Health and Medicine

Posts Tagged ‘ Health and Medicine ’

Anti-Vaccine Charity, No More

Last year I wrote a series of posts[1] around the Charitable organisation Immunisation Awareness Society and a complaint I had made to the Charities Commission. The Thrust of these posts and the complaint was that the Society does not fulfill the requirements of a charity and should be removed from the register. The effect of this is that they would also be stripped of their tax exempt status.

This indeed was my main goal. There are innumerable groups out there that I don’t agree with but you get that in a wide and varied world. In the case of the IAS though the speech they engage is is effectively publicly subsidised via the tax exemption, this should mean that they are constrained in what they can say. At the very least it should mean that they must present the facts undistorted by ideology.

Yesterday I found out that the Charities Commission agrees with me. In a decision handed down late last month they determined that the IAS does not qualify for charitable status and removed them from the charities register.

So, I guess you could say – I won.

It the words of one of my colleagues it also shows that one person can make a difference. Clichéd but true.

Reading through the Charities Commission decision it seems they focused on two things:

1. The biased nature of the information provided by the IAS and;

2. The political nature of their campaigning for a change in public policy.

This makes sense given the requirements that the Commission need to fulfil to determine whether an organisation meets the requirements to be a charity. Even so I’m a bit disappointed that there was no focus on the factual inaccuracy of and misrepresentation in the materials published by the IAS.

The decision does seem to skirt this line though when stating that “Overwhelmingly, the information on the website argues that vaccination is ineffective and dangerous” the inference being that is view is incorrect as well as being biased. Even so, none of the language of the report actually states this outright (that I can see).

There was also an additional point touched on that merely providing information does not in and of itself “advance education”. In other words to be an educational charity you actually have to actively educate people, not simply act as a repository of information – otherwise every private citizen with a decent library or informational website could become a charity.

Finally, in my personal 15 minutes of fame, the Commissions decision has been reported in the Dominion Post – complete with a quote from me. Not my most eloquent moment but it’s close enough to the point I wanted to make that I’m fairly happy.

[Edit: Thanks goes to commenter Hemlock for sharing the IAS response to this news]

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1. And here they are in all their tedious glory:
http://scepticon.wordpress.com/2011/10/11/anti-vaccine-charities-is-there-any-quality-control-on-charities/

http://scepticon.wordpress.com/2011/10/11/ias-complaint-part-1-thimerosal-in-your-vaccine-no/

http://scepticon.wordpress.com/2011/10/12/ias-complaint-part-2-gardasil-horrors-horrific-reasoning/

http://scepticon.wordpress.com/2011/10/13/ias-complaint-part-3-vaccine-ingredients-not-so-bad-really/

http://scepticon.wordpress.com/2011/10/14/ias-complaint-part-4-anti-vaccine-impact-in-new-zealand/

http://scepticon.wordpress.com/2011/10/17/defending-the-term-anti-vaccine/

http://scepticon.wordpress.com/2011/10/18/the-legitimate-risks-of-vaccines/

2012: 11/07
CATEGORY: Medicine
Sciblogs
Science
skepticism
5 comments

TCM and You: Cupping

I have noticed that Chinese massage seems to be becoming popular, and seemingly with it Traditional Chinese Medicine (TCM¹). At least browsing through two of the larger shopping centres in Hamilton (bring on the hick jokes) I saw massage centres offering these services. In particular cupping was advertised. But what exactly is cupping²?

As with many modalities in TCM Cupping appears to be based on pre-scientific notions of blood stagnation and energy blockages³. Applying cups with a slight vacuum to the skin is meant to draw out the “toxins” which then results in improved health, somehow.

The active part of cupping essentially boils down to a pressure difference. The pressure is lower on the inside of the cup and greater on the outside, this difference causes the skin to be forced up into the cup⁴. This process in turn causes blood to gather in the region and may cause minor damage to the area resulting in bruising.

Presumably the fact that the skin appears to be drawn up into the cup gives the impression that there is a general pulling action at work here and that toxins and other “bad stuff” are pulled out of the body in this fashion.

The trouble with this is that pressure difference is a fairly crude physical process and with regard to this biological system lacks what we in the science biz call “Specificity”⁵. What this means is that there is no way for the cup to restrict the “pulling action” to only harmful chemicals (the “toxins”, say) and allow everything else to be unaffected, i.e. it is not “specific” to toxins. Everything will be drawn up in the same way.

In which case you get a lovely bruise and feel like you’ve done something but that’s about it.

Ok, that’s fine for just thinking about it. What about evidence, we’re always going on about evidence here.

I attempted to find a Cochrane review on cupping but while one was listed for pain relief there did not seem to be a completed review for perusal. I did come across this review that found equivocal results for the effectiveness of cupping for pain.

The review comments on the putative mechanism of cupping:

“Assuming that cupping was beneficial for the management of pain conditions, its mechanisms of action may be of interest. The postulated modes of actions include the interruption of blood circulation and congestion as well as stopping the inflammatory extravasations (escaping of bodily fluids such as blood) from the tissues. Others have postulated that cupping could affect the autonomic nervous system and help to reduce pain . None of these theories are, however, currently established in a scientific sense.” [Emphasis added, citations removed]

The discussion of the reviews limitations is especially worth noting:

“Our review has a number of important limitations. Although strong efforts were made to retrieve all RCTs on the subject, we cannot be absolutely certain that we succeeded. Moreover, selective publishing and reporting are other major causes for bias, which have to be considered. It is conceivable that several negative RCTs remained unpublished and thus distorted the overall picture. Most of the included RCTs that reported positive results come from China, a country which has been shown to produce no negative results. Further limitations include the paucity and the often suboptimal methodological quality of the primary data. One should note, however, that design features such as placebo or blinding are difficult to incorporate in studies of cupping and that research funds are scarce. These are factors that influence both the quality and the quantity of research. In total, these factors limit the conclusiveness of this systematic review.

In conclusion, the results of our systematic review provide some suggestive evidence for the effectiveness of cupping in the management of pain conditions. However, the total number of RCTs included in the analysis and the methodological quality were too low to draw firm conclusions. Future RCTs seem warranted but must overcome the methodological shortcomings of the existing evidence.”

In conclusion then, you may see a placebo effect from this treatment – though I suspect this is over rated as a therapeutic outcome⁶. You may also find yourself covered in bruises (though I hear they are painless – think of them as CAM hickies). So… Dubious premise with dubious benefit, same thing – different day.

Here are a couple of images for you to keep in mind…

Mmmmm, cupping goodness.

[UPDATE 30/5/12: Islam appears to support cupping, check out this completely unbiased arabic wikipedia article]

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Footnotes:

1. Can’t get away from TLAs

2. So many jokes spring to mind, I mean come on – “cupping”?

3. See this link for some scary science illiteracy around cupping. And here’s good old Wikipedia. And “blood stagnation” really? isn’t that gangrene or septicaemia or something?

4. Keeping in mind that a vacuum does not suck, high pressure pushes. If I may geek out a bit here; hence one of my favourite exchanges from ST:TNG:

“You were right. Somebody blew out the hatch. They were all sucked out into space.“
“Correction, sir, that’s blown out.“
“Thank you, Data.“
“A common mistake, sir.“

- Riker and Data get precise about the physics of rapid decompression into the vacuum of space

5. Yeah, I know, it sounds made up.

6. See here, here and here.

Vaccines and Autism – Media Report Card (sciblogs.co.nz)
What’s The Harm of Alternative Medicine? (scepticon.wordpress.com)
Yoga Thai Massage: Herald, Wherefore Art Thou Sense? (scepticon.wordpress.com)
Why Do People Use Alternative Medicine? (scepticon.wordpress.com)
The Freedom of Ignorance: Health Freedom, What is it and Do We Want it? (scepticon.wordpress.com)

2012: 04/04
CATEGORY: Alternative medicine
Medicine
Questionable Techniques
Sciblogs
skepticism
4 comments

Amber Teething Beads: A Follow-Up

Over the week or so I expect the page views for my amber teething necklace post to top 20,000 over the two blogs. Interest in the article has just kept increasing over the last year or so of it being up, as opposed to the majority of my posts which slip into internet obscurity within days. In anticipation of the occasion I thought I’d cover some of the comments that this post has gathered over the last few months.

Many of the comments are along the lines of “It worked for me” and “Try it yourself”.

To the first, I don’t really have much to say. I can’t peer inside the inner workings of your child and determine what is going on. But at the same time a bunch of individuals making claims of efficacy without adequate control for bias, natural history and various other contingencies is not a compelling argument to me. Plenty of others swear by practices that have no hope of working*, why should this one get more credibility based on personal experience?

As to the second, three words for you: Anecdote and Confirmation bias. I know enough to realise that I am not immune to the wiles of confirmation bias, which would make my trial just another anecdote – something I don’t accept from others so what would make my own experience any more valid? I also realise that for most people this sort of reasoning is at best foreign and at worst incomprehensible. The general thinking appears to go something like “If I try something and it seems to work, then it works – QED”.

No.

Related to this point are appeals to the “Placebo Effect”, the idea being that simply trying something helps, somehow. This may be true. But I’ll expand on the faulty reasoning behind this assertion.

