ScienceBlogs Channel : Medicine & Health

PAPupuncture? On the rebranding of regional anesthesia as acupuncture [Respectful Insolence]

Orac none@example.com — Mon, 21 May 2012 04:00:00 -0500

Acupuncture has been a frequent topic on this blog because, of all the "complementary and alternative medicine" (CAM) modalities out there, it's arguably the one that most people accept as potentially having some validity. The rationale behind acupuncture is, as we have explained many times before, little different than the rationale behind any "energy healing" method (like reiki, for example) in that it claims to redirect the flow of "life energy" (the ever-invoked qi). The only difference is that acupuncturists claim to bring this therapeutic qi rearrangement about by sticking thin needles into the pathways in the body through which this qi is fantasized to flow. These pathways, called meridians, are just as much a fantasy as qi itself or the "universal source" that reiki masters claim to be able to channel through themselves and into believers. Contributing to the popularity of acupuncture is its mythology as having been routinely practiced for over two thousand years, a myth that was the creation of Chairman Mao, who elevated what was a marginal practice at the time to a modality that the state supported and promoted (1,2,3,4).

In addition, because acupuncture involves sticking actual metal objects into the skin rather than simply laying on hands or making magical gestures over the patient, it retains some credibility, even among doctors. It doesn't matter that, reviewing the totality of the research, one finds that it doesn't matter where you stick the needles or even if you stick the needles in the skin. The results are the same and indistinguishable from placebo. The inescapable conclusion is that acupuncture is placebo medicine with needles. Personally, I'd prefer my placebo medicine without needles, but that's just me.

Yet, the studies keep rolling in, trying desperately to demonstrate that acupuncture works or assuming that acupuncture works. I wrote about one of them just last week. It was a study that purported to show that acupuncture is a useful modality for reducing breathlessness and air hunger in patients with chronic obstructive pulmonary disease (COPD). As you might also recall, I found it underwhelming. I also recently became aware of a study that I just had to write about because it builds on the results of a study I wrote about two years ago that I characterized at the time as an interesting study whose authors seemed almost willfully to misinterpret their results. This one, thankfully, is not nearly as hyped as the study from two years ago, but it is very instructive how the original misinterpreted story is leading to a classic CAM "bait and switch" applied to acupuncture. Normally, we like it when science builds upon previous results, but it's not so great when a scientists "builds" upon an inappropriate interpretation of a study designed to legitimize quackery. Before I get to the present study, first let's look at the original study that inspired this followup.

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In which Orac basks in the adoration of an antivaccine fan... [Respectful Insolence]

Orac none@example.com — Fri, 18 May 2012 07:00:00 -0500

I'm sometimes asked why I do this. Why, people ask me, do I spend so much time generating post after post after post day after day after day? Obviously, one reason is that it interests me. Another reason is the passion that drives me to support science and science-based medicine and to detest the damage the pseudoscience, particularly pseudoscience in medicine, can do. There is, however, at least one more reason.

I'm referring, of course, to the adoration of my "fans."

Yes, the more I'm attacked, the more I know I've been effective against the forces of irrationality and pseudoscience. When someone like, say, J.B. Handley of the antivaccine crank organization Generation Rescue attacks me, I know I've hit a nerve. True, there is the problem that the forces of pseudoscience and quackery all too often prefer to attack through proxies; i.e., trying to get their enemies fired by harassing them at work. Be that as it may, there is no sweeter music than the outraged howls of a quack whose quackery has been punctured by the lance of reason, with the possible exception of Led Zeppelin.

It's even better when the quackery supporter in question is from a famous, high profile repository of woo, and the other day I hit the motherlode. Well, not quite. It wasn't NaturalNews.com, and it wasn't Mercola.com. No, it wasn't Whale.to either (although I have achieved the "honor" of having a page on Whale.to devoted to me.) It wasn't even Age of Autism (although I must really be falling down on the job; AoA hasn't mentioned me in quite a while). No, in some ways it's better. I've managed to annoy a blogger whose posts show up both on that all-purpose crank, Lew Rockwell, and--even better, Prison Planet, the all purpose conspiracy theory website. It's a hilarious post by someone named Karen De Coster entitled The Vaccination Nation Aggressors Are the Neocons of the Health World. (Here's the Prison Planet version and the version posted on De Coster's very own personal blog.) At least now I know what the comment thread after that nine month old post started perking up again with antivaccinationists taking me to task.

