That Mitchell and Webb Look: Homeopathic A&E

Just wanted to add a link to this hilarious sketch.
Sadly, it does have a morbid side to it as the last post demonstrates.

Spreading the word...

New science based veterinary blog promoting critical thinking!

Though I've been temporarily distracted from my little blog posting hobby, I continue to enjoy the wonderful and thoughtful writings of so many excellent thinkers.

As the scourges of psuedoscience, dogma and crankery continue their assault on reason and so many seem to trod a stuporous mindless path, it's very gratifying to note that there are many knowledgeable folks out there willing to take the time and energy to be "candles in the dark"...beacons of intellectual honesty and authentic reason.

In that vein, I am pleased to bring to your attention a new veterinary medicine site and its associated blog of note chalk full of critical thinking and reasoned posts. Please add The Skeptvet.com and The Skepvet blog to your links and enjoy some great reading!

Keep up the great work, we need it... !!

Acupuncture: forget the qi & meridians...AND any strong placebo effect

...even more dead in the water than thought.

There is an interesting research study published January 2009 regarding acupuncture treatment for pain. The most interesting thing about it is that it seems acupuncture isn't even much of a placebo, let alone anything else related to real healng. The second most interesting development as a result of this study is the almost comical cognitive dissonance from several media players as well as acupuncture apologists.

DC's improbable science has the goods and excellent discussion regarding the study and some of the sadly predictable -albeit quite athletic- false positive mental "spin" on the obviously negative implications for the institution that is acupuncture itself.

Dr Colquhoun notes in the comments section that even "modern" acupuncture denuded of the archaic and imaginative sophistry of "qi", points or meridians is dealt what could be a fatal blow:

"It’s true that the Medical acupuncture people, Adrian White et al. have abandoned the hocus pocus, and seem happy to admit that it doesn’t matter where the needles go. But that was already well-established before these last lot of reviews.

It was also quite well established already that in a non-blind comparison of acupuncture versus no acupuncture, the acupuncture wins.

The really new thing in the Madsen paper is that although acupuncture still beats no acupuncture, the advantage is too small to be much use to patients. So it may be a theatrical placebo, but the placebo effect isn’t big enough to matter in real life.

If this conclusion is confirmed by others, then acupuncture is dead. You can’t even make the (morally-dubious) argument that it’s a good placebo."

(my bold)

It's important to note that non-blind studies severely limit the quality of interpretations, especially for elucidating any effects beyond a placebo. Other superior studies clearly reveal no putative acupuncture effects beyond chance or placebo. In essence, as the study design improves acupuncture effects disappear.

Remember, this particular study relates to the very nebulous, variable and personal concept of pain- a realm fraught with confounding factors. Many studies regarding acupuncture effects deal with these rather subjective areas because that's pretty much what is left as the search for bigger effects has proven fruitless. If it is this hard to tease out any real acupuncture effect here from the a back ground noise of probability, acupuncture -as a legitimate medical modality- has a big, big problem.

Yet some people just don't get it...and the credulous will likely still drink deep from the twisted rhetorical kool aid and "feel" good.

Case studies in debunking fallacious thinking: anti-vaccine apologists and acupuncture "effects"considered

Here are three fabulous examples of lucid and clear analysis in action against the dogma and fallacy of ideological thought - critical thinking at it's best.

Respectful Insolence: Can we finally just say that acupuncture is nothing more than an elaborate placebo? Can we?

Heal Spiel: Response to antivaccination parent

Neurologica: Some follow up on migraines

These excellent fellow bloggers confront psuedo-science with clear, referenced, factual and reality based discussion cooly eviscerating delusional thinking; whether confronting antivaccine supporter claims or analyzing putative acupuncture "effects".

Very refreshing and stimulating...think I'll do a post on an animal related psuedo-science issue soon.

Statistical Literacy Guide

DC's Improbable Science has an interesting link -the Statistical Literacy Guide- located in the UK commons library archive regarding the oft misunderstood and abused science of statistics.

This is a great read and introduces the reader to many of the nuances of statistical analysis and how these important tools can be inappropriately spun "a la politico" into down right meaningless and vacuous interpretations.

A very helpful piece for those of us trying to tease out real meaning from a sea of confusion regarding "new" (or old) research purported to "prove" or support grandiose claims that pop up from most every sector in the medical and -especially- the psuedo-medical world.

How can you recognize pseudoscience?

What is it?....How can I recognize it?

From the Pseudoscience blog:

"A pseudoscience is a belief or process which masquerades as science in an attempt to claim a legitimacy which it would not otherwise be able to achieve on its own terms; it is often known as fringe- or alternative science. The most important of its defects is usually the lack of the carefully controlled and thoughtfully interpreted experiments which provide the foundation of the natural sciences and which contribute to their advancement.

Of course, the pursuit of scientific knowledge usually involves elements of intuition and guesswork; experiments do not always test a theory adequately, and experimental results can be incorrectly interpreted or even wrong. In legitimate science, however, these problems tend to be self-correcting, if not by the original researchers themselves, then through the critical scrutiny of the greater scientific community. Critical thinking is an essential element of science -----------------------------------------