The placebo effect as this seems now to be the “go-to” explanation for all things unexplained so it might be a good idea to dwell on this concept on it’s own for a bit. First off with regard to talking about the placebo effect, it depends on what you mean. The placebo effect started off being simply the improvement seen in the control group for clinical studies. It was the group that was given everything except the active treatment. Therefore by definition the placebo response is what happens when people aren’t treated. It was the catch all for everything that could affect the outcome that wasn’t due to the treatment itself: poor method design, confirmation bias, reporting bias, observer effect on the patients, regression to the mean, natural history of the disease, etc, etc.

Recently there has been some work done to see if there is a real change in people that is due to thinking they are getting an active treatment, the so called “Placebo response/effect”, this has been mixed. It is true that people will report less pain and their brain will show less activation in pain related areas. But people are susceptible to what they are told, it turns out if you tell people a cheap wine is expensive they will enjoy it more. Is there a placebo wine effect? possibly, but the wine didn’t change and neither did any underlying physiology in relation to placebo medical treatments.

In fact recent studies in asthma showed that while people reported feeling better while taking placebo their ability to perform on objective measures remained the same, while those on active medications improved. If you feel better while still having a life threatening condition are you better? I don’t think so.

So in appealing to the placebo effect you have to concede that 1. the beads don’t have any active ingredient, and 2. don’t make any difference to the underlying condition.
i.e. They do nothing.
Now notice in my original piece this is not what I say, I merely point out there is no good reason to think they are doing anything, not that they definitely aren’t. A subtle distinction I admit.

In essence the argument becomes: “If you think it works then it does”, well I would counter with why don’t you use something that we know does work and then you can capitalise on both effects: You will think it works and it will actually work too. Double goodness.

One poster asserted that amber necklaces were registered with the Therapeutic Goods Administration in Australia as a Medical Device. Arguing that this must mean they have therapeutic properties.

This one was my favourite as it was almost laughably easy to dismantle. After only a few minutes I found that this was completely untrue (you can search the TGA resister here). Not only that but there were suppliers admitting** that they couldn’t claim therapeutic benefits because they were not on the register:

“Amber Teething Necklace Information – TGA Australia

Due to regulations of the Therapeutic Goods ACT, policed by the Therapeutic Goods Administration (TGA), whose register does not recognise the claimed healing and theraputic[sic] properties of Amber we are unable to offer any detailed information on Amber Teething necklaces or Amber in general in a theraputic[sic] advisory capacity.

Therapeutic goods are defined in the Act to include goods that are represented in any way to be for therapeutic use. Therapeutic use is defined to include use in or in connection with influencing, inhibiting, or modifying a physiological process in persons.

In all amber related cases that we have seen, the TGA Panel note “that the advertisement appeared likely to breach section 42DL(1)(g) of the Act, which prohibits the publication of advertisements for therapeutic goods that are not included in the Register“” [Emphasis added]

A complaint was made against a supplier for making claims for the product and this was upheld in part because the necklaces are not on the register.

“The Panel noted, without making any formal finding, that the advertisement appeared likely to breach section 42DL(1)(g) of the Act, which prohibits the publication of advertisements for therapeutic goods that are not included in the Register.“

The website involved changed their wording to get around the regulations, spot the difference:

OLD: “natural pain relief provided by Amber works by placing the necklace on your body, this allows your skin to warm the amber beads, releasing healing oils which are then absorbed into the blood stream.“

NEW: “Amber is believed to soothe naturally, when Amber is worn next to the skin it is warm and it is reputed to release natural oils that can care for the skin.”

What a difference a few words make.

At the time the comment was made alleging the necklaces were on the register I suspected that intended therapeutic benefits would be enough to fulfil the therapeutic benefits category.

This is supported both in the declaration of the supplier above and from the wording from the complaint, just prior to the excerpt above it states:

“Therapeutic goods are defined in the Act to include goods that are represented in any way to be for therapeutic use. Therapeutic use is defined to include use in or in connection with influencing, inhibiting, or modifying a physiological process in persons.

In representing the advertised products to have an “active ingredient”, to release “healing oils which are then absorbed into the blood stream”, and to relieve teething in infants, the advertisement clearly constituted an advertisement for therapeutic goods.” [Emphasis added]

Lets say though that the product had been registered with the TGA or will sometime in the near future, I would note that unless the administration was in possession of studies that are not published elsewhere there is no way that they could be sure that an actual benefit is occurring. Bringing us right back where we are now.

As an extra note on the activities of the Australian government on this topic I found it amusing to see that the Australian Competition and Consumer Commission issued a safety warning about Amber teething beads end of September last year (see here and here and here).

I say amusing because, while it’s not impossible, I do find it unlikely that one branch of the government is condoning their use while another warns against them. Luckily this is not actually the case.

Finally, this post is not intended to address every conceivable objection to my arguments, merely a survey of what has been proffered so far. I am not really convinced by anything I have yet seen but I remain open to changing my mind so long as the evidence is of good quality. It doesn’t have to be much, a good start would be something that suggests succinic acid has the analgesic properties attributed to it. Then we could address whether succinic acid is released from the beads at ambient/skin temperature. Finally we would need to tackle whether the succinic acid is absorbed topically in any significant dose (decent dose response curves could be obtained at stage one of this theoretical research programme).

All three of these items would need to be looked at in order to state that amber beads have good plausibility for what they are marketed for.

[Update 29/4/13: Apparently there is a chain email circulating blaming amber beads for a case of SIDS. This seemed implausible to me and a very brief check seems to back up my gut feeling. There is no reason to think that amber beads contribute to SIDS at all. For a more thorough break-down go here: http://www.hoax-slayer.com/amber-teething-necklace-sids.shtml . I am not one who feels we need to latch onto any reason to vilify our intellectual opponents and spreading misinformation (especially easily debunked misinformation) is a big no-no in my book.]

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*Not that I think this product has “no hope” of working, it could as far as I know. We just can’t make that determination on the basis of anecdote and there are no trials that I’m aware of.

** Argh, this site seems to have removed any trace of of this page. Should have archived it. It has essentially been replaced with this (archive):

In keeping with Australian Fair Trading guidelines no therapeutic claims are made and no medical advice is offered. The material provided on allaboutamber.com.au is for information and educational purposes only and is not a substitute for medical treatment or diagnosis. We assume no responsibility for treatment or cure of any illness or disease. If you have a health problem we recommend seeking medical advice from your qualified natural/health professional. This information is strictly a source of general information and is not intended for use as a tool for self-diagnosis. All About Amber provides this information for you to make your own decisions, if you want to use them on your own family, we believe they work for us and please read the reviews to gather many other peoples opinions.

Which seems to me to be saying “We can’t claim the beads have any healing powers directly, but they really do.”

They haven’t yet learned this lesson for Hazelwood jewellery (archive)though:

How does hazelwood jewellery work?

Hazelwood products are believed to help to create an alkaline environment in your body, which may help, precent[sic] and appease many of the symptoms caused by being to acidic. Hazelwood, being an alkaline wood, has the natural property of absorbing and neutralizing the body’s acidity through contact with the skin. By doing so, the necklaces can also help with digestion, constipation, eczema, migraines, acid reflux, heart burn, nausea, arthritis, skin problems, etc. If you suffer from one of these issues, it is highly probable that you are suffering from an acidity imbalance, and hazelwood may be able to help you alleviate these symptoms in a natural way. Most people who suffer from an unbalanced pH are unbalanced towards the acidic. This condition forces the body to borrow minerals—including calcium, sodium, potassium and magnesium—from vital organs and bones to buffer (neutralize) the acid and safely remove it from the body.

Hhhhm, perhaps another post is in order. And a complaint.

As a brief aside, as it seems there are quite a few parents out there hungry for this information if you know of a good parenting or early childhood publication that would be willing to print the original article (probably in an altered form) then let me know.

And I’ll stop there before the footnotes become longer than the post.

Placebo Again. (sciencebasedmedicine.org)
Amber Teething Beads: A Few Points to Consider (scepticon.wordpress.com)
“I Was A Skeptic, but…” (scepticon.wordpress.com)
Why Do People Use Alternative Medicine? (scepticon.wordpress.com)

2012: 04/02
CATEGORY: Alternative medicine
Medicine
Questionable Techniques
Sciblogs
Science
skepticism
46 comments

Why Do People Use Alternative Medicine?

I often read that the reason people are turning to complementary/alternative/integrative(take your pick) medicine is because they are dissatisfied with the care received from mainstream/conventional/”western”* medicine. This may be true for a small segment of the population, those with a chronic illness or with terminal cancer spring to mind. But is this generally true of altmed users? Those who pick up a bottle of homeopathic remedy from the pharmacy or occasionally visit a naturopath?

I don’t think it’s quite as simple as that. A study “Why Patients Use Alternative Medicine” published in 1998 in the JAMA looked at this question using a survey sent to randomly selected participants. 1500 participants were sent the survey and 1035 completed it. Not too bad for a survey response rate.

The survey was geared to look at the use of altmed based on three paradigms:

“1. Dissatisfaction: Patients are dissatisfied with conventional treatment because it has been ineffective,5-6 has produced adverse effects, or is seen as impersonal, too technologically oriented, and/or too costly.