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The (not so) Thinking Moms' (D)evolution continues apace [Respectful Insolence]

Orac none@example.com — Thu, 17 May 2012 06:00:00 -0500

About a week ago, I took note of what appears to be a new offshoot of the antivaccine movement known as the Thinking Moms' Revolution (TMR). At the time, I pointed out the toxic combination of hubris mixed with ignorance that resulted in a risible "declaration of independence" from "medical tyranny." In reality, it was one long antivaccine rant full of long refuted myths and pseudoscience combined with a demand for an unethical study of the current vaccine schedule verus placebo. In brief, to anyone with half a brain, it would have been embarrassing. Apparently the woman who wrote it lacks even that intellectual capacity, belying the name "thinking moms."

One thing that the "declaration of independence" was about more than anything else was hostility towards scientific medicine. Indeed, the "independence" demanded was, more than anything else, "independence" from science-based medicine, about "freedom" to refuse vaccination based on misinformed consent that paints vaccines as dangerous--deadly, even--and denies their proven efficacy in preventing morbidity and mortality from infectious disease. More of this hostility was on display over the last week or so in the form of two posts. The one I noticed first appeared yesterday and demonstrates the pure hostility towards medical science of these 'thinking moms" directed at an individual physician as a surrogate for the vaccines they hate and the science that shows the worthlessness of "biomedical" autism quackery. It's in the form of an open letter entitled The Letter I Wish I Could Send To My Old Pediatrician. And so it begins:

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Now there's some "anti-science"... [Respectful Insolence]

Orac none@example.com — Wed, 16 May 2012 06:30:00 -0500

I'm sometimes criticized for referring to various people who are "anti-science" as, well, "anti-science." People, for whatever reason, have a hard time believing that anyone is anti-science; so when I point out how much, for example, antivaccinationists, alternative medicine believers, or creationists are anti-science, they have a had time believing it. This is particularly true because, just as antivaccinationists loudly protest that they are not "antivaccine," those who are anti-science equally loudly protest that they are not "anti-science." Such protestations are almost inevitably followed by statements that demonstrate beyond a shadow of a doubt that they are in fact anti-science.

That's why Mike Adams of the quack website NaturalNews.com is so useful. Whenever anyone doubts that there can be someone who is anti-science to the core, all I do is point him to Mike Adams. Last week, in fact, Adams provided me just such an example of his anti-science proclivities that I had meant to blog about at the time but didn't get around to it. In a way my not covering it when it was originally published was a good thing in that it gave Adams time to write a followup post that makes my point better than I ever could. I'll show you what I mean.

The first post appeared a little over a week ago and was entitled, histrionically enough, Human race being terminated by 'scientific suicide'. To call this post an example of crank magnetism liberally spiced with anti-science propaganda is a major understatement, all mixed in with a heapin' helpin' of pure arrogance:

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Acupuncture and COPD? Not so fast... [Respectful Insolence]

Orac none@example.com — Tue, 15 May 2012 03:00:00 -0500

I acquiesce.

I know that I'm not going to have a lot of control over my selection of blogging material for a given day when I see more than one or two requests for an analysis of an article. So it was, when links like these were showing up in my e-mail:

These two news stories refer to a study from Japan by Suzuki et al published online yesterday in the Archives of Internal Medicine entitled A Randomized, Placebo-Controlled Trial of Acupuncture in Patients With Chronic Obstructive Pulmonary Disease (COPD): The COPD-Acupuncture Trial (CAT). It is just what it sounds like: A test of acupuncture on COPD. First, let's see what these news stories say about it, beginning with U.S. News and World Report:

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The Pill for HIV: No, really, this is a bad idea [erv]

ERV none@example.com — Mon, 14 May 2012 12:00:02 -0500

So some panel at the FDA just approved this antiretroviral drug, Truvada-- they say its okay to prescribe this drug for HIV negative people to keep them from getting HIV.

Im going to this news the nicest way possible:

I think there were a lot of MDs, and very few PhDs, on this FDA review panel. If you know what I mean.

:-|

...

:-|

I have been over this before--

The Pill for HIV-1
The Pill for HIV-1: Never mind
The Pill for HIV: A bad idea, actually

--Prescribing an antiretroviral to negative individuals to prevent HIV is a neat idea. When it comes to this particular antiretroviral, it appears to be a very stupid idea. It has life threatening side effects, it has been shown to have a positive effect on some populations in one study, it has been show to have absolutely no effect in others. And then its ridiculously expensive-- $11K a year.

Know what we *know* works, has no adverse effects, and is dirt cheap?

CONDOMS.