science	pseudoscience	comment
The primary goal of science is to achieve a more complete and more unified understanding of the physical world.	Pseudosciences are more likely to be driven by ideological, cultural, or commercial goals.	Some examples: astrology (from ancient Babylonian culture,) UFO-ology (popular culture and mistrust of government), Creation Science (attempt to justify a literal interpretation of the Bible), "structure-altered" waters (commercial quackery.)
Most scientific fields are the subjects of intense research which result in the continual expansion of knowledge in the discipline.	The field has evolved very little since it was first established. The small amount of research and experimentation that is carried out is generally done more to justify the belief than to extend it.	The search for new knowledge is the driving force behind the evolution of any scientific field. Nearly every new finding raises new questions that beg exploration. There is little evidence of this in the pseudosciences.
Workers in the field commonly seek out counterexamples or findings that appear to be inconsistent with accepted theories.	In the pseudosciences, a challenge to accepted dogma is often considered a hostile act if not heresy, and leads to bitter disputes or even schisms.	Sciences advance by accommodating themselves to change as new information is obtained. In science, the person who shows that a generally accepted belief is wrong or incomplete is more likely to be considered a hero than a heretic.
Observations or data that are not consistent with current scientific understanding, once shown to be credible, generate intense interest among scientists and stimulate additional studies.	Observations or data that are not consistent with established beliefs tend to be ignored or actively suppressed.	Have you noticed how self-styled psychics always seem eager to announce their predictions for the new year, but never like to talk about how many of last years' predictions were correct?
Science is a process in which each principle must be tested in the crucible of experience and remains subject to being questioned or rejected at any time.	The major tenets and principles of the field are often not falsifiable, and are unlikely ever to be altered or shown to be wrong.	Enthusiasts incorrectly take the logical impossibility of disproving a pseudoscientific priniciple as evidence of its validity.
Scientific ideas and concepts must stand or fall on their own merits, based on existing knowledge and on evidence.	Pseudoscientific concepts tend to be shaped by individual egos and personalities, almost always by individuals who are not in contact with mainstream science. They often invoke authority (a famous name, for example) for support.	Have you ever noticed how proponents of pseudoscientific ideas are more likely to list all of the degrees they have?
Scientific explanations must be stated in clear, unambigous terms.	Pseudoscientific explanations tend to be vague and ambiguous, often invoking scientific terms in dubious contexts.	Phrases such as "energy vibrations" or "subtle energy fields" may sound impressive, but they are essentially meaningless.

Chiropractic wishfull thinking...

...pediatric specialty???

The chirotak discussion forum has a very enlightening thread regarding chiropractic perdiatric specialty training.

Really, no surprises.

Pediatrics: DC vs. MD Training« Thread Started on Dec 6, 2007, 10:34pm »

I have been looking through websites of various "Pediatric" Chiropractors and most seem to be very proud that they obtained their "Pediatric Certification" by completing a 300 hour course.

Let's compare the number of hours of training in Pediatrics:

DC= 300 hours at the Holiday Inn

MDPediatrician= 80 hrs/week X 50 weeks X 3 years= 12,000 hrs

Now how about those who treat childhood asthma and allergy:

DC= 300 hours at the Holiday Inn

MD Pediatric Allergist :-----12,000 hrs for basic Pediatric Residency------8,000 hrs for Pediatric Allergy Fellowship GRAND TOTAL= 20,000 hrs of training

QUESTIONS:

1) Do they bring newborn babies to the Holiday Inn so the DCs can practice adjustment?

A. Yes

B. No

2) If not, where do the DCs get their clinical practice on newborns?

A. Motel 6

B. Airport Best Western

C. Days Inn

D. They get no clinical practice

3) How delusional must one be to adjust a newborn or treat childhood asthma or epilepsy with some bogus nonsense?

A. Very

B. Very, very

4) What in chiropractic "philosophy" allows a DC to be an expert in vaccination and infectious disease?

A. Sid said so

B. It has to do with nerve energy

C. C3 is pressing on the pituitary

D. Nothing.....nothing at all

5) Is the infectious disease seminar always held at the Holiday Inn or can it sometimes be at the Ramada?

A. Always at the Holiday Inn

B. Sometimes at the Ramada

C. Holiday Inn on South Cobb Parkway only

D. Holiday Inn off of Delk Road and I-75 only

Detoxin' your wallet dry!

...on todays snake oils
Steven Novella at Nuerologica blog has -as usual- an excellent take down of some really juicy pseudoscience and related hubris that can only be described as classic scam artistry.

He notes "There is a cycle to the snake oil market - like the fashion industry. Words and claims come in and out of fashion, used for marketing impact rather than scientific accuracy. Some words, like “natural” and “energy” have staying power, while others last for a time and then may fade, but can come back into fashion like wide ties.... Recently “detox” is all the rage."

Dr Novella notes that the Sense about Science group is in the forefront of taking down the ridiculous and spurious claims purveyors of "detox" nostrums blantantly trumpet to a sadly creduluos populace.

As their Debunking Detox pamphlet puts it:

" The multi million pound detox industry sells products with little evidence to support their use. These products trade on claims about the body which are often wrong and can be dangerous."

Dr Novella concludes his post noting that "What the marketers of detox products have done is made the term “detox” meaningless - actually the term now is nothing but a red flag for snake oil."

On a related note, I was recently introduced to a "super juice" supplement product called Goji juice. Of course it's supposed to be nothing short of some miraculous nectar from the gods.

Not!

Under closer scrutiny, other than being made from dehydrated goji berrys from China, this product does not live up to the rather outlandish claims of many of its distributors (looks like fodder for a future investigative post!).

In fact, these wild statements are reminsent of the false hype and hyperbole from the Mangosteen crowd. It's the same old pimping up of some "exotic" special elixir....basically fruit juice in a golden wrapper. An interesting skeptical blog seeks to take this issue head on. I wish them well!

An acupuncture fallacy in action

...confusing correlation with causation (among other things…)

For the last 6 weeks, Sam the dog had been seen and treated with acupuncture for an undetermined lameness by a local “natural” veterinarian who specializes in Chinese Medicine and Acupuncture therapy. Sam was being seen by a conventional vet and wasn’t responding typically to palliative treatment. That is, he would get better and then get worse intermittently.