2. Need for personal control: Patients seek alternative therapies because they see them as less authoritarian16 and more empowering and as offering them more personal autonomy and control over their health care decisions.

3. Philosophical congruence: Alternative therapies are attractive because they are seen as more compatible with patients’ values, worldview, spiritual/religious philosophy, or beliefs regarding the nature and meaning of health and illness.”

According to the survey results satisfaction, or lack thereof, with conventional medicine did not correlate well with altmed use. 54% of respondents reported being “highly satisfied” with conventional medicine providers, of these 39% use alternative therapies. Of those who were highly dissatisfied (40%) only 9% were users of altmed.

It seemed as if those who were fans of medicine overall were more likely to participate in both camps. A sort of “the more the merrier” approach to health care.

What was predictive of alternative medicine use was personal philosophy. Those who considered there to be a strong mind/body/spirit connection as well as those who had had a “transformational experience” were more likely to use alt med than those who did not.

Education and health status also correlated with altmed use. Those with higher educations were more likely to use it, as were those who described themselves as having a lower health status.

The situation was slightly different for those who shunned conventional medicine altogether in order to embrace altmed. These folks tended to be distrustful of and dissatisfied with conventional practitioners, as well they desired a high degree of control over their health and believed in the importance and value of “inner experiences”.

This proportion of the population was quite small however – only 4.4% of the survey respondents fell into this group. Even so somehow the reasons for this group’s embrace of altmed has been generalised to the wider population.

The observation that users of altmed tend to be greater consumers of health services overall is also supported by the paper “Association Between Use of Unconventional Therapies and Conventional Medical Services“. This survey had a base of 16,068 individuals from which to pull data representing a 77% response rate from the 24,676 pool that was originally sampled.

According to this survey only 6.5% of the population use both altmed and conventional medicine** (and 1.8% using only altmed), with this group making more visits to their physician than those who used conventional medicine only. One possible reason for this is the so-called “worried well”, a portion of the population that focuses on their health to a degree higher than would be expected given their health status. Support for this is given within the paper:

“Compared with those with only conventional visits, those who used both types of care had significantly more outpatient physician visits (7.9 vs 5.4; P<.001), and used more of all types of preventive services except mammography. These groups did not differ significantly in inpatient care, prescription drug use, or number of emergency department visits.”

This on it’s own does not show a “worried well” connection but in the comments section of the paper it was noted:

“…there was no difference in any of the 4 self-reported health measures between respondents who had physician visits only, and those who had those visits in conjunction with unconventional therapy. Poor health status appeared to drive use of health services in general, that is, those using no services reported better health than those using either conventional medical services or unconventional therapies. However, poor health was not associated with increased use of unconventional therapies over and above conventional medical care.” [emphasis added]

So it would seem, at least in this sample, that dissatisfaction with conventional care cannot be the driving force for the majority of altmed users. More plausible is that altmed users seek to make the most of every perceived avenue for health.

Another survey published in 2001 also supported the general conclusion that dissatisfaction with conventional medicine does not lead to altmed use for most consumers. “Perceptions about Complementary Therapies Relative to Conventional Therapies among Adults Who Use Both: Results from a National Survey” surveyed 831 respondents who used both regular and alternative medicine.

Of these 70% would visit a conventional medicine practitioner as their first port of call. Only 15% went to a altmed provider first. There was also no significant difference in the level of confidence in altmed providers and regular medical professionals.

To quote the conclusion:

“National survey data do not support the view that use of CAM therapy in the United States primarily reflects dissatisfaction with conventional care.”

From a paper presented at the Proceedings of the 1997 Conference of
the Australian Association for Social Research and published in the Journal of Sociology; “Postmodern values, dissatisfaction with conventional medicine and popularity of alternative therapies“[PDF File download]:

“Those individuals who value natural remedies, are against chemical drugs, do not favour technological progress, and welcome variety in choice of therapy are more likely to have a positive attitude towards alternative medicine.”

These attitudes were enveloped under the “postmodern” rubric and were found to be a better predictor of altmed use than satisfaction levels with regard the conventional medicine.

To elaborate on that point, a further finding was that dissatisfaction with interactions with physicians rather than health outcomes was associated altmed use. This is a subtle point and worth dwelling on as it seems to be a valid criticism of the way in which conventional medicine is practised. It was not that altmed users were unhappy with the actual results of the care received via conventional medicines but the way in which they feel they are treated by doctors.

It seems that those turning to altmed may feel that conventional doctors do not give enough respect, time, don’t listen and are too authoritative. I don’t want to put too much emphasis on this perspective as it isn’t entirely consistent with the picture built up so far and the sample size of this survey was relatively small compared with the ones above (only 209 respondents), but it is worth considering.

In conclusion, while it might be true that some dissatisfaction does lead to an increase in the use of alternative medicine it seems unlikely to me that this is the main reason. I’m not sure why it has become the go-to reason trotted out by participants on both sides of the debate, ease I suppose. I could of course be wrong, perhaps there is a mountain of research out there that I’ve missed pointing in the complete opposite direction. I’m willing to grant that possibility, in the absence of such though I’ll have to go with personal philosophy being the largest contributing reason people use altmed.

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*I hate with a passion the label “Western Medicine”, what? – people from other cultures can’t use science? Nonsense.

** I suspect that the wildly differing definitions of what constitutes “Alternative” medicine are to be blamed for the fluctuating figures around the proportion of users.
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Astin, J. (1998). Why Patients Use Alternative Medicine: Results of a National Study JAMA: The Journal of the American Medical Association, 279 (19), 1548-1553 DOI: 10.1001/jama.279.19.1548

Eisenberg DM, Kessler RC, Van Rompay MI, Kaptchuk TJ, Wilkey SA, Appel S, & Davis RB (2001). Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Annals of internal medicine, 135 (5), 344-51 PMID: 11529698

Druss, B. (1999). Association Between Use of Unconventional Therapies and Conventional Medical Services JAMA: The Journal of the American Medical Association, 282 (7), 651-656 DOI: 10.1001/jama.282.7.651

Siahpush, M. (1998). Postmodern values, dissatisfaction with conventional medicine and popularity of alternative therapies Journal of Sociology, 34 (1), 58-70 DOI: 10.1177/144078339803400106

Aditional reading:

Joy, J.M. (2004). Complementary and Alternative Medicine (CAM): Do Barriers to and Dissatisfaction with Traditional Care Affect CAM Utilization Patterns, Masters Thesis, Texas Tech University Health Sciences Center

Chiropractic for the 21st Century (scepticon.wordpress.com)
First, Do No Harm (scepticon.wordpress.com)
The Freedom of Ignorance: Health Freedom, What is it and Do We Want it? (scepticon.wordpress.com)
Thai Yoga Massage: Herald, Wherefore Art Thou Sense? (scepticon.wordpress.com)
Breaking News!: Have Constipation? Moxibustion Won’t Help! (scepticon.wordpress.com)

2012: 03/26
CATEGORY: Alternative medicine
Medicine
Psychological
Sciblogs
Science
4 comments

First, Do No Harm

Primum non nocere

A while ago I was accused of advocating that doctors should break the Hippocratic oath. That the cardinal rule of “First, do no harm” should be ignored. Setting aside that this phrase does not appear in the Hippocratic oath, what do we mean by harm in the context of medicine?

I was reminded of this by a post on Science Based Medicine by David Gorski in which he muses over the measure of patient satisfaction as a proxy for how well hospitals meet their obligations with regard to patient care. To kick it off the good doctor notes that many interventions used by modern medicine cause harm, often direct harm.

Does this mean that doctors are throwing out their obligation not to harm patients? No, because we recognise that the concept of harm in this case includes those harms that would occur were we to withhold treatment as well as recognising that the total harm is reliant on the amount of benefit obtained by the patient.

The accusation against me was in the context of my arguing against the claims of anti-vaccinationists that vaccines do more harm than good. I don’t want to rehash that argument here but I do want to dwell a bit on our concept of harm and how it applies in the medical arena.

One of the themes that return to over and over again on this blog is that of risk vs benefit. The amount of harm or risk can only be appropriately assessed in light of the benefit accrued. As pointed out by doctor Gorski there are many procedures that hurt, they hurt a lot. Should a doctor refuse to perform them then? Even if they could save a patient’s life?

Of course not.

It is plainly ridiculous to assert that short term harm out weighs long term benefit, it might but that calculation has to be made in each case. In many cases the benefit will be clear, in others less so. If a patient undergoes a painful procedure that is relatively short lived and then makes a full recovery then the choice is fairly simple. If the recovery is likely to be only partial and the patient’s quality of life is ever after severely reduced then we may weigh up the benefits of that treatment differently.

What then of treatments that are good for most but may harm a few? These are the tricky cases and it depends on a few variables. One is can we identify the persons that will be harmed, second, how much harm are they likely to suffer and what percentage of the treatment population do they make up? Finally what total benefit will accrue to the population if treatment is green lit?

I listed these variables in the order of importance I estimate they have. If we can identify prospectively harmed persons then they may be removed from the treatment group, harm avoided. If this information is unavailable then we may move to the next criterion: how much harm will they suffer? If this is likely to be relatively mild then all to the good. If the harm is considerably more serious then we may stop the treatment altogether in order to avoid these instances. The last two variables may switch in order depending on the situation or individual values.

