The Nature of Science

Showing posts with label Health. Show all posts

The 10,000 Mile Diet

This article, Shop locally, eat globally? , appeared in today's edition of our university bulletin. I thought it was worth posting a link because, unfortunately, many of my relatives, friends, and colleagues think you can support a large city by only eating food grown within one hundred miles (161 kilometers).

Pierre Desrochers knows how to serve up controversy. When an acquaintance mentions she follows a 100-mile diet to help the environment, Desrochers calmly asks how much energy it takes to heat an Ontario greenhouse.

When a colleague lauds local food as more nutritious than products shipped thousands of miles, Desrochers politely points out that the diet of a 19th-century German peasant consisted of lentils and peas.

Now, the University of Toronto Mississauga geography professor has published a controversial new book that goes beyond polite mealtime conversation and pits what Desrochers calls the “romanticism” of local eating, or locavorism, against the realities of a global food-supply chain.

Desrochers is the co-author of The Locavore’s Dilemma: In Praise of the 10,000-mile Diet, in which he argues that we should stop obsessing about how many miles our food has travelled to get to our dinner plate.

“Three centuries ago most people were eating local food,” Desrochers says. “Why do we think the world moved away from that? There are significant benefits—particularly, environmental and economical—in collaborating to produce food in the best geographic locations.”

Don't Muzzle Our Doctrors

Last summer, the Ontario College of Physicians and Surgeons published a draft proposal on Non-Allopathic (Non-Conventional) Therapies in Medical Practice. It was horrible. As I noted at the time, "The document is flawed from the beginning because it gives credence and respectability to "alternative medicine," otherwise known as non-evidence based medicine or quackery" [Non-Allopathic (Non-Conventional) Therapies in Medical Practice].

Many groups took notice of the draft policy and criticized the Ontario College of Physicians Surgeons for their gutless response to a serious crisis in health. One of those groups was the Committee for the Advancement of Scientific Skepticism, a committee of Canada's Centre for Inquiry [Media Advisory: Ontario Doctors Given the Green Light to Promote Quackery]. The members of CASS worked hard to lobby for changes and they co-ordinated their activities with several other groups that are opposed to the weak-kneed position of the College.¹ The College conducted a survey of its members and discovered that 78% of them opposed the draft policy. About one third of the people who filled out the survey were directed to the site by CASS or its allies [Skeptical Activism Sends a Message to CPSO. Very impressive.

Those behind-the-scenes activities had an impact as more and more people voiced their criticism on the FeedBack Site.

All this lobbying convinced the Toronto Star newspaper that something serious was afoot and yesterday, Sunday Nov. 20, 2011, the newspaper published an editorial that sides with science [Don’t muzzle our doctors]. The paper deserves praise for getting it right and giving us hope that science will win in the end..

Patients walk into allergist Dr. David Fischer’s office almost every day expressing interest in trying “natural” therapies. These range from harmless diet changes to the truly bizarre, like applied kinesiology, says the Barrie physician. It’s an experience shared by other doctors. “We’re on the front line of dealing with ideas for which there is often a dearth of scientific evidence.”

Alternative medicine is booming even without much proof it works. A record 20,000 people are expected at Toronto’s Whole Life Expo at the downtown convention centre next weekend. Three-quarters of Canadians regularly use some form of natural health product, opening their wallets to spend at least $4.3 billion yearly. And the herbs and homeopathic tinctures they buy are just one facet of unconventional medicine — a thriving sector encompassing everything from acupuncture to zone therapy (supposedly stimulating the body’s organs through hand or foot massage).

Ontario’s College of Physicians and Surgeons is bending to the trend with a new policy inhibiting doctors’ criticism of unconventional therapies. In doing so it risks encouraging even broader use of dubious and potentially harmful treatments.

Make no mistake — blind trust in alternative cures can be dangerous. An unknown number of Canadians are opting out of science-based medicine to treat even deadly conditions, like cancer, with unproven “natural” approaches.