After declining, for the moment, further diagnostics this veterinarian grudgingly ceded to the clients wishes to pursue alternative treatments making clear –to her credit- the difference between science and non-science based modalities. This is an unfortunate, yet fairly common scenario among a percentage of many a veterinarians client roster. The ever present, albeit usually tiny, clad of holistically oriented people who innocently –and sometimes tragically- muffle and slow the course of getting to the bottom of a case like Sam.

On the other hand, this is fairly familiar territory and many veterinarians will attempt to establish some kind of continued interaction with these folks in the interest of their patients. In fact, to some alternative veterinarians’ credit there are those who insist on some type of interaction with science based practice and require that a “conventional” diagnosis be given.

That most of these cases are either chronically or terminally ill patients undergoing a constellation of naturally occurring waxing & waning cycles of disease seems to be overlooked –especially when they are experiencing a usually quite temporary upswing. Anything good is ultimately and erroneously attributed to whatever strange concoction or instrument is used.

Because Sam wasn’t responding “as expected” it was determined -quite correctly by the attending alternative vet- that a clearer diagnosis was needed. The regular conventional veterinarian was called on to now pursue a diagnosis after the clients’ discussion with their alternative vet. Yes, the irony is duly noted.

However, by claiming that the acupuncture treatment wasn’t working and actually making the problem worse he used the wrong reasons. Whether an animal is getting better or worse, without a profound knowledge base of the natural history of disease and a good dollop of solid science based studies and data supporting the therapy being used, you really can’t claim anything –good or bad.

It turns out Sam the dog was dying from a severely malignant form of spinal bone cancer. He was basically terminal from day one and is now under focused conventional and humane end of life care…and Chinese herbs for cancer. Any improvement quite possibly will be attributed to the herbs.

The main point of this tale is that when something bad happens in the realm of alternative medicine, the problem is often attributed to an equivocal diagnosis, or that the alternative treatment was started too late, or that some diseases are made worse by one alternative modality…all mostly claims made without any solid evidence (including -on balance- acupuncture studies).

…and here’s one of the big problems. There is always something else to try or mix with the science…often without really knowing what’s going on. This brings all involved dangerously close to the edge of a dark abyss.

Without the proper tools -the light of reason- we're destined to stumble through interminable blind alleys and false hopes...armed with little more than hat tricks to bide the time.

Understanding Chopra woo

Another reason to support separation of "church" and medicine...

Being that there are a lot of folks who think Dr. Chopra has unique qualifications and solidly researched support for his quest to "integrate" scientific medicine with whispy shades of a strange belief based system -religion- here are two well put together posts regarding Deepak Chopras modus operandi.

Pharyngula 2006:

"Chopra is a doctor, supposedly, but every time I read something by him that touches on biology, he sounds as ignorant as your average creationist. He also writes incredibly poorly, bumbling his way forward with a succession of unlikely and indefensible claims. "

Skeptico 2005
"Skepticism has become a legitimate form of inquiry that Deepak parenthetically acknowledges (in a left-handed sort of way) as occasionally laudable, another refrain we often hear in the form of “I’m a skeptic too, but…,” where skepticism is fine as long as it is someone else’s codswallop under the microscope."

It is important to note that Chopra, over the years, has developed whole made up world views from stunningly naive, flimsy and often outright wrong assumptions about the actual nature of phenomena around him.

Mind you he has said some pretty interesting things regarding human wisdom and how we can all get along but this guy is just as fallible and screwed up as any of us. He really needs to get off that high horse and admit it though.

If Chopra wants to promulgate a belief system, that's fine. What he can't -or at least shouldn't be aloud to do- is force this system on everybody else. This is exactly what he would like to do imposing "magic" based medicine onto science based medicine.

He should just get real, put on a priest robe, stick to teaching ancient Hindu wisdom and call it good.

Deepak Chopra does it again...

...or on being an uncritical CAM apologist
...or how to insert foot in mouth

Orac has a nice response to Chopras most recent "rebutal" against reason which just so happens to be related to yesterdays post about Steve Salernos very fine take down of the "Integrative" medicine movement. For good measure, Chopra calls on the "authority" of alternative medicine experts Andrew Weil and Rustum Roy to shore up his vain effort to claim scientific legitimacy -failing miserably.

As Orac notes "... Basically, the argument being made by the Woo-meisters Three boils down to an attack on evidence-based medicine based on exaggeration and cherry picking, topped off with a huge dollop of conspiracy-mongering and playing the victim. There is not a single positive, science-based argument that Chopra's woo or Andrew Weil's "integration" of the dubious with the evidence-based produces better health outcomes than the evidence-based medicine they attack..."

Yep...you can dress it up with the finest of imaginary cloth...but it still comes down to one simple fact...the emporers' still butt naked!

The bigger problem though, as Salerno points out so eloquently, is that in spite of the fact that most of the alternative movement is more illusion than real...more belief based than fact based...more bullshit and sofist rhetoric than a real reflection of reality...it is poised to adversely influence and contaminate an already severely strained health system.

The Chinese did something like this decades ago. They dressed up -made up- a scam health system to "appease" the populace who were devoid of access to science based medicine. It was called Traditional Chinese Medicine.

Orac nails it with this ominous warning:

"...Chopra's article demonstrates beyond a shadow of a doubt is that advocates of unscientific medicine and quackery apologists are a potent political force, and their new strategy has become clear. With the impending inauguration of Barack Obama as the President of the United States, they see a huge opportunity in his plans to overhaul the government health care system to insert into legislation provisions that will pay for unproven and pseudoscientific CAM/IM modalities. They will sell these provisions as "reform" and as "health maintenance," when they represent neither."

It is my hope his voice and the many others calling for reason be heard.