Should a vital treatment be withheld from the general population if a very small percentage with be greatly harmed by it? Frankly I don’t know. Help – is there a Medical Ethicist in the house?

Often I’ll find that the people who oppose modern medicine will emphasise the risks of medicine while over-hyping the benefits of alternative medicine. The claims that iatrogenic (caused by medical treatment) harms are enormous abound. This point of view seems completely ignore the benefits received by individuals and society by medicine in it’s current form*.

This seems perverse to me, the idea appears to be that any risk is unacceptable – a completely untenable position to my mind – every action carries risk. I take my life in my hands every time I drive to work, but the risks a relatively low and the benefits are more important to me – and the majority of other drivers I suspect. To argue that we should abstain from automotive transport until it is completely safe misses the point entirely. As does decrying the risks of the majority of medical science in the face of the undoubted benefit received.

To conclude this ramble, harm or risk is part of the human condition. Arguably the complete removal of risk is not only impossible but not even desirable**. We have to live with risk and harm, the key is to ensure we balance these against the good that comes from acting in the world to oppose even greater harms.

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*This is quite an extreme view and I would hasten to add that I don’t think the majority of alternative medicine users (however you may break that group down) would subscribe to it, but it exists.

** Depending on how this might be achieved. Possibly we could make ourselves impervious to harm rather than removing everything that might harm us.

Keeping the customer satisfied (sciencebasedmedicine.org)
What’s The Harm (scepticon.wordpress.com)
The Freedom of Ignorance: Health Freedom, What is it and Do We Want It? (scepticon.wordpress.com)
The Legitimate Risks of Vaccines (scepticon.wordpress.com)
Anti Vaccination in NZ (scepticon.wordpress.com)
Defending the Term “Anti-Vaccine” (scepticon.wordpress.com)

2012: 03/21
CATEGORY: Alternative medicine
Medicine
Psychological
Sciblogs
skepticism
1 comment

The Freedom of Ignorance: Health Freedom, What is it and Do We Want it?

When policy around how herbal remedies, alternative medicines, supplements and all sorts of other practices outside the mainstream of medical practice is discussed the concept of “Health Freedom” inevitably comes up. It’s not always couched in that term but the idea is that people should be free to choose whatever method of healthcare that they wish.

Sounds good right? Who wants to impinge in someone’s freedom to make their own decisions? Isn’t that what living in a free country is all about? Personal autonomy, the right to take action unfettered by how someone else thinks I should run my life. That’s how I want to live, why should I want to take that away from others?

Well, I don’t. But the notion of freedom has always come with a caveat (several actually), that is – it is inherently restricted by ignorance. Is someone who is uninformed about the actual state of affairs truly free?

That’s what those who speak out about alternative medicine are actually trying to achieve. We aren’t attempting to “defend our turf” or “squelch the competition” we are attempting to inform the public about the true underpinnings of these therapies and point out they they are either unsupported by science or have in fact been disproved.

As has been noted before, a majority of New Zealanders are unaware that Homeopathic medicines do not contain any active ingredient and yet many people think they are scientifically proven.

Education was also the intent of the co-ordinated Sciblogs rebuttal to the poorly conceived and executed series on alternative therapies printed by the Herald earlier this year. (see here, here, here and here)

Policies that are aimed at restricting access to herbal or alternative medicine usually are doing so from the aspect of quality control. Does the remedy or practice have good evidence of efficacy, is it safe? These are the questions that we should be asking about every medical practice, not just those in the “alternative” (or complementary, or integrative, pick your marketing phrase of choice) camp.

Unfortunately is is not in the interests of those pushing alternative modalities to undergo strict evidence based testing so the issue is re-packaged from a quality control issue to a “freedom” issue.

Similar tactics are seen in arenas outside the medical realm. In biology the evolution vs creationism/intelligent design “debate” is framed as “Academic Freedom” as is the debate around climate change. This is not a coincidence. Whether or not these decisions are made consciously or not there has been convergence on the “Freedom” aspect of these cases for a reason, people respond to it. We are jealous of our freedom, and rightly so, freedom forms the basis of our society.

But as I alluded above, freedom is not an absolute and unalloyed good under all circumstances. It comes up against restrictions in all sorts of ways, some epistemological (as in the case of whether a choice is really free if the person is not aware of all the factors affecting that choice) and some are practical (as in should we allow freedom to include the freedom to sell harmful products?).

Conclusion

The natural/alternative remedies debate is not, at it’s heart, about freedom at all. Rather it is about education and quality control. We should subject all medical practices to the same rigorous examination regarding safety and efficacy. Long term “after market” monitoring should also factor into this equation to catch those practices that looked good in the necessarily limited testing that they are subjected to prior to being rolled out to the general public but may still have safety problems.

In this way we should be able to serve the public’s health interests and avoid false choices about freedom.

2012: 02/16
CATEGORY: Alternative medicine
Medicine
Sciblogs
Science
skepticism
7 comments

Chiropractic for the 21st Century

Every week I get a number of email alerts about various online medical journals. Each email represents the opportunity for blogging material though many are deathly dull.

Several of the journals I receive alerts from are in the AltMed domain and I sometimes wonder why I bother looking through them at all. The mix is usually some proportion of “Survey of x population using y alternative modality” often merely chronicling the depressing rise of AltMed/CAM in general use (either actual or claimed depending on your definition of CAM).

The rest are often boringly conventional in their attempt to be scientific having titles like “Effects of vitamin E suplementation on renal non-enzymatic antioxidants in young rats submitted to exhaustive exercise stress“. These I don’t bother with. I just don’t have the expertise to parse them with any reliability.

Then there are the odd gems, either for comedic value or because they offer an alternative perspective on alternative medicine.

Recently one of the later came down the intertubes and into my in-box. Published in BioMed Central’s journal “Chiropractic & Manual Therapies”, the article is entitled “The Five Eras of Chiropractic & the future of chiropractic as seen through the eyes of a participant observer”.

The paper starts with a potted history of Chiropractic and the environment that it was founded and grew up in to the present. The early days could be seen as Chiropractic’s first opportunity to start down the science based path. In 1910 the “Flexner Report” on medical education was published and with it’s acceptance by the medical educational community came legitimation to those who abided by it’s recommendations. As well as:

“…generous funding via the Rockefeller Foundation while schools that did not assent, simply ceased operation due to lack of funding. The result was that, by 1930, only 76 of the 168 medical schools remained.“

The impact on Chiropractic is characterised thusly:

“In part because of the rejection of science by a significant element within the chiropractic profession, and in part because the Flexner Report dismissed the chiropractors as “unconscionable quacks who should be dealt with by the public prosecutor and the grand jury”, the chiropractic profession bypassed the era of educational reform.“

The early twentieth century therefore saw a great deal of animosity towards the nascent Chiropractic practice and the emerging scientific medicine of the time. Indeed the author argues that this conflict essentially shaped Chiropractic as we know it today. In order to defend Chiropractic from the legal attacks being made on it it was necessary to develop a definition of Chiropractic that would insulate it from charges of practising medicine without a licence, charges that were common against Chiropractors of the time.

This is related as involving four simple concepts:

“1. Chiropractic is not medicine; chiropractic has a “separate and distinct philosophy and practice”.
2. Chiropractors do not diagnose, but analyze the spine for the cause of dis-ease.
3. Chiropractors do not “treat,” but adjust the spine for the cause of dis-ease.
4. The Chiropractic profession has been built upon success in cases where medical doctors failed.“

Putting aside the obvious sophistry in these concepts (how might we define the difference between diagnosis and “analyz[ing] … for the cause of dis-ease” or between treatment and “adjust[ing] the spine for the cause of dis-ease“?) it is argued then that the very fact of opposition by the medical establishment helped to solidify the tenets and practice of Chiropractic:

“During this journey, the chiropractic community developed and embraced a distinct lexicon and rationale toward health and its maintenance in order to emphasise the difference between medicine and chiropractic. Thus the “philosophy of chiropractic” became “an unyielding dogma”.“

With this legal history at it’s back Chiropractic moved into the next period of it’s history where it was the focus of a co-ordinated and sustained attack by the medical establishment in the form of the AMA.

Carrying out the opposition to Chiropractic was the “Committee on Quackery”:

“The Committee on Quackery was well funded, and operated a highly successful campaign that was centred on three main strategies:
1. An ethics based boycott, which deemed it unethical for AMA members to have professional dealings with chiropractors;
2. Convincing other organizations to adopt or adapt the AMA’s anti-chiropractic policy; and
3. Instituting a comprehensive political campaign to thwart chiropractic progress on several fronts, including but not limited to education, research and insurance funding.“

This campaign was put to an end in 1987 thanks to a permanent injunction ordered against the AMA, after a lawsuit was levelled against it by a number of Chiropractors. At this point it’s difficult not to see the Chiropractic as a beleaguered philosophy deserving of empathy on behalf of it’s persecuted adherents.