So we are going to give these drugs to people who dont need them (wear a goddamn condom), while people who *do* need them (HIV+ individuals) are having their coverage cut domestically and abroad, and then there is this minor thing we have to deal with with HIV... DRUG RESISTANCE.

You have to take drugs like this *religiously* for them to have the best chance of working (and even then, drug resistance develops). Ask any chick on The Pill, anyone who has to take blood pressure meds every day, or hell, even when you are on antibiotics for a week for a UTI or something-- everyone forgets a pill now and then. Lets imagine what happens if you forget a pill if youre taking antiretrovirals to prevent HIV infection-- you forget one pill, take one the next day, whatevs. Not whatevs. If youre exposed to the virus, it will be replicating in non-therapeutic levels of the antiviral. You will be selecting for variants of the HIV quasispecies that are resistant to the virus. In the mean time, youre thinking 'IM TAKING ANTIRETROVIRALS! IM FINE!!!' and not regularly getting tested for HIV. So HIV gets to thrive and have a great time, even in the presence of Truvada. And then you have sex with someone else "IM ON THE HIV PILL WE CAN TOTALLY BAREBACK IT!!! **HIGH-FIVE**" and you transmit a highly fit, drug resistant variant of HIV to someone else. And now they cant use some kinds of antiretrovirals because they wont work.

There is *one* instance where I think this is a good idea-- if you have got a genetically vain HIV discordant heterosexual couple who have threatened to kill themselves/everyone if they dont conceive a child together. And even then, only when they are trying to conceive. And even then, only with an antiretroviral that is proven to work for these purposes (the Truvada trials that were stopped were with heterosexual women).

In all other instances, this is a TERRIBLE idea.

JUST WEAR CONDOMS.

WEAR CONDOMS.

JUST WEAR GODDAMN CONDOMS, PEOPLE.

And its not just me--

"Truvada needs to be taken every day, 100 percent of the time, and my experience as a registered nurse tells me that won't happen," Karen Haughey told the panel. "In my eight years, not one patient that I've cared for has been 100 percent adherent."

...

The AIDS Healthcare Foundation, which opposes approval of Truvada, estimates that 20 HIV-positive patients could be treated for the cost of treating one patient with preventive Truvada.

This is stupid.

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"Plausibility bias"? Try "reality bias" when it comes to clinical trials. [Respectful Insolence]

Orac none@example.com — Mon, 14 May 2012 03:00:22 -0500

Last week, I pointed out that, when referring to a therapy and considering whether it should be tested in clinical trials, plausibility does not mean knowing the mechanism. Today, I intend to elaborate a bit on that. As my jumping-off point, I couldn't ask for anything better (if you can call it that) than an article by homeopaths published last week online in Medicine, Health Care, and Philosophy entitled Plausibility and evidence: the case of homeopathy. You'll get an idea of what it is that affected Orac like the proverbial matador waving his cape in front of a bull by reading this brief passage from the abstract:

Prior disbelief in homeopathy is rooted in the perceived implausibility of any conceivable mechanism of action. Using the 'crossword analogy', we demonstrate that plausibility bias impedes assessment of the clinical evidence. Sweeping statements about the scientific impossibility of homeopathy are themselves unscientific: scientific statements must be precise and testable.

Scientific. You keep using that word. I do not think it means what you think it means. Of course, his being a homeopath is about as close to a guarantee as I can think of that a person doesn't have the first clue what is and is not scientific. If he did, he wouldn't be a homeopath. Still, this particular line of attack is often effective, whether yielded by a homeopath or other CAM apologist. After all, why not test these therapies in human beings and see if they work? What's wrong with that? Isn't it "close-minded" to claim that scientific considerations of prior plausibility consign homeopathy to the eternal dustbin of pseudoscience?

Not at all. There's a difference between being open-minded and being so "open-minded" that your brains threaten to fall out. Guess which category homeopaths like Rutten fall into. But to hear them tell it, homeopathy is rejected because because we scientists have a "negative plausibility bias" towards it. At least, that's what Rutten and some other homeopaths have been trying to convince us. This article seems to be an attempt to put some meat on the bones of their initial trial balloon of this argument published last summer, which Steve Novella duly deconstructed.

Before I dig in, however, I think it's necessary for me to "confess" my bias and why I think it should be your bias too.

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Settling Conflicts: Guns and Homeschooling [Greg Laden's Blog]

Greg Laden none@example.com — Sun, 13 May 2012 10:06:24 -0500

There was a time when I blogged regularly about homeschooling, though I have not done so in a long time. A while back I started to blog about gun ownership. I engaged in each of these topics for similar reasons. I have a political and professional interest in homeschooling (as a science educator) and a complex culinario-political interested in guns (as a political progressive who likes to eat wild animal but does not like people shooting each other). But the reason I blogged about these issues was more narrowly defined. I wanted to see if it was possible to achieve détente among people with dramatically different perspectives on a specific issue.