-adendum-

It appears Dr. Chopra has earned an additional well deserved laser guided intellectual thumping from Skeptico:

"Chopra’s piece is just one logical fallacy after another. This is Chopra's article, summarized:
Ad hominem
Appeal to authority
Red herring
Science was wrong before
Appeal to other ways of knowing
Straw man

Add claims of “concerted research and clinical practice” that his woo works, without one shred of evidence that his woo works, and you have Chopra’s entire article. (He should employ me as his editor.)"

"Alternative" Medicine and Bullshit

...either way, the stink still comes through

"The Touch That Doesn't Heal" is a very insightful article regarding the rather sad tale of the insiduous and undeserved penetration of unproven...and disproven (within the realm of reason) "alternative' or "integrative" therapies into more mainstream medicine.

Steve Salerno nicely articulates the problem of incorporating therapuetic modalities built on smoke and mirror "logic" into the real world of disease, limited funds and the false assumptions of efficacy proffered by CAM (Complementary and Alternative Medicine) to a credulous population (many doctors included).

"...A survey of 32,000 Americans by the National Center for Health Statistics, released earlier this month, suggests that 38% of adults use some form of "complementary and alternative medicine," or CAM -- now aggressively promoted for everything from Attention Deficit Disorder to the Zoster virus. The survey polled consumers on 10 provider-based therapies -- for example, acupuncture -- and 26 home remedies, such as herbal supplements.

On the other hand, it should be noted that all is not lost. The reality of CAMs inroads may not be as entrenched as appears as suggested by Mark Crislips excellent post at the Science Based Medicine Blog . Still, there is a critical disconnect -a collective cognitve dissonence- opening a "back door" and for non-science based practices to garner a legitamacy that doesn't exist. You can use all the perfume you'd like...but bullshit is bullshit and that ol' smell eventually comes through!

Salerno continues "...This should be a laughing matter, but it isn't -- not with the Obama administration about to confront the snarling colossus of healtallowing h-care reform. Today's ubiquitous celebration of "empowerment," combined with disenchantment over the cost, bureaucracy and possible side effects of conventional care, has spurred an exodus from medical orthodoxy. As a result, what was once a ragtag assortment of New Age nostrums has metastasized into a multibillion-dollar industry championed by dozens of lobbyists and their congressional sympathizers..."

"Indeed, one of the great ironies of modern health care is that many of the august medical centers that once went to great lengths to vilify nontraditional methods as quackery now have brought those regimens in-house. "We're all channeling East Indian healers along with doing gall-bladder removal," says Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics. Mr. Caplan harbors no illusions about what's behind the trend: "It's not as noble as, 'I want to be respectful to Chinese healing arts.' It's more, 'People are spending a fortune on this stuff! We could do this plus our regular stuff and bill 'em for all of it!'..."

"...Meanwhile, CAM has secured its own beachhead within the National Institutes of Health in the form of the National Center for Complementary and Alternative Medicine (NCCAM). "Special commercial interests and irrational, wishful thinking created NCCAM," writes Wallace Sampson, a medical doctor and director of the National Council Against Health Fraud, on the Web site Quackwatch.com. And Sen. Tom Harkin (D., Iowa), who credited bee pollen with quelling his allergies, was single-handedly responsible for the $2 million earmark that provided seed money for NCCAM, chartered in 1992 as the Office of Alternative Medicine. Despite the $1 billion spent in the interim, the center has failed to affirm a single therapy that can withstand the rigors of science..."

This article is well worth reading. One take away is that the battle for reason goes on...and on. Here's to a great year of critical thinking!

STORM by Tim Minchin, 2008

An instant classic........Tim Minchins' masterfull performance "Storm" can be heard on his latest DVD... well worth ordering if you are a fan of sublime musicality and awe inspiring comedic irreverence.

Though not doing it justice, here is the transcript of this wonderfully sharp and witty poem....enjoy!

--------------------------------------------------------------------------

Storm

Tim Minchin

In a North London top floor flat,
All white walls, white carpet, white cat.
Rice paper partition, Modern art And Ambition

The host's a physician,
Lovely bloke,
Has his own practice,
His girlfriend's an actress -
An old mate of ours from home,
And they're always great fun,
So to dinner we've come -

The fifth guest is an unknown,
The hosts have just thrown us
together for a favour.
The girl's just arrived from Australia,
And she's moved to North London,
And she's a sister of someone.
Or has - some connection.

As we make introductions,
I'm struck by her beauty,
She's irrefutably fair,
With dark eyes and dark hair.
But as she sits, I admit:
I'm a little bit wary,
As I notice the tip,
Of the wing of a fairy,
Tattooed on that popular area,
Just above the derrière,
And when she says "I'm Sagittarius!"

I confess, a pigeonhole starts to form,
And is immediately filled with pigeon,
When she says her name is *Storm*

Conversation is initially bright and light-hearted,
But it's not long before Storm gets started.

"You can't know anything.
Knowledge is merely opinion."

She opines over her Cabernet Sauvignon
Vis-à-vis,
Some unhappily empirical comment made by me.
Not a good start I think,
We're only on pre-dinner drinks,
And across the room my wife widens her eyes,
Silently begging me "Be nice!"

A matrimonial warning,
Not worth ignoring.
So,

I resist the urge to ask Storm,
Whether knowledge is so loose weave,
Of a morning, when deciding whether to leave,
Her apartment by the front door,
Or the window on the second floor.

The food is delicious,
And Storm whilst avoiding all meat,
Happily sits and eats,
As the good doctor slightly pissedly holds court on some anachronistic aspect of medical history.

When Storm suddenly insists:
"But the human body is a mystery
Science just falls in a hole
When it tries to explain the nature of the soul."

My hostess throws me a glance,
She, like my wife, knows there's a chance,
I'll be off on one of my rare, but fun, rants.
But I shan't, My lips are sealed,
I just want to enjoy the meal.

