October 28th, 2010 by Steve Novella, M.D. in Better Health Network, Health Policy, Opinion, Quackery Exposed, Research
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In my group practice, the Yale Medical Group, drug company-sponsored lunches and similar events have been banned. This is part of a trend, at least within academic medicine, to create some distance between physicians and pharmaceutical companies, or at least their marketing divisions. The justifications for this are several, and are all reasonable. One reason is the appearance of being too cozy, which compromises the role of academic physicians as independent experts.
But the primary reason is the belief that “detailing” by pharmaceutical sales representatives has a negative effect on the prescribing habits of physicians. There is reason to believe this may be the case because of cases of bad behavior on the part of pharmaceutical marketing divisions — ghost writing white papers, for example.
The concern, backed by evidence, is that pharmaceutical companies introduce spin and bias into the information they provide to physicians, whether though CME, detailing, literature, or sponsored lectures. Even when the information itself is not massaged, it is cherry picked, so in the end physicians are not getting a thorough and unbiased assessment of the facts. Read more »
*This blog post was originally published at Science-Based Medicine*
October 21st, 2010 by Harriet Hall, M.D. in Better Health Network, Health Policy, Health Tips, News, Opinion, Research, True Stories
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Dr. Novella has recently written about this year’s seasonal flu vaccine and Dr. Crislip has reviewed the evidence for flu vaccine efficacy. There’s one little wrinkle that they didn’t address — one that I’m more attuned to because I’m older than they are.
I got my Medicare card last summer, so I am now officially one of the “elderly.” A recent review by Goodwin et al. showed that the antibody response to flu vaccines is significantly lower in the elderly. They called for a more immunogenic vaccine formulation for that age group. My age group. One manufacturer has responded. Read more »
*This blog post was originally published at Science-Based Medicine*
October 17th, 2010 by Peter Lipson, M.D. in Better Health Network, Health Tips, Opinion, Quackery Exposed, Research
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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*
October 14th, 2010 by Steve Novella, M.D. in Better Health Network, Health Policy, Opinion, Quackery Exposed, Research
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Any promoter of science-based medicine often faces the question: “What’s the harm?” What is the harm if people try treatment modalities that are not based upon good science, that are anecdotal, or provide only a placebo benefit? There are generally two premises to this question. The first is that most “alternative” placebo interventions are directly harmless. The second is that direct harm is the only type worth considering. Both of these premises are wrong.
The pages of Science Based Medicine (SBM) are filled with accounts of direct harm from unscientific treatments: Argyria from colloidal silver, death from chelation therapy, infection or other complications from acupuncture, burns from ear candleing, stroke from chiropractic neck manipulation — the list goes on. You can read anecdotal accounts of such harm on the website, whatstheharm.net.
Of course, as we often point out, harm and risk is only one end of the equation — one must also consider benefit. It is the risk-benefit ratio of an intervention that is important. But generally we are talking about interventions that lack any evidence for benefit, and therefore any risk of harm is arguably unacceptable. Read more »
*This blog post was originally published at Science-Based Medicine*
October 7th, 2010 by Harriet Hall, M.D. in Better Health Network, Book Reviews, Health Tips, Opinion
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I write a lot of critical articles. It’s nice to be able to write a positive one for a change. I received a prepublication proof of The Mayo Clinic Book of Home Remedies: What to Do for the Most Common Health Problems. It is due to be released on October 26 and can be pre-ordered from Amazon.com. Since “quackademic” medicine is infiltrating our best institutions and organizations, I wasn’t sure I could trust even the prestigious Mayo Clinic. I was expecting some questionable recommendations for complementary and alternative medicine (CAM) treatments, but I found nothing in the book that I could seriously object to.
It is organized alphabetically, starting with acne and airplane ear and progressing through bedbugs, boils and bronchitis, dandruff, depression and diabetes to warts, wrinkles and wrist pain. Each entry consists of (1) a description of the problem and its symptoms, (2) treatments you can try at home, and (3) when to seek professional medical help. It concludes with a short section on emergency medicine that covers anaphylaxis, bleeding, burns, CPR, choking, fracture, heart attack, poisoning, seizure, shock and stroke.
Nowhere does it mention acupuncture, chiropractic, energy medicine, or homeopathy. It gives good, clear guidance about when a health problem should not be treated with home remedies. Its recommendations about diet and exercise are solid. It doesn’t recommend anything that can’t be supported by published studies and common sense. When it recommends herbal remedies and dietary supplements, it is cautious about what it claims. For instance, glucosamine and chondroitin are listed for osteoarthritis, but they point out that further study is required and they say “because the supplements may help and appear to be safe, it may not hurt to give them a try.” Not exactly a strong recommendation. Read more »
*This blog post was originally published at Science-Based Medicine*