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If your toddler falls from your window, will it necessarily die? [Greg Laden's Blog]

Greg Laden none@example.com — Sat, 12 May 2012 09:51:07 -0500

No! A surprising number of toddlers who manage to get their way through a window opening to fall to the pavement below live. Something just over three thousand toddlers do this every year in the US.

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Your Friday Dose of Woo: Heal your genome? [Respectful Insolence]

Orac none@example.com — Fri, 11 May 2012 08:00:18 -0500

It's been a while since I've done a bit of Your Friday Dose of Woo, and I actually kind of miss it. It's not that there hasn't been anything that hasn't been worthy of this "honor" for a while. On the other hand, there hasn't been anything in a while that combines just the right proportions of pure woo, utter ridiculousness, and pure pseudoscience to provide the perfect "inspiration" to start me on a roll. Oh, it's out there, but for some reason I've let myself become bogged down by topics that are just too serious. It's time to lighten up, at least for a little while.

So it was when I came across something that would be scary if it weren't so obviously nonsense as I was in Scottsdale last weekend attending a meeting. Now, you might not know this (or you might very well know it), Arizona is woo central, so much so that it even licenses "homeopathic physicians" and even lets these quacks do surgery. Indeed, not within a couple of hours of where I stayed is Sedona, which might as well be the capital of crystal nation, and, the last I heard, the Health Ranger himself Mike Adams was living near Tucson, while the "Phaelosopher Adam Abraham" apparently lives in Phoenix. We last met him a few months ago when he was combining energy woo with The Secret.

Now, Abraham has kicked it up a notch, advertising what he calls the Genome Healing Workshop, which will take place from June 11-18 in Scottsdale. The woo is truly strong in this one:

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Two more tragic tales of Burzynski patients [Respectful Insolence]

Orac none@example.com — Thu, 10 May 2012 09:00:00 -0500

One of my newer blogging interests is the "alternative" cancer doctor named Dr. Stanislaw Burzynski. Although I had heard of him years ago, mainly in the context of his desperate patients tapping into the generosity of kind-hearted strangers to pay for his "antineoplaston" therapy, I hadn't really written much about him until very recently. About six months ago, Burzynski came to my attention because of his clinic's use of an Internet legal thug named Marc Stephens, who threatened skeptical bloggers with legal action after they had criticized the Burzynski Clinic and then later disavowed him in apparent embarrassment with a classic not-pology. It was at that point that I posted a trio of articles about the dubiousness and lack of science behind Burzynski's therapy and his claims for it, starting with a deconstruction of antineoplaston therapy and Burzynski's propaganda movie, then moving on to a discussion of why his "personalized gene-targeted cancer therapy" is basically "Personalized Medicine for Dummies" incompetently administered with an "everything but the kitchen sink" approach to highly expensive targeted therapies mixed with chemotherapy, and finishing with how Burzynski has gravitated to overselling an orphan drug that shows mild promise in some cancers because it is a prodrug for one of his antineoplastons.

One thing I had been looking forward to after focusing my attention on Burzynski was his hearing before the Texas Medical Board. It was originally apparently scheduled for January 2012, but then apparently delayed to April 11, 2012. Unfortunately, it's been delayed again. Although it looked as though Burzynski might slither away from justice again, what I've learned is that there has simply been a continuance. There will be more legal wrangling, and eventually there will be a hearing. It can't come too soon, but unfortunately Burzynski continues to practice during the months of delay.

The thing that bothers me the most about Burzynski is how he offers false hope to patients with terminal cancer at a cost of tens--or, commonly, hundreds--of thousands of dollars. He offers his antineoplaston therapy under the auspices of clinical trials, but then requires that the patient pay exorbitant sums of money for drugs and treatments, even though requiring patients to pay to be in clinical trials is considered dubious at best and highly unethical at worst. These patients, desperate to grasp at what they perceive to be their last chance to live, then do all sorts of desperate things to raise the money, often including all sorts of fundraisers. Indeed, what piqued my interest was the reaction to the case of Billie Bainbridge, who raised loads of cash because various British celebrities took an interest in her case and participated in concerts for her charity. Meanwhile, Burzynski claims that he has higher success rates than conventional medicine, that he doesn't use chemotherapy (he does), and that his therapy is nontoxic (it isn't; it's quite toxic), selling it through interviews with credulous quackery promoters like Suzanne Somers. Elsewhere, on various patient discussion forums, Burzynski shills make it sound as though Burzynski is the only one who can save patients with stage IV cancer.