And although Storm is starting to get my goat,
I have no intention of rocking the boat,
Although it's becoming a bit of a wrestle,
Because, like her meteorological namesake,
Storm has no such concerns for our vessel.

Pharmaceutical companies are the enemy,
They promote drug dependency,
At the cost of the natural remedies,
That are all our bodies need,
They're immoral and driven by greed,
Why take drugs when herbs can solve it?
Why do chemicals when
Homeopathic solvents can resolve it?
I think it's time we all return to live,
With natural medical alternatives.

And try as I like,
A small crack appears in my diplomacy dyke.

By definition, (I begin)
Alternative medicine, (I continue)
Is either not been proved to work,
Or been proved, not to work.
Do you know what they call
'Alternative Medicine'
That's been proved to work?

-- Medicine


So you don't believe in any natural remedies?
On the contrary, Storm, actually,
Before we came to tea,
I took a natural remedy,
Derived from the bark of a willow tree.
It's a painkiller, virtually side-effect free.
It's got a, a weird name,
Darling, what was it again?
Maspirin?
Baspirin? Oh, yeah -
Aspirin!
Which I paid about a buck for,
Down at the local drugstore.

The debate briefly abates,
As my hosts collect plates.
But as they return with dessert,
Storm pertly asserts,
Shakespeare said it first:
There are more things in
Heaven and Earth,
Than exist in your philosophy
Science is just how we're trained, to look at reality,
It doesn't explain, Love or spirituality.
How does Science explain
Psychics, auras, the afterlife,
The power of prayer?

I'm becoming aware,
That I'm staring,
I'm like a rabbit suddenly trapped,
In the blinding headlights of vacuous crap.
Maybe it's the Hamlet,
She just misquoted,
Or the fifth glass of wine I just quaffed.
But my diplomacy dyke groans,
And the arsehole held back by its stones.
Could be held back no more.

Look up, Storm, So I don't need to bore ya,
But there's no such thing as an aura,
Reading auras is like reading minds,
Or tea leaves, or star-signs,
Or meridian lines.
These people aren't plying a skill,
They're either lying, or mentally ill.
Same goes for people who claim
To hear God's demands,
Spiritual healers who think
They've got magic hands.
By the way, why do we think it's okay,
For people to pretend they can talk to the dead?
Isn't that totally fucked in the head?
Lying to some crying woman whose child has died,
And telling me you're in touch with the other side?
I think that's fundamentally sick.
Do I need to clairify here,
That there's no such thing as a psychic?

What are we - fucking two?
Do we actually think that
Horton heard a Who?
Do we still believe that Santa brings us gifts,
That Michael Jackson didn't have facelifts?
Or are you still so stunned
by circus tricks,
That we think the dead would,
Wanna talk to pricks like John Edward?

Storm, to her credit,
Despite my derision
Keeps firing off cliches
With startling precision
Like a sniper using
Bollocks for ammunition.

You're so sure of your position,
But you're just close-minded,
I think you'll find that
Your FAITH in science and tests,
Is just as blind as the
faith of any fundamentalists,

Wow, that's a good point,
Let me think for a bit.
Oh wait, my mistake,
That's absolute bullshit.
Science adjusts its views
Based on what's observed.
Faith is the denial of observation,
so that belief can be preserved.

If you show me that, say,
Homeopathy works,
I will change my mind,
I will spin on a fucking dime.
I'll be as embarassed as hell,
Yet I will run through the streets yelling,
It's a MIRACLE!
Take physics and bin it!
Water has memory!
And whilst its memory
Of a long lost drop of onion juice is infinite,
It somehow forgets all the poo it's had in it.

You show me that it works,
And how it works,
and when I've recovered,
from the shock,
I will take a compass and carve
'Fancy That',
On the side of my cock.

Everyone's just staring now,
But I'm pretty pissed and I've dug this far down.
So I figure.. In for a penny, in for a pound!

Life is full of mystery, yeah,
but,
there are answers out there.
And they won't be found,
By people sitting around,
Looking serious,
And saying: Isn't life mysterious,
Let's sit here and hope,
Let's call up the fucking Pope,
Let's go on Oprah,
And Interview Deepak Chopra.

If you must watch telly,
you should watch Scooby-Doo,
That show was so cool!
Because every time
There was a church with a ghoul,
Or a ghost in a school,
They looked beneath the mask.
And what was inside?
The fucking janitor,
or the dude who ran the water slide!
Because,
throughout history,
every mystery
ever solved,
Has turned out to be -
Not Magic!

Does the idea that
there might be knowledge frighten you?
Does the idea that
one afternoon on Wiki-fucking-pedia
Might enlighten you,
Frighten you?
Does the notion that there might not be a supernatural,
so blow your hippy noodle,
that you'd rather just stand in the fog of your
Inability to google?

Isn't this enough?
Just,
this world?

Just this,
Beautiful,
Complex,
Wonderfully Unfathomable,
Natural World?

How does it so fail to hold our attention
That we have to diminish it
with the invention
of cheap man-made
myths and monsters?
If you're so into your Shakespeare,
Lend me your ear
To gild refined gold,
To paint the lily,
To throw perfume on the violet,
Is just fucking silly
Or something like that.
Or what about Satchmo?
I see trees of green,
Red roses too...

And fine, if you wish to,
Glorify Krishna and Vishnu,
In a post-colonial,
Condescending,
Bottled-up-and-labeled
kind of way,
Whatever, That's okay.

But, here's what gives me a hard-on,
I'm a tiny, insignificant
Ignorant bit of carbon.
I have one life,
And it is short and unimportant,
But thanks to recent scientific advances...

I get to live twice as long,
As my great-great-great-great
uncleses and auntses.

Twice as long!
To live this life of mine,
Twice as long,
To love this wife of mine.
Twice as many years,
Of friends, of wine,
Of sharing curries and getting shitty,
At good looking hippies,
With fairies on their spines,
And butterflies on their titties.