....

The field of allergy medicine, Fischer’s specialty, is especially prone to alternative approaches. Natural practitioners using applied kinesiology, for example, check for allergy by placing a food item in a patient’s mouth or in their hand. Then they pull down on the person’s free arm to assess its strength. If this “muscle testing” shows notable weakness, the patient is deemed to be allergic.

There is no good evidence that this method works, and no sound scientific reason why it should. Yet patients come in with an interest in that, says Fischer. “I’d like to be able to tell them it’s quackery.”

He may not be in a position to say so much longer under a new policy proposed by the college of physicians and surgeons. It states that doctors are obliged to give a patient their best professional opinion on an alternative treatment goal or decision, but physicians “must refrain from expressing personal, non-clinical judgments.”

....

There’s no denying alternative medicine is immensely popular. Patients are more independent than ever before, often researching their illness and trusting their own solutions. And a host of unconventional “natural” healers has risen capitalizing on that trust — offering unproven therapies with little validity and which, in some cases, are a menace.

The college shouldn’t seek to accommodate that trend or retreat to a neutral corner. Rather it should leave doctors free to punch hard against those peddling dubious cures and to challenge people’s comforting, but irrational, beliefs. Science-based medicine serves patients best. If doctors can’t vigorously defend it, who will?

1. I'm a member of CASS but I had nothing to do with this campaign.

Non-Allopathic (Non-Conventional) Therapies in Medical Practice

The College of Physicians and Surgeons of Ontario has produced a draft policy on Non-Allopathic (Non-Conventional) Therapies in Medical Practice. The document is flawed from the beginning because it gives credence and respectability to "alternative medicine," otherwise known as non-evidence based medicine or quackery.

The policy is designed to provide guidelines for physicians who are: (1) tempted to employ non-evidence based medicine, (2) tempted to condone non-evidence based medicine in situations where it might harm patients. We all recognize that front-line physicians face these issues all the time and they often find themselves in a position where they disagree with the choices their patients are making.

However, most physicians don't hesitate to tell you that you should stop smoking. They seem to enjoy lecturing you on the benefits of diet and exercise even when it's clear that a patient prefers a different lifestyle. Why should it be any different when a patient reveals that they are taking homeopathic concoctions or when they refuse to vaccinate their children. Don't physicians have a professional responsibility to inform their patients that they are making unwise decisions?

The draft policy address these issues but it does so in a way that's far too lenient toward quack medicine. To begin with, it defines allopathic medicine as,

Different operative terms have been adopted that were deemed to be value-neutral: ‘Allopathic medicine’ refers to traditional or conventional medicine (as taught in medical schools) and ‘non-allopathic therapies’ refer to complementary or alternative medicine.

This is idiotic. "Allopathic" medicine is NOT a value-neutral term. It's the term used by homoepathic quacks to describe medicine that uses drugs to treat patients. By adopting this terminology, the College of Physicians and Surgeons is playing right into the hands of the quacks.

Allopathic Medicine: refers to the type of treatment, diagnostic analysis and conceptualization of disease or ailment that is the primary focus of medical school curricula and which is generally provided in hospitals and specialty or primary care practice.

Non-Allopathic Therapies (Non-Conventional Therapies): refers to a broad range of procedures or treatments that are not commonly used in allopathic medicine; this includes those referred to as complementary or alternative. Non-allopathic therapies tend to differ from allopathic medicine in terms of diagnostic techniques, theories of illness and disease, and treatment paradigms. The categorization of specific therapies as non-allopathic is fluid: as clinical evidence regarding efficacy is accumulated, certain non-allopathic therapies may gain broad acceptance and thus be accepted in allopathic medicine.

I work in a medical school. The operative phase is "evidence-based medicine" and I suspect that's a term used in most medical schools in Ontario. That's what is taught in medical schools and hospitals and that's how you describe proper medicine.