He ain't, and he can't.

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you read it here first [Dynamics of Cats]

Thu, 10 May 2012 01:14:21 -0500

prescience

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Once again: "Plausibility" does not mean "knowing the mechanism" [Respectful Insolence]

Orac none@example.com — Wed, 09 May 2012 03:00:00 -0500

I tend to get lost in complexity from time to time.

I know, big surprise to my regular readers, but I suppose it's a good thing that at least I know that this is a weakness of mine. Indeed, it must be part and parcel of my seeming tendency to produce epic posts of ridiculous length that sometimes surpass 5,000 words, although, in all fairness, my average post length is probably less than 2,000 words, which is still too long for many people but not beyond the pale. Of course, part of the reason for this is that I like to leave no stone unturned. In particular, I tend to like to make my refutations of the various bits of pseudoscience, quackery, and antivaccine nonsense that serve as the fodder for Orac-ian Insolence, Respectful and otherwise, as comprehensive as possible. I imagine the various ~~targets~~ topics of this blog, stung by having their bad science, logical fallacies, and bad reasoning punctured, looking for a single weakness that they can attack, believing that doing so will cause my entire argument in a post to come tumbling down. That's why I try to construct many of my posts like the proverbial spider web, with intermeshing arguments weaving together into what (I hope) is a seamless whole, where, even if I made a mistake in one area, the rest of the web remains sound. My computer 'nym notwithstanding, I am actually human and do occasionally make mistakes from time to time that go beyond typos or the occasional fragment or run-on sentence.

So it's a rare treat when I find a bit of nonsense that is not only allows me to explain a nice, simple principle that quacks frequently try to misrepresent for their benefit but actually foreshadows a post I was planning to do in the near future, I can't resist. It's therapeutic. Maybe I can even keep this post under 1,500 words (although I'm sure some smart-ass will note that I've already used up over 300.) That nonsense is, not surprisingly, a defense of homeopathy. It is, however, a defense based on a single statement and entitled If Homeopathy Can't Work, Then Neither Can Anesthesia. Not surprisingly, it's written by Heidi Stevenson, a homeopath whom we've met before pontificating about how anecdotal evidence is better than clinical trials and making nonsensical attacks on Stephen Barrett, but her screed is so brain dead that it could well have been written by Dana Ullman. Let's take a look, shall we.

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Dining In The Dark: There are a few tickets left! [Greg Laden's Blog]

Greg Laden none@example.com — Tue, 08 May 2012 23:09:31 -0500

Next week, Amanda and I will be Dining in the Dark. It has been determined that I will be wearing a suit.

If you are in the Twin Cities, why don't you join us! Click Here to find out what it is all about.

I just checked and there are a few tickets left. Better hurry!

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Supplements: Not mystical anticancer magic [Respectful Insolence]

Orac none@example.com — Tue, 08 May 2012 03:00:00 -0500

It's no secret that over the years I've been very critical of a law passed nearly 20 years ago, commonly referred to as the DSHEA of 1994. The abbreviation DSHEA stands for about as Orwellian a name for a law as I can imagine: the Dietary Supplement Health and Education Act. Of course, as we've pointed out time and time again, the DSHEA is not about health, and it's certainly not about education. Indeed, perhaps my favorite description of this law comes from blog bud and all around awesome internist Dr. Peter Lipson, who refers to it as a "travesty of a mockery of a sham." Rather, it's about allowing supplement manufacturers and promoters of so-called "complementary and alternative medicine" (CAM, with or without a preceding "s," depending on your taste) who do not want pesky things like government laws and regulations to interfere with their selling of pseudoscience to market various compounds as "dietary supplements" with near-impunity. As Harriet Hall once put it so accurately, the DSHEA is "a stealth weapon that allows the sale of unproven medicines just as long as you pretend they are not medicines."

The DSHEA accomplishes this by making a seemingly reasonable distinction between food and medicine and twisting it in such a way that allows manufacturers to label all sorts of botanicals and various other compounds, many of which have substances in them with pharmacological activity, and sell them as "supplements" without prior approval by the FDA before marketing. As long as the manufacturer is careful enough not to make health claims that are too specific, namely that the supplement can diagnose or treat any specific disease, and sticks to "structure-function" statements ("it boosts the immune system!"), almost anything goes, particularly if a Quack Miranda Warning is included.