And if perchance, I have offended,
Think but this, and all is mended,

We'd as well be ten minutes back in time
For all the chance you'll change your mind.

Treating evidence with contempt

Sad commentary regarding the use of critical thinking by many complemenary and alternative proponents:

"For 15 years I have studied the effectiveness and safety of treatments such as acupuncture and homeopathy. Often, the results were not what the proponents ofthese treatments had hoped for. One would have thought that this might lead to debate, further research, or even health policy changes. Sometimes it has, but recently we have witnessed a new phenomenon.

People or organisations promoting highly questionable treatments are treating the evidence with contempt and flex their legal muscle to have it their way. The New Zealand Journal of Medicine recently published an article showing that most chiropractors use the title "doctor." The argument was that this might mislead patients and cause harm. As a consequence, the chiropractors sought to silence the journal by threatening legal action. (1) Fortunately the attempt failed.

The Guardian was sued for libel by Matthias Rath. The paper had exposed Rath’s strategyof convincing South Africa’s government that his vitamin pills were more effective than antiretroviral drugs for treating AIDS. The Guardian put up a fight, and eventually Rath dropped the libel action and was ordered to pay costs. (2) An editorial in the Guardian (http://www.guardian.co.uk/commentisfree/2008/sep/13/matthiasrath.aids noted that Rath’s activity in South Africa "provides a terrible illustration of thepotential consequences of treating the evidence with contempt."

Science journalist Simon Singh recently condemned the British Chiropractic Association for advocating chiropractic care as a treatment for childhood asthma and a rangeof other paediatric conditions. Instead of arguing their corner publicly, the association filed a libel action against Singh (www.telegraph.co.uk/news/newstopics/mandrake/2570744/Doctors-take-Simon-Singh-to-court.html). The case is likely to come before the courts soon.

When I critically commented on a report that Prince Charles had commissioned on the cost effectiveness of alternative medicine, (3) my university received a letter from the prince’s first private secretary, Sir Michael Peat, to "draw attention"to what he perceived as a "breach of confidence" on my behalf. It took a gruelling 13 months of an internal inquiry at Exeter University to clear my name.

Since I published a book with Simon Singh that evaluated the evidence for or against homoeopathy and other alternative treatments, (4) UK homoeopaths have been engaging in an elaborate campaign of multiple letter writing, repeatedly invoking the Freedom of Information Act to harass and silence me. This letter shows that they have failed. All of this "is not just unpleasant, it is also unhealthy," commented Ben Goldacre. (5)

I would add that the frequency of these events in recent months is downright scary. People who use legal muscle and power, rather than reason and debate, are a danger to reason and progress. What is at stake here is our right, I would argue our duty, to speak out against misleading claims and dangerous concepts. We should find ways of protecting ourselves against such enemies of reason. "

Cite this as: BMJ 2008;337:a2063 Edzard Ernst, Laing chair of complementary medicine"

Gilbey A. Use of inappropriate titles by New Zealand practitioners of acupuncture,chiropractic, and osteopathy.

N Z Med J 2008;121(1278):15-20Boseley S. Matthias Rath drops libel action against Guardian.

BMJ 2008;337:a1710(18 September.)Henderson M. Prince plots alternative treatments for the NHS.

Times 2005 Aug 24:1.Singh S, Ernst E. Trick or treatment? Alternative medicine on trial. London: BantamPress, 2008. Goldacre B. With their money, myopia and abuses, these pill makers match big pharma.Guardian 2008 Sep 13:34.

On occasion, I will be passing previous posts relating to evidence and science based veterinary medicine, complementary and alternative veterinary medicine and other pertinent skeptical issues to the Vetskeptics blog.

This is an attempt at consolidating veterinary & other medical information relating to skeptical information about CAM/CAVM that may prove useful and interesting in a more focused venue. Time permitting, some of these posts will be expanded upon. As always, posts from anyone interested in contributing (see vetskeptic blog) are welcome.

The Beyond the illusion post touches on some of the factors that confound and fool practitioners and others into thinking ineffective therapies work when they really don't.

Integrative medicine and hat tricks

So many times the devil really is in the details. So it seems, time after time,
I and many others find ourselves confronted with the same tired and increasingly tenuous arguments from Complementary and Alternative Medicine proponents.

Sadly, it doesn't seem to slow the creep of medicine back towards a far more
dangerous era -one of "curative anarchy"- that society wisely decided
to collectively walk away from a hundred years ago.

How quickly we forget...

These modalities continue to find fertile ground with the credulous by insiduously blanketing and confounding themselves with a false legitimacy. By appropriating and altering innocuous sounding concepts such as 'freedom of choice', 'teaching the controversy' and having a 'balanced' discussion (where none exists) -all for the sake of an ideology- many CAM supporters succeed only in weakening and degrading the pillars of reason and critical thought.

A colleague, Dr. Novella writes a sharp and clear post regarding one of CAMs
more succesful hat tricks...the bait & switch.

Excellent reading.

on choosing humanity over magic

Good article on how taking into account 'provenance' helps us ellucidate -even with our limited capacity - truer realities. Though we can never completely escape our biases nor should we (pattern seeking social primates that we are), we can sure strive for balance between -not magic and reality- but humanity and reality.

The article talks about 'woo' which is a catch phrase -as most of you are aware- for a broad collection of credulous mind sets. Here is a brief primer of what 'woo' is (thanks Orac):

Beliefs that clearly demonstrate magical thinking, uncritical acceptance of things for which no good evidence exists. This includes, but is not limited to, psychic phenomenon, ghosts, the paranormal, "energy healing" and a wide variety of other mystical and pseudoscientific beliefs.