The opposite of evidence-based medicine is "non-evidence-based treatment." Those are not "value-neutral" terms. They are something different—it's called "truth," and truth is not neutral. The College of Physicians and Surgeons needs to acquire some gumption and stand up for what's being taught in the medical schools and stand up for science. This draft policy is ridiculous, it announces that the College is abandoning science and evidence in favor of condoning quackery.

Here's how the draft policy would read if we substitute the true definitions.

Respect Patient Autonomy

Patients are entitled to make treatment decisions and to set health care goals that accord with their own wishes, values and beliefs. This includes decisions to pursue or to refuse evidence-based or non-evidence based therapies.

The College expects physicians to respect patients’ treatment goals and decisions, even those which physicians deem to be unfounded or unwise. In doing so, physicians should state their best professional opinion about the goal or decision, but must refrain from expressing non-clinical judgements.

Nothing has been lost by using "evidence-based" instead of "allopathic." Now, let's look at the meaning of this policy statement.

It's classic gobbledygook because it confuses "respect" with "responsibility." Physicians are not obliged to "respect" parents who refuse to give their child a life-saving blood transfusion. They aren't obliged to "respect" parents who deny their children vaccinations. They certainly don't "respect" parents who abuse their children. And I've never encountered a physician who "respects" smokers and drug users, have you?

Lots of patients don't earn respect and don't deserve it.

Read the guideline carefully as I amended it. If they were adhered to, then no physician could possibly recommend non-evidence based therapies since that would conflict with their professional opinion (or, at least it should). But later on we read,

Providing Non-Allopathic Therapies

When providing non-allopathic therapies, physicians are expected to demonstrate the same commitment to clinical excellence and ethical practice, as they would when providing allopathic care.

What the heck is that all about? The policy should read ...

Any physician who provides non-evidence based therapies (especially for a fee) will be subject to charges of professional misconduct and may lose his/her license to practice medicine in Ontario.

That's the only sensible policy that's consistent with what's written elsewhere in the document. You simply can't provide non-evidence-based therapies while maintaining "a commitment to clinical excellence and ethical practice." That's oxymoronic.

The Committee for the Advancement of Scientific Skepticism (CASS) is very interested in this issue. Read what Michael Kruse has to say on his blog Skeptic North: Ontario Doctors Given Green Light to Promote Quackery.

I would not be writing this if I thought we could do nothing to oppose and change the viewpoint of the CPSO. That is why CASS is calling on members of both the public and the medical field to read the policy and comment on it. There is strong representation in the current comments of supporters of alternative medicine and we do not want all of the feedback to be pro-pseudoscience. Please visit the CPSO policy site above and fill out the comment form available at the bottom of the page. The deadline for this consultation is September 1st 2011, so we must move quickly and let the CPSO know the safety of Ontarians depends upon sound medical opinion based on modern scientific evidence.

Please voice your opinion at Feedback: Non-Allopathic Therapies draft policy. Your response has to sent by email to ThirdPartyProcesses@cpso.on.ca. I have no idea how much censorship is applied to the responses they post—I suspect it's considerable so don't expect criticisms to appear on the website.

Don't Mess with Skepchick!

Skepchick asked you to boycott movie theaters that were showing the anti-vaccine video promoted by Age of Autism [Let’s all go to the movies and save ourselves some lives]. Many of us posted complaints on the AMC website.

Yesterday Age of Autism and SafeMinds released the following statement as reported in the latest posting on Skepchick [Good guys win!]. Congratulations Skepchick!