Not surprisingly, given what a big business supplements have become in this country largely due to the DSHEA, manufacturers and CAM advocates fight tooth and nail against any attempt to update the DSHEA to correct some of its more unfortunate consequences. Led by supplement industry lap dog Utah Senator Orrin Hatch and Iowa Senator Tom Harkin, who together make up a bipartisan tag-team in defense of the supplement industry and do their best to block any effort to increase its regulation by the FDA. We saw that most recently when Arizona Senator John McCain, of all people, introduced a bill in 2010 to try to tighten up the DSHEA and was thoroughly slapped down by Orrin Hatch. More recently, not satisfied with how good things are for the supplement industry, another bipartisan team of woo-friendly legislators U.S. Representatives led by Utah's Jason Chaffetz (a Republican) and Jared Polis (a Democrat) introduced the Free Speech About Science Act, which basically seeks to allow the supplement industry to make more liberal claims about its products. All it will need is a "peer-reviewed" paper to support it (Mark and David Geier would do!), and you can claim almost anything. Anything to grow the supplement industry, which is currently around $30 billion a year.

That's why it's critical, from time to time, to look at actual evidence, and just last week Maria Elena Martinez, PhD, of the University of California San Diego, and co-authors did in a commentary published online in the Journal of the National Cancer Institute entitled Dietary Supplements and Cancer Prevention: Balancing Potential Benefits Against Proven Harms.

As several of us have pointed out before, there are science-based roles for supplementation. For instance, in the case of nutritional deficiencies, and Martinez et al point out the very same thing:

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Nature's Cures [Life Lines]

Dr. Dolittle none@example.com — Mon, 07 May 2012 18:44:36 -0500

Image: PopSci

Researchers have been finding treatments for various conditions in what might be considered by many to be the least expected place: venoms. These toxic substances can cause reactions ranging from mildly annoying to deadly depending on the animal. But in small doses or in purified forms, these toxins are just the right medicine for some people. Here are some drugs derived from various animals:

-Captopril, used to treat hypertension, isolated from pit vipers
-Exenatide (Byetta), used to treat diabetes, isolated from gila monsters
-Xen2174, used to treat severe pain, isolated from cone snails

For more examples, see the recent article in New Scientist

After figuring out the specific active ingredient in these venoms, scientists are able to create synthetic versions that can be mass-produced to avoid the need for "farming" these creatures.

Snake venom alone may contain any one of the following types of venom or a combination of toxins:
-Cytotoxins: initiates the digestion of prey. Like the name implies, it is toxic to cells, especially muscle cells. Some may target specific cells, like cardiac muscle cells causing heart failure while others may be more general.
-Hematoxins: destroys red blood cells, vessels or causes clotting.
-Neurotoxins: targets the nervous system.

With the wide variety of potential toxins in nature, it is likely that many treatments are just waiting to be discovered in animals.

Sources:
PopSci

New Scientist

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The (not so) Thinking Moms' (D)evolution's Declaration [Respectful Insolence]

Orac none@example.com — Mon, 07 May 2012 03:00:04 -0500

One of the most inaptly named groups I've ever seen is called Thinking Moms' Revolution (henceforth abbreviated as TMR). Given the reality of what TMR really is, the word "thinking" applied to TMR is, as they say, so wrong it's not even wrong. As for a "revolution," what TMR really represents is nothing revolutionary at all, unless you consider antivaccinationism, run-of-the-mill antiscience paranoia, and big pharma conspiracy theories to be "revolutionary." I don't know about you, but I do not. I've followed such activities for well over a decade now, and in light of that experience, perusing the TMR website, I am struck less by anything resembling "thinking" or "revolution" than by a smug sense of self-congratulation at how its members are allegedly not "brainwashed" like everyone else.

Don't believe me? Then look at the web page in which the "Thinking Moms" introduce themselves. I mean, gag me with the proverbial spoon (as they used to say in the 1980s). We have members going by the handles of Dragon Slayer, Goddess, The Booty Kicker, Killah, Savage, Saint, Princess, Mountain Momma, The Professor, and several others that are equally nauseatingly self-congratulatory. How edgy. How "revolutionary."

How tiresome. (Yes, I know I use a 'nym, but my little affectation is so obscure that very few readers know its significance. Come to think of it, few readers care about its significance even after I explain where it comes from. Maybe I should rename myself "Quack Killah." Yeah, that's the ticket...)