Woo is resistant to reason. Indeed, woo has a double standard when it comes to what it considers to be good evidence. It is very accepting of a wide variety of fuzzy, mystical ideas, but is often incredibly distrustful and skeptical of anything having to do with "conventional" science or "conventional" medicine. Woos tend to be very quick to react to defend their particular brand of woo and very unforgiving of its being questioned.

Acupuncture: still no point to the point...

This has been a summer full of distractions and challenges needing a lot of attention. Add to that a touch of blog writer “blues” and you get a dry spell regarding postings. Consequently, this blog –not to mention the new blog baby - has been neglected and hungry for forward movement and novel discussion.

Hopefully, this little post will get things going again. All in all, this is a fun and gratifying way of expressing ideas and thoughts and helps to keep the mind sharp and attentive.

The following is a comment on my “Veterinary acupuncture” post that, although friendly and thoughtful, latches on to a few canards and fallacies in order to defend the concept of acupuncture as a viable medical therapy. Obviously, I disagree and felt compelled to write a quick response which follows the commentators blurb.

"Unfortunately there are far too many veterinarians, physicians and researchers who dismiss acupuncture as a hoax or as in this case lacking adequate scientific and clinical proof to warrant its use. Clearly the problem has been that clinical and scientific studies of acupuncture have lacked adequate controls. Without proper controls study results are nothing more than hearsay. However more recent scientifically controlled studies would argue that perhaps acupuncture therapy has merit. In this regard recent studies using microarray technology to examine acupuncture effects on gene expression in peripheral blood are no less than fascinating. For example Shiue et al (2008) have shown that acupuncture therapy significantly reduced allergic rhinitis symptoms, including nasal symptoms, non-hay fever symptoms, and sleep in human patients and this was accompanied by and alteration in the balance between T-helper 1 and T-helper 2 cell-derived proinflammatory versus anti-inflammatory cytokines in the blood. Such studies are paving the way for a more scientific explanation of acupuncture's effects. One only has to examine the recent fMRI studies of acupuncture effects on brain activity in humans and animals to conclude that acupuncture point stimulation has remarkable effects on brain activity compared to non-acupoint stimulation (see for example Napadow et al., Hum Brain Mapp, 2005). These are real effects and whether they underlie the ability of acupuncture to alter pain sensation in humans and animals remains to be proven with certainty, but nonetheless acupuncture has the capability to change brain activity. In our own studies we have found that acupuncture can prevent tumor growth if given at the very early stages of tumor cell proliferation. Conversely if acupuncture is applied later on after a tumor begins to grow, it significantly enhances tumor growth, which is why acupuncture is typically not recommended as a treatment for cancer. On the other hand acupuncture provides clear relief of pain in animal models of neuropathic pain and inflammatory pain. These effects are real folks and I have seen them first hand, so I refuse to believe that acupuncture is of no value in the medical community, be it veterinary or human medicine. There is evidence that acupuncture does not work in certain individuals and works well in others, so there is clearly individual variation in the ability of acupuncture therapy to work effectively. Taking all of this into account, I would argue that you shouldn't dismiss acupuncture until you have tried it!”

The real unfortunate issue is not that acupuncture is dismissed as a hoax, but that – even with a preponderance of disappointing evidence- this modality continues to expect unearned acceptance.

Though plagued with poorly designed studies that are often replete with equivocal results or laced with regional geographic bias, better designed acupuncture studies are out there. However, the news is not good for any real acupuncture effect. The infamous placebo –among other problems (i.e.; expectation, suggestion, counter-irritation, operant conditioning, and other psychological mechanisms) - continue to confound even “modern” acupuncture technique (that is to say; those acupuncture practices that use needling and claim no association with the ‘elam vital’, points, or meridians).

The studies you mention do not address a critical issue with respect to acupuncture- whether or not its putative effects exist. The attempt to correlate a claimed acupuncture effect to epigenetic influence puts the cart before the horse (and is reminiscent of what ‘nutritional supplement support’ advocates claim for a favorite herb, vitamin, or tonic du jour) and purported brain responses apparently observed by fMRI are interesting but it seems apparent that any mechanical puncturing of the dermis –on points or no points, shallow or deep- will effect changes.

There is little or no evidence that acupuncture is effective for any real medical disease (i.e.; neoplasm) nor, for that matter, for less well defined symptoms (including chronic pain, depression, allergies, asthma, arthritis, bladder and kidney problems, constipation, diarrhea, colds, flu, bronchitis, dizziness, smoking, fatigue, gynecologic disorders, headaches, migraines, paralysis, high blood pressure, PMS, sciatica, sexual dysfunction, stress, stroke, tendonitis and vision problems). Interestingly, promising and plausible mechanisms –if any- seem associated with completely different modalities that are confused with acupuncture (i.e.; TENS, psychosomatic, placebo).

Seeing acupuncture effects “first hand”, no matter how impressive, is simply anecdotal testimony and adds nothing to a scant evidence and science based foundation supporting acupuncture. In short, the accumulating evidence suggests most of the perceived beneficial effects of acupuncture are probably due to the power of suggestion and forms of the ‘placebo effect’.

Whether or not acupuncture is of any value to the medical community might be better discussed in a philosophy of science course. For example, acupunctures place might be better off in the realm of personal belief or preference (i.e.; priest or shaman) and well outside of medicine (If you believe in it, it will make you think you feel better – that’s your business).

As for having tried acupuncture…been there done that. I’ve also extensively observed its use in animals by certified veterinary acupuncturists.

Not impressed.

Vetskeptics blog

A blog baby!
This little blog project at wanderingprimate has always been about pondering on a rather wide breath of topics. Hopefully regular readers- if any- have enjoyed some of these posts as I have meandered- or wandered- about from topics in physics, medicine and other science related themes that have caught my fancy. As long as it is enjoyable, I plan to continue writing and perhaps broaden the scope a bit- touching more on other sciences and philosophy from time to time.