SafeMinds was notified late yesterday afternoon that AMC Theaters has decided to block the SafeMinds Public Service Announcement (PSA) on influenza vaccines with mercury. The PSA alerts parents and pregnant women of the presence of mercury in most influenza vaccines and the ample availability of mercury-free alternatives. The CDC has declined to give a preference for the mercury-free versions, so it is important that the public is aware of its options. AMC’s advertising representative had reviewed and approved the PSA to run in AMC cinemas over the Thanksgiving weekend. A small group of vocal vaccine proponents dismissive of mercury concerns learned of the PSA and bombarded the AMC website, leading to the company’s decision to prevent its release. SafeMinds thanks its supporters who viewed the PSA and contributed to its efforts to educate the public to avoid unnecessary mercury exposure. Mercury in all forms is dangerous, especially to the developing fetus and infants, as referenced on the PSA website www.safemindsflu.org. SafeMinds will continue its mission to educate the public on this important healthcare topic.

BTW, the ad was NOT a public service announcement by any stretch of the imagination.

Teaching the Controversy About Homeopathy

I've got a confession to make. I've been posting about homeopathy this week but everything I've said has been negative. You know there must be another side to this "controversy" so in the interest of fairness, here it is. These homeopaths are putting forward the best possible case for taking homeopathic "remedies."¹

1. If you pay attention, you'll notice that there's no scientific evidence presented. You already know why.

[Hat Tip: Tony Burns]

More Homeopathic Woo: Super-Memory

This gets better and better as the week goes on. PZ Myers has discovered a company that markets fragments of DNA to promote good health. You don't actually eat the DNA, instead you drink water that has been exposed to the DNA [More Magic Snake Oil].

The company is called Homeovitality® and one of their products is Super Memory/IQ. I'm showing a picture of the product taken from their website in order to prove to you that it actually exists. This is part of the discussion concerning its scientific/medical efficacy—an important part of science education and social responsibility.

How does it work? Before I explain it to you, you'd better be sitting down. Try and remain calm.

There are two genes in your genome called CRM2 and SNAP-25. CHRM2 encodes a muscarinic receptors and various alleles of this gene have been associated with alcohol dependence and drug dependance, according to the Online Mendelian Inheritance in Man (OMIM) database [CHOLINERGIC RECEPTOR, MUSCARINIC, 2; CHRM2]. SNAP-25 encodes a synaptosomal-associate protein of 25kDa molecular weight. There have been reports that alleles of SNAP-25 are associated with hyperactivity but a separate study did not confirm this association according to OMIN [SYNAPTOSOMAL-ASSOCIATED PROTEIN, 25-KD; SNAP25].

Homeovitality® had some DNA sequences made for each of these genes: a 164 bp fragment in the case of CRM2 and a 144 bp fragment in the case of SNAP-25 [What is Homeovitality®?]. They used these pieces of DNA to make the Super Memory/IQ product.

Homeovitality® products have also been succussed at each dilution stage so they will also help to promote desirable forms of hybrid vigour in a “like promotes like” mode of action involving some of the mechanisms (4) described by Dr. Kratz, (http://kulisz.com/how_does_homeopathy_work.htm).

Homeovitality® products are safe because firstly, they are used at similar dilutions to classical homeopathic disease remedies and secondly, hybrid vigour is a completely natural biological process that has been developed by nature over millions of years to enable all creatures to enjoy “super health” and disease resistance.

"Succussed refers to the practice of forcefully striking the various dilution solutions in order to help "potentize" the effect. "Hybrid vigor" refers to the belief that these DNA sequences—or, more appropriately, the memory of these sequences—will produce heterozygosity in patients and that's a good thing.

The "Science" Behind Homeopathy

Are all homeopaths and their supporters complete idiots? Do they all think they're practicing some form of black magic? No, they usually don't think that at all. Many of them honestly believe that there's scientific evidence supporting homeopathy. They actually believe that water can retain some magical properties after it has been exposed to certain chemicals. How is this possible? It's because of "nanobubbles."

Here's John Benneth explaining the "science" behind homeopathy. This is woo of the highest order. Read Orac's take-down at Your Friday Dose of Woo: The physics of homeopathy and "nanocrystalloids". There are no reputable scientists who believe what John Benneth claims. If he's implying that there's scientific support for homeopathy, then what he's saying is not true.