Emerging from this legal victory Chiropractic has been slowly edging it’s way into mainstream acceptance with the development of Chiropractic based courses in universities and a surge in chiropractic research. Unfortunately the steadfast refusal of many Chiropractors to relinquish the unscientific concepts of old has meant that as a profession they are still looked upon with disdain:

“Chiropractic’s problem is that subluxation based chiropractors are not only deluding themselves, they are indoctrinating patients into believing in a purportedly dangerous mythical entity, and that without regular adjustments, patients will not only fail to reach their full potential, they will likely suffer serious health problems.

Some authors have suggested that this may be a threat to public health . And this, at a time when the profession has just entered The Era of Chiropractic Opportunity.”

The opportunity discussed is that of the ever growing need for specialists in musculoskeletal care. As the worlds population ages the demand for providers who are proficient in the treatment of pack pain/musculoskeletal disorders will only increase.

It is into this world that the Chiropractic profession must be re-born as the evidence based providers of musculoskeletal care that are needed. The problem is that if Chiropractic insists on holding onto the non-scientific notions of DD Palmer then it voluntarily relegates itself to the back waters of medical practice.

This then is the proper focus of the article: where Chiropractic will go from here.

Least attractive to the author is the prospect that the practice will stay on it’s current trajectory, keeping the outdated concepts that it was founded upon and denying the very science that would confer upon them the legitimacy they crave.

Two options are given as alternatives to this “Status Quo” approach: one is to definitively split the profession into those that follow the traditional method of chiropractic practice, so-called “Straight Chiropractic”, and those who are willing to discard tradition and step into the light of science and evidence based practice.

The second and preferred option is to move forward with a united front, ditching along the way those parts of Chiropractic that are unsound and unproven. This is also recognised as the most difficult route for the profession, requiring near superhuman commitment from the individuals and organisations that make up the world’s Chiropractic profession:

“Escaping from the dogma house will require extraordinary cooperation amongst all aspects of the profession. Organizations such as the World Federation of Chiropractic and all major chiropractic associations will need to agree upon and adopt a position statement identifying the chiropractic subluxation as an historical construct that remains a hypothesis, which cannot form the basis for patient care until and unless there is a body of scientific evidence to support it.“

“If the profession is to gain the trust of the consuming public it must, of necessity, become truly self-policing.

Only in this way will chiropractic generate the cultural authority required for recognition as a group worthy of the title “Profession”.

No longer can we cast a blind eye. By our silence we are giving consent.“

Should Chiropractic refuse to move properly into the 21st Century then the consequences for it as a whole may be dire, leaving it’s future as a force in medical practice in doubt.

“The chiropractic profession can choose to be illiterate, but it will do so at its peril. It is realized that thinking is hard and that those who are unaccustomed to thinking may even find it unpleasant. On the other hand, thinkers have always found it rather fun and there are no confirmed reports of anyone dying or being seriously injured by thinking. Thinking may necessitate changing our minds – which may not be a bad thing. At the very least the profession owes it to its patients.“

Subluxation Theory: A Belief System That Continues to Define the Practice of Chiropractic (sciencebasedmedicine.org)

2012: 01/24
CATEGORY: Alternative medicine
Medicine
Sciblogs
Science
skepticism
3 comments

Thai Yoga Massage: Herald, Wherefore Art Thou Sense?

So here I am, again latching onto the brilliance of others and writing my own counterpoint to the nonsense that is currently being run in the NZ Herald under the “Alternative Therapies” summer fluff.

Previously Alison kicked us off by looking at the use of medicinal leeches, as did Siouxsie, and Michael took on Ayurvedic Medicine.

The latest round concerns something called Thai Yoga Massage or Nuad (Nuat) Boran. Essentially the practice consists of the massaged party adopting a series of yoga positions while the massager applies pressure to the body’s “Sen” lines. Those familiar with acupuncture’s “Meridians” can replace Miridian with Sen and get the general idea.

From an article describing the practice:

“The theoretical basis for traditional Thai healing is rooted in the belief that all forms of life are sustained by a vital force (lom) that is carried along invisible energy pathways (sen) running through our bodies. This energy force is extracted from air, water, and food, and it is believed that disease and dysfunction come about when energy becomes blocked along these pathways. Accordingly, Thai massage’s intent is to free this trapped energy, stimulate the natural flow of life force, and maintain a general balance of wellness.”

Thus Nuad Boran is a system of energy medicine based on pre-scientific notions of “Vital Force” or “Life Energy”, blockages in which are the cause of disease (though exactly what disease seems to be harder to pin down). It is also claimed to be based partly on Ayurvedic medicine.

So what exactly does this “Alternative Therapy” treat? From the same article quoted above:

“The result of a full-body Thai session is often an exciting and powerful mind/body experience, bringing both the recipient and the practitioner to greater states of physical and mental well-being.”

But that’s kind of vague, what else?

Like many alternative treatments and especially the ones covered by the Herald this week the actual claims for Thai Massage seem to centre around improved blood flow. At least that’s the impression I got from looking at the listed clinical research on this page.

But apparently in the medical literature Thai Massage is mainly focused on pain relief, though there is this one hopeful study trying to use it as a treatment for Autism (the current trendy target for alternative therapies where nothing is too insane to try including chemical castration). Though a brief look at the abstract implies to me that they took one implausible treatment added a second implausible treatment and decided that Implausible² = Success.

Pain is a good candidate for effective use of Thai Massage; the end point is subjective and massage involves close contact which humans generally find inherently soothing. Hopefully any successes in the pain arena will not be parlayed into evidence that the treatment “works” for any other condition.

The main issue I have with all the literature I’ve been able to dig up so far is that only Thai Massage was included in the studys. The specific reason for using Thai Massage (at least traditionally) is the claims regarding redirecting and unblocking life energy. Remove that unscientific aspect and why wouldn’t any massage work just as well?

I’m perfectly sanguine about the possibility that Thai Massage may be beneficial for perception of pain and reliving stress for the reasons given above. Should we be saddled with the extra hypothesis about life force, with the implication that there is something mystical and magical going on; giving the added justification that the therapy could be of use beyond pain and stress (and whatever else massage is good for)?

I don’t think so.

As Michael pointed out in his post, even the Herald reporters aren’t approaching these “therapies” as medical treatments but more as a relaxing massage/spa session (except for the leeches, but perhaps there are those out there who would consider this relaxing).

Frankly, after the above it should be “’nuff said”. But how does the Herald approach this wellspring of traditional medical wisdom?

Well, possibly this article is the most honest so far, explicitly calling the technique a “relaxation therapy”. The life force concept is only briefly and obliquely referenced and the main emphasis is that this is simply a massage.

Even so, there are vague hints that the procedure is beneficial to your health is way that go beyond simple massage.

Passages like:

“…the yoga-like stretches help to stimulate and move air through the body.

“Every vital part of the human body, from the heart to the lungs, needs good air flow to function well, and Thai massage is aimed at stimulating these air vessels in the body,” said Nucharee Weerawan”

Do subtly imply that the massage will not only relax you but will help your body to “function well” whatever that might mean in this context. Which in turn may lead people to be more open to the idea that the massage could be used to treat more serious ailments. Or maybe the population will actually think things through for themselves and see through more extravagant claims.

I’m hoping for the later.

Though reading further into the description of the massage given, it doesn’t sound especially pleasant. Despite the attempt at a positive spin in the last line.

2012: 01/13
CATEGORY: Alternative medicine
Medicine
Questionable Techniques
Sciblogs
skepticism
5 comments

The Webwhisperer: A Medical Resource

I generally look with interest to see how people are getting to my blog. Often the referrer is Mr Google, the next culprit is usually Facebook, then there are pages where someone has posted a link to an article I written for others to check out. These are the most satisfying.

Sometimes it’s someone pointing out how stupid I am, many times I’m being used as a resource on some forum discussing AltMed. Today I found I was being linked to by a site called the Webwhisperer.

The Webwhisperer is a blog run by a UK doctor who is attempting to create a resource of reliable medical information, mainly for the doctor’s own family to access it seems but I think it has wider appeal and application.

Since the beginning of the year the Webwhisperer has been running a series on infant teething, the fifth and latest post is a link to my own article on Amber Teething Beads with a favourable intro. Ok, so I’m referred to as a mother but I’ll let that go (mainly because comments are disallowed and I can’t see any other way to contact the author. But also because I’m secure in my masculinity. Mostly).

Teething is something that can be quite distressing for new parents and is a topic that that every family member has an opinion on the best way to handle. A medical resource that gives factual information can be invaluable. So check it out.

There are many, many other topics covered on the site from allergies and alopecia to breast implants and pregnancy. I plan to browse it regularly. You should too.

2012: 01/12
CATEGORY: Medicine
Sciblogs
Science
Leave a comment

Breaking News!: Have Constipation? Moxibustion Won’t Help!

What’s Moxibustion, And why would you want to use it for constipation? The first I can answer, the second…not so much.

Moxibustion is the practice of burning ground up mugwort and applying the smouldering plant indirectly or directly to the skin to alleviate illness. In the indirect method acupuncture needles are inserted and the burning mugwort is used to heat either the skin or the needle. Direct methods are exactly what it sounds like, the mugwort is burned while sitting on the skin and your skin burns too. The amount of skin burning can vary – from minor to burns that will leave scars. On purpose.

Why would you want to subject yourself to this? Beats me.