Not surprisingly, there's a lot of cross-pollination between TMR and the antivaccine crank blog Age of Autism. In fact, AoA is where I saw the most hilarious bit of arrogance yet from TMR, as it was published on AoA first. Apparently the "Thinking Moms'" opinion of themselves goes beyond thinking that they understand immunology, vaccine science, pharmacology, toxicology, and drug development better than...oh, you know...actual scientists. Apparently the "Thinking Moms" view themselves as revolutionaries on par with the Founding Fathers, so much so that they have posted their very own Declaration of Independence from Medical Tyranny. I was going to say that "words fail me," but you know that would be a lie. If that were the case, this would post would be just a brief link with a suggestion that you all point and laugh. Instead, however, I see a great deal that reveals the mindset not just of antivaccinationists but of quacks and cranks in general.

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I know you are, but what am I? [Respectful Insolence]

Orac none@example.com — Fri, 04 May 2012 08:00:00 -0500

Denialism. You keep using that word. I do not think it means what you think it means.

The story might be apocryphal, and it might not even be true, but it's often used as a metaphor. I'm referring to the "boiling frog" story. Basically, the idea is supposedly based on an observation that a frog, when placed in a pot of hot water, will immediately jump out. However, or so the story goes, if the frog is placed in room temperature water and the water is heated gradually enough, the frog won't notice and will eventually boil to death without trying to escape. The metaphor, of course, is designed to illustrate how people will almost always notice rapid change, but, if the change is sufficiently slow, might not notice it at all and will readily acclimate themselves to the new situation if given sufficient time. Of course, the phenomenon underlying this metaphor might very well not even be real, but it's still probably a useful metaphor.

Being in the skeptic movement and having been very active over the last seven years blogging about skepticism, promoting science-based medicine, and combatting the antivaccine movement, this metaphor might be the reason why I didn't notice a particular tactic being increasingly used by denialists of all stripes until relatively recently, which is also relatively late. It took Mark Hoofnagle, who had disappeared from the skeptical blogging front for a couple of years pursuing his general surgery residency, to be slapped in the face with it and comment to me that he had been noticing this phenomenon upon returning to blogging about science denialism on his very own denialism blog. He was right, but in fact denialists had been doing this for a long time, and it was only a shock to Mark because he had stopped paying attention for a while and then was, like the proverbial frog, thrown back into the water.

Part of what led me to think about this phenomenon was a doozy of a post published on--where else?--that wretched hive of scum and quackery (no, not The Huffington Post--I mean that other wretched hive of scum and quackery), the antivaccine crank blog extraordinaire, Age of Autism. The post is by someone whose name is not familiar to me as one of the regulars, Cathy Nevison, and entitled Autism and the Antarctic Ozone Hole. Yes, in this post, Nevison does exactly what the title implies and tries to liken "autism epidemic denialists" to anthropogenic global warming denialists. Before I delve into the numerous deficiencies in Nevision's crank arguments, I do have to pause to express amusement about a passage right in the first paragraph:

A recent Associated Press report that 1 in 88 American children has an autism spectrum disorder (ASD) asserts that, "Better diagnosis is largely responsible for the new estimate..." Another AP report, on a study finding that 1 in 38 South Korean children has an ASD, quotes the lead author as saying, "It doesn't mean all of a sudden there are more new children with ASDs. They've been there all along, but were not counted in previous prevalence studies." These are extraordinary claims and examples of autism epidemic denial. Equally remarkable is that the AP presents them as unquestioned truth, making no effort to counter them with dissenting viewpoints. In contrast, the media has been diligent about "balancing" articles on the threat of climate change with opposing views from "climate skeptics," which has contributed to climate change denial.

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NCCAM: I say we take off and nuke the entire center from orbit. It's the only way to be sure. [Respectful Insolence]

Orac none@example.com — Thu, 03 May 2012 03:23:19 -0500

Over the years that this blog has been in existence, beginning very early on, there has been one overarching theme. That theme is that the best medicine is science-based medicine. Sure, we could quibble about how that was originally defined, and I used to be more of a booster of evidence-based medicine until its blind spot with respect to "complementary and alternative medicine" (CAM) and "integrative medicine" (IM). That blind spot, as I've explained time and time again, both here and elsewhere at my not-so-super-secret other blogging location under my real name, that blind spot is prior plausibility. Once I learned about John Ioannidis, Bayesian statistics, and how doing clinical trials with a low prior plausibility is far more likely to produce false positive results than true positive results, I realized that testing modalities with incredibly low prior plausibilities is so unlikely to be fruitful that it's only something that should be considered when money is no object, and that's even leaving aside the dubious ethics of doing clinical trials of treatments like that.

And, of course, money is always an object, arguably now more than ever.