Homeopathy Kills

Here's what can happen if a homeopath treats his own daughter. He ends up in jail, she ends up dead.

If Water Has a Memory ....

Yes, I'm aware of the fact there's another, possibly better, version of this poster using another word for "crap."

What Is Homeopathy?

Homeopathy awareness week is coming up and scientists from all around the world are gearing up to explain why homeopathy doesn't work—that's why it's called "alternative" medicine. It's a part of quack medicine that's not "real" medicine. Real medicine is based on scientific evidence.

Many people don't know what homeopathy is all about. They confuse homeopathy with a host of other forms of non evidence-based medicine like naturopathy and herbalism. That's a big mistake. Homeopathy is a form of treatment where you drink water that supposed to contain the magical imprint of some chemical. The chemical is often quite dangerous but, don't be worried, it's not really present in the treatment you pay for.

Here's the Wikipedia description of homeopathy.

Homeopathy (also spelled homoeopathy or homœopathy) is a form of alternative medicine, first proposed by German physician Samuel Hahnemann in 1796, that attempts to treat patients with heavily diluted preparations. Based on an ipse dixit[1] axiom[2] formulated by Hahnemann which he called the "law of similars", preparations which cause certain symptoms in healthy individuals are given as the treatment for patients exhibiting similar symptoms. Homeopathic remedies are prepared by serial dilution with shaking by forceful striking, which homeopaths term "succussion," after each dilution under the assumption that this increases the effect of the treatment. Homeopaths call this process "potentization". Dilution often continues until none of the original substance remains.

Don't confuse it with anything else. There's absolutely no evidence that homeopathy works. The scientific data, taken as a whole, is conclusive. Be wary of those who believe in homeopathy because their advice on other forms of treatment may not be based on evidence either. Homeopathy is bad enough but it often keeps even worse company.

Shona Holmes and Canadian Health Care

Shona Holmes is a Canadian citizen. She suffered from a number of symptoms including dizziness and loss of vision. Her family doctor in Canada sent her for an MRI and the results suggested a brain tumor. Homes might have to wait months before seeing a neurologist for further tests. (This hasn't been confirmed, to my knowledge.)

Shona Holmes decided to fly to the the Mayo Clinic in Scottsdale Arizona. There she was eventually diagnosed as having a Rathke's cleft cyst (RCC) in her brain. This is not a tumor and it is not life-threatening. It does, however, threaten her vision, which was already impaired.

Eventually, after more tests and at least one further visit to Scottsdale, the cyst was removed. It's not clear how long it took from making the first appointment at the clinic to the actual surgery but the article on the Mayo Clinic website suggests it was about a month. Incidentally, this article has been removed from the Mayo Clinic website but it is cached here.

The bottom line is that Holmes suffered from a non-life-threatening cyst that affected her vision and could have eventually led to blindness. She choose not to wait for treatment in Canada but to pay for treatment in Arizona.

Shona Holmes is suing the Government of Ontario in order to force it to revise and/or dismantle public health care. The suit [Lindsay McCreith and Shona Holmes/The Attorney General for the Province of Ontario] is being supported by the Canadian Constitution Foundation, a right-wing group that's described here.

To summarize, we have a patient with a non-life-threatening brain cyst who may or may not have had to wait a long time for treatment in Canada but choose to go to an American clinic where she was operated on after about a month. This patient is sufficiently opposed to Canada's health care system that she has collaborated with a right-wing group to sue the Government of Ontario for allegedly violating her rights.

Oh yes, one more little bit of information, this is the same Shona Holmes you see in this video warning Americans about the dangers of universal health care. This Shona Holmes was going to die of a brain tumor if she had stayed in Canada.

It's pretty clear that Holmes is not telling the truth in the TV ad. The only question is whether she "misinformed" the group Patients United Now or whether they pressured her into making untrue statements in the TV add. Canadian Cynic wants to know [Shona Holmes: Useful idiot or puppetmaster?].