But people do, and others study what it might be good for and publish papers about it. One of these turned up in my in-box this morning courtesy of BioMed Central Complementary and Alternative Medicine. With a title like “The effectiveness of moxibustion for the treatment of functional constipation: a randomized, sham-controlled, patient blinded, pilot clinical trial” how could I ignore it?

Reading the study I was transported to a place where the underlying physical process of disease matters not a whit and where the sweat, facial features, , body energy, duration of disease, and pulse type are methods of determining treatment. To be fair other measures were also used, including stomach pain, stuffiness and duration of disease.

No indication was given of how “body energy” was measured. Stuffiness was not defined – I’m sure these are standard things that every doctor knows about.

Frankly, if you are using a magical treatment to unblock your magical life energy then this is the type of thing you should expect to be important.

The study itself was quite small, as the title suggests, only 25 participants. 12 in the treatment arm and 13 in the sham moxibustion arm. Now, how do you do sham moxibustion? Apparently, as it is the heat from burning the mugwart that is important, you just introduce an insulator to stop that heat reaching the patient.

Luckily the procedure used was the indirect acupuncture type, so those in the sham group didn’t wonder why no third degree burns where in evidence.

This approach leaves all the burny, smokey goodness of the mugwort though. Given the negative outcome of the study I suspected this would come up in the discussion. I was not disappointed.

We’ll get to that in a bit. First I want to cover how the patients were divided into “deficiency syndromes” and “excess syndromes”. Constipation in traditional Chinese and Korean medicine is apparently due to either a deficiency or excess of qi (chi), you know, the life energy. This is where checking out people’s faces and sweating etc comes in.

I’ll quote directly from the paper at this point:

“A patient with a deficiency syndrome has sunken, weak pulse, whereas a patient with an excess syndrome has superficial and broad pulse. The patients having symptoms such as a pale face, heavy sweat, and depression were considered to have a deficiency syndrome; the patients having symptoms such as a swollen face, little sweat, and chest pressure were considered to have an excess syndrome. Syndrome pattern differentiation was conducted by an OMD before randomization.”

Further on:

“Five participants were diagnosed with an excess syndrome, and twenty-one participants were diagnosed with a deficiency syndrome. In this study, the most prevalent symptoms for an excess syndrome were a strong body energy and superficial pulse; for a deficiency syndrome the symptoms were a long duration of disease and weak body energy.”

Given that “body energy” plays such a part in dividing the patients I was hoping at this point it would be defined and a method to assess it given. Alas, I was out of luck. Obviously it’s too basic to explain here.

To the results!

I already gave the game away: moxibustion was no different than sham moxibustion when it comes to improving symptoms of constipation. To their credit the authors admitted this could be because moxibustion is, in fact, ineffective. But then, maybe they chose the wrong acupuncture points (never mind that large well designed studies show that where you stick the needles has no effect on outcomes). Or perhaps the sample size was too small – I’ll give them this one, though if there was a significant effect then even a small sample should have shown it.

Then the inevitable, perhaps the sham moxibustion was effective after all. Because, you know, the smoke and stuff. And, oh yeah, the patients actually had “excess-cold” syndromes when normally you’d expect excesses to be warm – so maybe that has something to do with it…

Can you say “rationalising”?

The authors also note that while a number of adverse events have been reported for moxibustion, the patients in this group only experienced redness. Another quote:

“Previously reported adverse events related to moxibustion treatment include burns [no kidding, I thought that was a feature - not a bug], an itching sensation, infection, allergy and xerophthalmia [dry eyeballs]“

Dry eyeballs…. hmmm, better than a punctured lung.

The paper concludes with the obligatory call for larger more rigorous studies, despite the fact that this is an implausible treatment based on magical thinking. Oh well, such is the way of things nowadays.
———————————————-
Park JE, Sul JU, Kang K, Shin BC, Hong KE, & Choi SM (2011). The effectiveness of moxibustion for the treatment of functional constipation: a randomized, sham-controlled, patient blinded, pilot clinical trial. BMC complementary and alternative medicine, 11 (1) PMID: 22132755

2011: 12/06
CATEGORY: Alternative medicine
Medicine
Sciblogs
Science
skepticism
2 comments

Get Your Up-To-Date Vaccine News

Thanks to my recent single-minded posting I’ve stumbled across this resource that pulls together news and blog posts on vaccines and anti-vaccine topics.

It uses a cool functionality of Scoop.it to collect posts which are then “curated” by a real person (hate those obviously fully automated ones that often ping my posts).

Vaxfax monitor is a Scoop.it site, which means the curator specifies keywords and the software trawls Twitter, Google, Digg and Youtube to generate content that matches the keywords. Once this is done the output is offered to the curator to vet. The posts that are retained through this process are published to the main site while those that don’t make the cut are discarded.

The curator of this feed is a poster who goes by the handle anarchic_teapot. Regarding anarchic’s chosen Nym I took this from the about page:

“My handle was chosen entirely at random, so don’t read anything political, social or ironic into it. I have no connection with the Anarchist Teapot Collective, or the coder using the handle anarchic.teapot (with a period, not a hyphen). I’m pretty certain I used the name first, though.”

I contacted anarchic_teapot to get a bit more information about the process involved in putting this feed together and to get a feel about the person behind the page and for why this resource is important.

[Scepticon] Where abouts in the world are you based?

[anarchic_teapot] I live in France, surrounded by sunshine, wine and cheese. And lots of other stuff that’s bad for my diet.

[Scepticon] The agregator uses keywords to collect content, is there any way to get random stuff you’ve noticed into it?

[anarchic_teapot] It’s also possible to scoop stories directly off the Internet, using a browser widget. In fact, the 3 main aggregators I use: paper.li, scoop.it and newsvine now all offer this service.

[Scepticon] What’s the difference between those services?

[anarchic_teapot] Scoop.it will publish each article immediately it’s validated. You choose any tags and which sites you’re going to publish to. It’s useful for getting breaking news out the door, but does require a lot of time curating. Another drawback is that it can mean a lot of tweets going out, and I don’t like flooding the intertubes, out of respect for my long-suffering readers. I want to keep them!

Paper.li does quite a good job of finding keywords, and you can pick the regularity at which it’s updated. At most, you’ll have two tweets a day.
The (big) disadvantage is that you can’t remove unwanted content until after an update.

Newsvine doesn’t send out tweets, although I suppose it would be easy to send your personal RSS feed through a service like Twitterfeed for that. On the other hand, it does allow comments, so you can get a discussion going. You can also write quite a lengthy post about the article you’ve seeded, as they call it. However, you have to go find your content for yourself; it won’t go looking for you. Although you *will* be warned if Newsvine thinks someone has already seeded the same story.

[Scepticon] Once the stories are gathered what happens?

[anarchic_teapot] Every time I check the feed, I have up to 100 stories that I can either discard, block the source (porn sites, bots, or other minor noise) or decide to publish. I try to keep Scoops recent (past 2-3 days) and from reliable sources. I also try to keep repetition down.

[Scepticon] Why did you feel the need to create such a resource, what do you see as the goal of aggregating all this stuff in one place?

[anarchic_teapot] I suppose the need comes from not having enough time to check major news sources regularly, and nobody to do it for me. I’ve always been one to let the computers do the spadework. Putting it all in one place gives me the chance to spend more time sifting through the dross. There is a lot of dross. I have some absolute doozies lined up for future blogging.

At the same time, to see so much quackery being sold so hard scares me.
It keeps me motivated, and I understand why others are so implicated in the struggle for science too.

[Scepticon] What is the criteria for inclusion, do you simply include those things you already agree with?

[anarchic_teapot] Well, it’s all a bit subjective, as things have to be when you’re playing editor (I hate the word curator, that’s for museums) to any sort of publication. As a rule of thumb, I try to keep to stuff that’s informative, not too technical – I’m not the health professional in the family – and of immediate use. I had to think about announcements of potential breakthroughs (HIV and malaria are currently doing the rounds) but decided it would be quite enough to deal with currently available vaccines.

[Scepticon] What is the main focus, news stories that demonstrate harm of anti-vaccine views or information about vaccines themselves?

[anarchic_teapot] Both, really. For reasons of space, I try to avoid localised reports, unless the story is of wider relevance (e.g. a clinic offering free shots probably won’t make it, but an outbreak of mumps may). I occasionally throw in some of the nastier antivax stuff, well flagged as such, in the hope that someone better qualified than me will pick it up and pillory them.

The teapot also admitted to using the generated content prior to publishing as a means of keeping an eye on the shall-we-say “less reasoned” content out there. I believe the term used was “Stupidity detector”, turning these gems into the bases of blog posts.

One of the things that I am grateful the anarchic for is the attempt to keep the feed from turning into an agglomeration of random crap.As noted earlier, I often get pingbacks from sites that have linked to my posts (and sometimes published portions of them) that when I check are simply grabbing everything with a keyword with in filtering, even to the point that the main purpose of a page is 180^o opposed to what I’ve written but presents my content as if it’s in line with the site’s philosophies.

According to the teapot:

“The nice thing about Scoop.it is that you don’t *have* to publish anything.”

Ah, how refreshing.