The normal sequence of development of a drug or treatment is a progression from preclinical research (basic and translational science that can involve any combination of biochemical studies, cell cultures studies, and animal studies) to early stage pilot clinical trials. If the drug or treatment shows promise in these early studies, then--and only then--are large phase III clinical trials warranted. In an ideal world, basic science considerations determine plausibility, translational preclinical studies solidify the plausibility of a treatment, and then clinical trials confirm whether that plausibility translates into a working therapy that is both efficacious and safe. Similarly, in an ideal world, the first steps of this process are informed by clinical observations that lead to laboratory investigations that progress through the various steps to clinical trials. The paradigm of bedside to bench and back to bedside often works. Indeed, the entire ethics of our current clinical trial system assumes that there is a certain degree of prior plausibility based on preclinical evidence before subjecting human subjects to the potential risks of a clinical trial.

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He Should Have Been Wearing a Helmet (Repost from QM) [Greg Laden's Blog]

Greg Laden none@example.com — Wed, 02 May 2012 15:22:52 -0500

Martha and I were walking down the street...Downer Street, if I recall correctly...heading north from the campus of the University of Wisconsin in Milwaukee. We were close to the Kinko's, which was on the west side of the north-south trending street, and about to cross. We were in fact off the curb and checking for traffic. A car was heading to the north, away from us. Since we were walking north and crossing the street diagonally, we were looking at the car from behind, but I could see that the light blue sedan was driven by a middle-aged woman with curly hair and largish glasses. Heading south, towards us, was a man on a bicycle. He had short dark hair, was large-framed and about 6 feet and 1 or 2 inches in height, driving a white or gray ten-speed bike. It might have been a Peugeot.

The bike was heading south at a reasonable clip, but he had stopped pedaling about 100 feet back. The car was slowing and had a left signal on, indicating that she would turn into the driveway of the bank just north of Kinko's. That would be across the path of the oncoming bike, if she continued. But she was stopped.

It was obvious that the bike rider assumed that the car would stay stopped and let him continue before she made her turn. Therefore, he did not slow down much. But, just as the two vehicles were about 20 feet apart, the car made a small jerking motion, as if the driver was adjusting her foot on the brake. At no point, however, did she move forward. I do note, however, that her front tires were turning left as this was all happening. Depending on what the bike rider saw, he may have reasonably interpreted the signs and signals to mean that this car was about to pull in front of him. I'm pretty sure, however, that this was not going to happen.

The bike rider slammed on his brakes, but it seems that the front brake stuck more firmly than the back brake. The bike stopped instantly and the rear tire started to swing around to the right. But that was irrelevant now, because the bike rider, who was already leaning forward on the handle bars as per normal, was in the air.

He flew up into the air and over the front of the bike, and as he did so, his body rotated 90 degrees and his legs rotated 180 degrees. So, there was a moment in time when this large framed man looked like this:

This is a stick figure like a cartoon, but it is not meant to be funny. It is decidedly not funny. The point of this figure is to illustrate so there is no ambiguity this statement: The second to last experience this man had was being perfectly upside down, with his entire body up in the air and no contact with anything but the air around him.

The last experience he had was his head being pounded into the pavement with the full weight of his body.

He collapsed to the ground and convulsed. I said to Martha "Go into Kinko's and call 911," which she did. The nearest rescue facility with an ambulance was almost in sight a couple of blocks up the street, so they would be there in a moment.

I ran over to the man and made myself look big so that cars coming down the street would notice us and not run us over. He was now on his side convulsing heavily and continuously. His convulsing was causing his head and neck to whip around, so I got down and held his body in place so he would damage himself less.

The woman who was driving the car got out and was staring. Two people who had walked out of a local store and did not see the accident came over and yelled at me.

"Leave him alone!" one of them screamed at me.

"He's an epileptic! He's just having an epileptic fit! Don't treat him like he was sick or something."

The woman who had been driving the car was distraught. She said "I didn't hit him! I don't know how this happened! I was waiting for him to go by!"

He continued to convulse. Martha came out of Kinko's and was standing nearby helping to keep traffic from either hitting us or causing a jam that would make it hard for the ambulance to come down the street. The ambulance was there in moments, and just as the EMTs came rushing over, the man with the bike stopped convulsing. He stopped moving. Eyes that were rolled back in his head became a blank stare.

I lied to Martha. I said I thought he'd probably be OK. It seemed to me that he was dead. To this day, I do not actually know. Perhaps he simply lived the rest of his life in a wheelchair. Or maybe he was fine.

Oh, did I mention? He was not wearing a helmet.

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