Along the way, I have managed to build up a fairly significant body of veterinary posts that have proven useful and may be of some use to others. With that in mind, I’ve decided to create a new veterinary specific blog site -Vetskeptics- with the goal of collecting these posts into an easier to access format and, at the same time, initiate a veterinary specific site that promotes critical thinking and skepticism.

My goal is to add to the scarce resources on the "ether" net for veterinary skeptics, or any animal lover tired of the pseudo-scientific blather out there. I hope to improve on some of the old posts and have new authors send in their own quality posts in an effort to put together a more collaborative site of like minded veterinarians, veterinary technicians, animal care-givers or any animal lover interested in sharing their thoughts.

If nothing else, it will be a nice skeptical reference blog. If you are interested in helping out, please have a gander at the site and drop me a line at (drg at vetskeptics dot com).

It could be a lot of fun!

“Big” Pharma Marketing

Doctors need to navigate with care

Much of alternative medicine makes dubious assumptions about the world of healing that set it apart from the real world. In essence, this makes it an untenable world view- at least scientifically speaking- and simply a non-starter. On the other hand, that’s not to say these methods have nothing to offer or teach us. Many of these modalities claim to “reach” people because they tend to cater to clients needs. Though, they often go too far, there is a germ of truth to these claims. By attempting to co-opt very real human social needs –empathy for example- they have in some way helped direct attention to important social aspects of human interaction.

The previous post touched on some of the more nuanced qualities of the “human” side of medicine and how important it is to understand and be aware of the complexities of social interactions –networking- and how it can impact health. It plays into the “art and science” of medicine and reminds us that it is a uniquely human endeavor.

Though it is difficult to wrestle with these issues, it is just as important to consider them as it is to debunk the non-science and falsehoods of alternative methods. This brings us to a related theme regarding the effect of networking.

It’s not a stretch to note that the state of medicine today is full of structural and foundational problems (i.e.; health care distribution, client/doctor relations). For example, pharmaceutical companies can make practicing science and evidence based medicine more challenging than it should be. Market pressures, commercial demands, and fierce competition within the industry create a need to vie for each and every costumer -in this case doctor- and can drive their therapeutic choices to some degree.

Here is where ugly “big pharma” conspiratorial accusations begins to bubble up out of the woodwork and out of many peoples mouths. Indeed there may be shades of this occuring. However, this probably gives the industry too much credit as any business works this way at some level –at least in a capitalistic society. On the other hand, an awareness of these forces (of the market) and how they work is crucial for doctors and patients (especially in this age of direct advertising) so that they can better navigate these sometimes muddy waters.

It needs to be made clear that market pressures drive the alternative medicine market in the same way –perhaps more so- as they do the pharmaceutical industry (sometimes they are one and the same!). In addition, the alternative industry (i.e.; supplements, homeopathic products, Chinese herbs) is not nearly as tightly regulated or policed as their “counterpart” is, making arguments against “big pharma” sound a bit hollow.

The science based medicine blog has a very interesting post “A foolish consistency” by Mark Crislip that discusses the undo influence of industry over the practices of medical doctors. As mentioned, topics like these need to be targeted and discussed openly and honestly. This is the best way to identify real problems and find solutions in a complex world.

By the way, veterinary medicine doesn’t seem -for the most part- to suffer near the pressure our counterparts in human medicine do. It seems easier to stand back and assess a particular drug or machine without some type of “market loyalty” ploy (i.e.; fancy gifts, free good or trips to wherever) getting in the way.

In the world of marketing and consumer “wooing” a saving grace, at least to some degree, with pharmaceutical companies is that they are tightly controlled and claims about their products need to be substantiated. Even with the biases often inherent in substantiating a product, it is still possible to evaluate them critically. That said there is still a question of whether pharmaceutical marketing is always a bad thing.

As noted by Crislip: “Does this marketing lead to worse outcomes? Or just more expensive treatment. I don’t have data. I will note that one of the driving forces of antibiotic resistance in bacteria is the overuse of broad spectrum antibiotics and choice of antibiotics is more often driven by marketing rather than science. Association or causality? ” This is definitely food for thought.

Crislip ends the post with the following quote: “In the interests of patients, physicians must reject the false friendship provided by reps. Physicians must rely on information on drugs from unconflicted sources, and seek friends among those who are not paid to be friends” http://medicine.plosjournals.org/perlserv?request=get-document&doi=10.1371/journal.pmed.0040150

At least one commentator, Dr RW gives doctors a bit more credit in their ability to discern the difference between market pressures and good medicine and find a balance between them.

He notes that “Many physicians I’ve discussed this issue with are aware that they are influenced by pharmaceutical company promotions. There is no reason to think there is massive self deception in the ranks of physicians. On the other hand many physicians would dispute any claim that industry promotions impact negatively on patient outcomes. As you acknowledged, there’s not a shred of evidence that they do. It is equally plausible that industry promotions (and their influence on doctors’ prescribing habits) are beneficial to patient outcomes…”

With respect to doctors applying evidence to practicing medicine as opposed to uncritically following “the market” there probably is some problem. However as Dr RW notes “I suspect many physicians do apply it (evidence). I certainly do. How? By being aware of the bias inherent in industry promotions. By applying appropriate analysis to the claims (e.g. looking not only at relative risk but also absolute risk) and by checking any such claims.”

It bears repeating that evaluating and studying issues like these dynamic market pressures which can impact social networks (doctors and patients) allows for a better understanding of real problems and opens the doors for meaningful improvements. These positive attributes; that of being self critical and self correcting, are part of what makes science based medicine –on balance- such an effective and successful practice as it thrives even in the buffeting winds of demanding special interests.