Vaccines and Autism – Media Report Card Expanded (sciblogs.co.nz)
Anti-Vaccine Charities – Is there any Quality control on Charities? (sciblogs.co.nz)
IAS Complaint Part 1: Thimerosal in Your Vaccine? No. (sciblogs.co.nz)
IAS Complaint Part 2: Gardasil Horrors – Horrific Reasoning (sciblogs.co.nz)
IAS Complaint Part 3: Vaccine Ingredients: Not So Bad Really (sciblogs.co.nz)
IAS Complaint Part 4: Anti-Vaccine Impact in New zealand (sciblogs.co.nz)
Defending The Term “Anti-Vaccine” (sciblogs.co.nz)
The Legitimate Risks of Vaccines (sciblogs.co.nz)

2011: 10/19
CATEGORY: Medicine
Science
skepticism
Interviews
Sciblogs
1 comment

Anti-Vaccine Charities – Is there any Quality control on Charities?

I haven’t really been writing much lately, for this blog at least. Much that is due to simple procrastination but earlier this year my free time was spent doing something equally stimulating.

Back in July I submitted a complaint to the New Zealand Charities Commission, which they (allegedly) are currently investigating, about the Immunisation Awareness Society (IAS). This is a charitable organisation that disseminates anti-vaccine information, while at the same time denying that they are anti-vaccine.

Grant has recently done an excellent post on some of the nonsense put out by IAS representatives, go have a read if you’ve not seen it yet.

My complaint focuses on the fact that to be a registered charity an organisation must fulfil a charitable purpose (makes sense). The particular legislation outlines these purposes as:

“the relief of poverty, the advancement of education or religion, or any other matter beneficial to the community.”

In my complaint I detail how the advancement of education is not met by the IAS, that they are anti-vaccine and that they therefore do not constitute a benefit to the public. As they do not relieve poverty nor advance religion this effectively should remove them from the arena of “Charity”.

To answer the question posed in the title, theoretically – yes there is quality control over charities. Part of the mandate of the Charities Commission is to:

“promote public trust and confidence in the charitable sector”,

“monitor charitable entities and their activities to ensure that entities that are registered as charitable entities continue to be qualified for registration as charitable entities”

and

“inquire into charitable entities and into persons who have engaged in, or are engaging in, conduct that constitutes, or may constitute, a breach of this Act or serious wrongdoing in connection with a charitable entity”

In large part my compliant is based on this previous post about the IAS, cleaned of snark and updated with a few references. In addition I dismantle a few of the “Educational” posts on their website to show how the information they promote is factually incorrect and geared towards convincing parents not to vaccinate their children.

In particular I look at This post that attempts to link NZ vaccines with Thimerosal and thereby to Autism even though both links in this chain are fictitious. Next I go over This post which is a copy of a submission to an FDA committee by Roberta Boyce founder of the anti-Gardasil website truthaboutgardasil.org, predicably criticising the Gardasil vaccine for being some sort of secret plot to make people sick and sterile. Okay maybe you couldn’t have predicted that. Finally I take apart yet more claims about the “Toxic” ingredients of vaccines, similar to another of my previous posts. Then I cover potential and actual damage caused by anti-vaccine sentiment (like the Auckland Measles outbreak).

I have no doubt that the IAS will rail against this complaint claiming that I’m trying to suppress free speech (nothing of the kind, they can continue their activities without being a charity) or that I’m attempting to smear them (no need, their output speaks for itself) or that I’m a henchman for the Immunisation Advisory Centre (no affiliation, but if they want to throw some money my way…;-)).

I’m hopeful that this complaint will at least get the Charities Commission to pay attention to the IAS and it’s output. Like I said I’m not interested in shutting them down, upholding free speech means defending those you don’t agree with (or something, I’m hazy on the details. People tell me it’s good). The issue I have is that these guys are essentially receiving a government subsidy (in the form of tax exemptions) for spouting inaccuracies.

Finally I have to give enormous thanks to Simon Clendon who kicked me into action after my post on the IAS philosophies and took on the task of editing the brain dump that resulted. He also made a bridge to the nice people at the IMAC who provided some extra info (still no affiliation just a few emails).

For those who want more on how I deal with the IAS misinformation I will repackage the various sections of the complaint as follow-up posts (tagged “IAS complaint”). Plus, I went to all that work, might as well eh?

If you want to read the full complaint in all it’s damning detail and mind numbing depth you can find it in PDF form Here, I’ve also got a snappy snip url: http://snipurl.com/iascomplaint. Go on, you know you want to. Tell your friends.

There are also a few supporting documents at that address as well, just to make finding them easier. If this inspires you to make your own complaints then go for it, the more the merrier, probably. I’m sure you needn’t go to as much trouble as I did (though if you want to, it’s fun. Plus by now the IAS has continued to march ahead with new misinformation).

Why are Internet anti-vaccine messages dangerous (medicalxpress.com)
Vaccines and Autism – Media Report Card (scepticon.wordpress.com)

2011: 10/11
CATEGORY: Medicine
Questionable Techniques
Science
Psychological
skepticism
Sciblogs
7 comments

Are You Ready for the Faux-Zombie Apocalypse?

The title of this post is a somewhat obscure reference to an episode of the Nineties Sci-Fi show “Sliders“. The premise of the show was based on the Multiverse theory in physics, a favourite trope in science fiction.

In “Sliders” a small group of individuals are accidentally set adrift in the multiverse, travelling from Earth to Earth in the hopes of getting home again. The show gave a unique opportunity to explore interesting historical counter factual situations, you know, of the “What if Hitler won the war” variety.

This was handled a little unevenly throughout the 5 season run of the show and some episodes were definitely more plausible than others. One of the less plausible ones sprang to mind when I read this press release a couple of months ago*.

In this episode the intrepid inter-dimensional explorers find themselves on a world where a fat-loss pill turns it’s users into mindless fat craving monsters – coincidentally resembling movie zombies. Cool huh?

Okay, so that isn’t likely to happen. But in a world where approximately a fifth of the population is overweight and a majority of the world populace has more to fear from over rather than under-eating the focus on obesity and methods to combat it is only going to grow. The solutions to obesity likely will need to be multi-pronged, each facet adding an incremental advantage. With this in mind medical solutions have their place alongside education, social and legislative approaches.

One of the medically based avenues open to us is to regulate the activity and/or amount of brown fat in our bodies.

Brief biology lesson: Humans (and other animals) have two main types of fat cell; brown and white. White fat is the regular old fat that we think of, know, and loath. It contributes to unsightly cellulite, increases our risk of various diseases that kill us and is generally something that you want to only have in moderation.

Brown fat on the other hand is a slightly different beast. Like white fat it is a repository of energy, but unlike white fat it is not simply a passive receptacle for these lipids¹. Brown fat gets it’s colour (and hence name) from the high density of mitochondria in the cells. The presence of such high numbers of mitochondria allows the cells to channel the force, oh wait that’s a different organelle, sorry. They mean that the cells can burn energy and contribute to thermal regulation, what’s known as Non-shivering thermogenesis.

This type of heat regulation is most important to infants and it was thought that as we grew and matured the brown fat disappeared. This is now known not to be the case, further, manipulation of brown fat in adults may give us a means to burn extra calories and hence reduce our white fat.

Another paper released last year attempts to give a detailed background of the possibility of manipulating brown fat for the purpose of weight regulation. It also notes the potential benefits and drawbacks of this approach and is a very interesting read. Essentially though the idea with utilising brown fat is to increase the body’s basal metabolic rate (the amount of energy you consume while at rest), by doing this we can increase the total number of calories used by the body and effectively burn up the excess calories consumed.

The press released that sparked this post is related to a paper presented at The Endocrine Society’s 93rd Annual Meeting in Boston. It details an investigation into the location of brown fat in the adult body and the mechanisms involved in the creation of brown fat from undifferentiated progenitor fibroblast cells. The fat tends to be deep within the adipose tissue of the neck and chest as well as mixed in with white fat, hence the thinking that we lost it as we age – it’s not easy to find. This incremental step in understanding gives us another tool that may be used to increase our proportion of brown fat cells and thus increase our metabolic capability.

Previous work by the same lead author has correlated amount of brown fat with BMI, finding an inverse relationship. The implication here is that a larger amount of brown fat does contribute to a higher metabolic rate and there for allows some individuals to avoid long term accumulation of fat, confirming that this is a potentially viable approach to weightloss. The numbers of this study were pretty low though and I’m not sure how clinically relevant this finding is.

The authors caution however that benefits may be modest, the lead author is quoted:

“As powerful as brown fat could be at burning calories, we can easily out-eat the benefit.”

So don’t be looking at this as a panacea for obesity, as noted above we will likely have to tackle this problem from multiple sides. Those who view our increasing dependence on drugs and medical interventions with suspicion may not be happy with treating obesity in this fashion², but it is such a growing problem we should use every tactic at our disposal to reduce the risks associated with this threat to our health.

So, bring on the human experimentation and lets hope the reducing of people to vacant fat-starved cannibals is kept to a minimum.

