No matter how frequently you test this causal relationship, the result will be similar.
Sometimes conflicting results are obtained by repeating a study. When this happens, the reader should be careful in interpreting the conclusions – there may be a flaw in the study design, or it may be that the conclusions drawn were inaccurate. There could have been a false positive result, or no appreciable effect of the treatment under consideration, therefore leaving the results to chance. Flipping a coin gives you heads one minute and tails the next. Yet a person unfamiliar with coins could conclude (after one flip) that it has a head on both sides. In the end, therefore, one can be more confident in a study’s result if it is born out by other studies.
And so as we conclude this series, I hope that you now feel well equipped to perform CPR (credibility, plausibility, reproducibility checks) on health news. A little healthy skepticism can protect your brain from all the mixed health messages that barrage us each day. At the very least, now you’ll appreciate why most health news reports include an expert quote stating something to the effect of “it’s too early to know for sure if these findings are relevant.” That statement may be the most trustworthy of the entire report.
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Next up: Shannon Brownlee’s book “Overtreated: Why Too Much Medicine Is Making Us Sicker And Poorer.” Shannon and I corresponded about this book two years ago, so I’m looking forward to seeing how it has turned out. Once I’ve finished it I’ll give you my thoughts here in this blog.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