———————————————————————

Cypess, A., Lehman, S., Williams, G., Tal, I., Rodman, D., Goldfine, A., Kuo, F., Palmer, E., Tseng, Y., Doria, A., Kolodny, G., & Kahn, C. (2009). Identification and Importance of Brown Adipose Tissue in Adult Humans New England Journal of Medicine, 360 (15), 1509-1517 DOI: 10.1056/NEJMoa0810780

Tseng, Y., Cypess, A., & Kahn, C. (2010). Cellular bioenergetics as a target for obesity therapy Nature Reviews Drug Discovery, 9 (6), 465-482 DOI: 10.1038/nrd3138

———————————————————————

* Yes, I really am that lazy.

1. Yes again, I know that’s a gross over simplification. White fat does stuff too.

2. I have no evidence of this but I’m sure they’re out there.

Brown Fat, Also Known As Good Fat, More Common In Leaner Children (medicalnewstoday.com)
‘Good fat’ most prevalent in thin children (eurekalert.org)
Calorie-burning brown fat is a potential obesity treatment, researchers say (eurekalert.org)

2011: 08/16
CATEGORY: Medicine
Sciblogs
Science
2 comments

Holy Hyperbole Batman!!

Apparently the Armageddon predicted by Harold Camping is not the only one we have to contend with. Watch out, it’s The Next Armageddon!

Did you know that the WHO is not the health promoting organization we think it is but really the most nefarious institution in human history?[1]

According to one conspiracy nut[2] the WHO has put into action a plan to kill over 3 billion[3] people. Huh, WHO’da thunk it?

WHO is really going to take this seriously?[4]

The target of this hysteria is the Codex Alimentarius, a set of regulatory guidelines put out by the WHO to:

“..develop food standards, guidelines and related texts such as codes of practice under the Joint FAO/WHO Food Standards Programme. The main purposes of this Programme are protecting health of the consumers and ensuring fair trade practices in the food trade, and promoting coordination of all food standards work undertaken by international governmental and non-governmental organizations.”

At least, that’s what “They” want you to think. Mwahahaha!

Russians and Nazis and conspiracies, Oh My!

The first thing you’ll notice about this brightly coloured screed[5] is the complete absence of references. A large number of extremely serious allegations are made and not a single effort has been made to allow you to verify these for yourself.

The first real claim made (apart from the whole killing three billion people thing) is that a Nazi war criminal teamed up with the United Nations to control the population of the world through the food supply. Not a sniff of backing for this is included in the text. Searching on the name of the Nazi[6] and United Nations turns up only other conspiracy sites using virtually identical text. I’m convinced.

This page also taps into the paranoia around water fluoridation by asserting that fluoride is both a poison and has the effect of eliminating aggression and ambition. the proof?

“…. and the fact that it is used in many drugs prescription[sic] shows that it eliminates aggression and ambition in people.”

What more do you need sheeple??? Obviously it must be true, its all in black and white (except the bits in red). Plus, you know, the Russians used it in experiments and got the same results. Uh, where did you get that tidbit? Show me that paper, and the others where it was replicated. Oh, it’s part of the conspiracy you say. How convenient.

Regarding poisons, I’ve said it before: Dose Matters. Things that in high doses would kill us are routinely used in medicine. There is a range where the benefit’s of a substance outweigh the risks. To deny this is to fundamentally misunderstand medicinal and toxicological science.

Of course, this is all the work of evil entities that have been planing population control since the early 1960′s. I have to say that this is some impressively long term planning. I’m surprised there’s no mention of the “Illuminati” if anyone is good at long term, surely it’s them.

Conspiracies, conspiracies everywhere….

“Why Are You Not Aware Of This?

Because the strategy was so thought-out that it’s almost impossible to realise our food is being used against us. But when you dig deeper you will see that everything is set up to kill us slowly over time… without one factor being the main cause, because there are many. Basically, for those who die… it will be made out as their own fault…”

Yep, almost impossible. Almost. Only those who have the ability to scratch the surface, pull back the curtain and pierce the fog can work it out. Gosh they must have keen insight. Or perhaps they are engaging in overactive pattern recognition and faulty reasoning, not to mention MSU[7] syndrome. It could go either way.

But wait, there’s more. Not only is this guy warning us out of the goodness of his heart, he’s also willing to sell us a book that tells you how not to be killed by the evil powers that be. How nice.

The price of USD$37 is just symbolic, you know nominal, don’t worry about it at all.

My favourite of the benefits touted as to why you should buy the book is:

“The naked truth behind UMAMI (the taste scam behind 90% of the foods today…which is so toxic and makes the foods taste so good and irresistible). What you don’t know is that UMAMI has a terrible effect over your health. Here’s how to avoid it… “

I’ll give him the benefit of the doubt and presume that this is an example of poor editing. Umami isn’t a chemical, it’s the subjective experience of taste that we interpret as savoury/meaty taste. Perhaps what is being referred to here is glutamate or MSG, which for a short time was considered to have negative health effects.[8] Subsequent study has failed to bear this out. So even that generous reading of this point is, well, wrong. Sorry.

If it seems like I haven’t really taken any of this seriously, it’s because I don’t. There are some claims where the only reasonable response is ridicule. There are dozens of assertions put forward on the web page in question. Many of which don’t even give enough information to know exactly what is being claimed[9], let alone providing any basis for refutation or confirmation.

Without providing any details the page is “not even wrong” it’s incomprehensible. The only value it has is to whip up unfounded fear and paranoia, all to pave the way towards buying the book that will save you. From another perspective it has one other value, entertainment.

HT to Alison for bringing this to my attention. Thanks for the hilarity.

————————————————————————–

Footnotes:

1. If you’re an anti-vaxxer, don’t answer that. Also, don’t quote-mine me. Satire has it’s weaknesses.

2. He says he’s not but methinks he doth protest too much.

3. For maximum effect try to read this in the tone of Dr. Evil.

4. Last one, honest.

5. Though not nearly as bad as most conspiracy sites, so there’s that.

6. Hermann Schmitz, president of I.G. Farben the major producer of poison gas for the Germans. http://www.ess.uwe.ac.uk/genocide/cntrl10_trials.htm#Farben

7. Making Shit Up.

8. Ooooh, the dreaded Wikipedia. Inside joke, don’t worry about it.

9. “All nutrients (vitamins and minerals) that have any positive health impact on the body are to be considered toxins/poisons and are to be removed from all food because Codex prohibits the use of nutrients to “prevent, treat or cure any condition or disease”. “ -What does that even mean? Are they going to suck all of the beta-carotene out of carrots? How would you even go about implementing such a retarded scheme?

2011: 05/25
CATEGORY: Hoaxes
Psychological
Sciblogs
skepticism
Warped Science
2 comments

Vaccination Awareness Week Round-Up

There’s still officially one more day of ~~Anti-~~Vaccine Awareness Week (two really, as it’s an American idea) but here’s a round up of the posts anyway. While I know there are lots of great in-depth posts around the blogosphere on this the following list has been restricted to NZ posts to keep the local flavour. The posts are in roughly chronological order.

The University of Auckland Library at Tamaki Library blog Misinformation spread about HPV vaccine

Me Anti-Vaccination in NZ

Scott at Imperatorfish They Can’t Vaccinate Against Tin-Foil Hat Syndrome

Michelle at Skeptics In The Pub Vaccines: The actual facts (well, the links to some anyway…)

Alison Campbell at Bioblog on polio

Michelle at Skeptics In The Pub More facts about vaccines….

Me A Side Benefit of the ‘Flu Vaccine – Reduction in Heart Attacks

Michael Edmondsat Sciblogs Guest Work “I’m not a Scientist but …”; Dissection of an antivaxxer’s argument

Alison Campbell at Bioblog chelation quackery around vaccination

Grant Jacobs at Code for Life Immunisation, then and now

Alison Campbell at Bioblog homeopathic vaccinations – fail

The next couple are not specifically about vaccination but I think are worth a mention:

Grant Jacobs at Code for Life If presenting a claim on a popular issue

Megan Leask at Southern Genes This Week in Science History: 1-11-10

If anyone knows of a post I’ve missed then please feel free to add it in the comments.

[Edit] One more – Alison @ Bioblog vaccination & smallpox

—

For those of you interested in the international posts, blogger Liz Ditz has done an awesome job collating all of the posts here:

The Big List of Reality-Based Vaccine & Infectious Disease Blogging

2010: 11/05
CATEGORY: Alternative medicine
Medicine
Sciblogs
Science
skepticism
2 comments

	Laura Bergeron on Commenting
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	Laura Bergeron on Amber Teething Beads: A Few Po…
	Scepticon on Amber Teething Beads: A Few Po…

Just the Biased Facts

Anti-Vaccine Charity, No More

TCM and You: Cupping

Amber Teething Beads: A Follow-Up

Why Do People Use Alternative Medicine?

First, Do No Harm

The Freedom of Ignorance: Health Freedom, What is it and Do We Want it?

Chiropractic for the 21st Century

Thai Yoga Massage: Herald, Wherefore Art Thou Sense?

The Webwhisperer: A Medical Resource

Breaking News!: Have Constipation? Moxibustion Won’t Help!

Get Your Up-To-Date Vaccine News

Anti-Vaccine Charities – Is there any Quality control on Charities?

Are You Ready for the Faux-Zombie Apocalypse?

Holy Hyperbole Batman!!

“Why Are You Not Aware Of This?

Vaccination Awareness Week Round-Up

Rhyming Prose

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