Clinical trials
oracknows | January 26, 2016Ben Swann, anchor of the evening news for the local Atlanta CBS affiliate and the face of his Truth In Media series of videos, thinks himself an investigative journalist and a truth teller, but much of what I see him reporting more closely resembles reporting as though done by a cross between Ted Baxter, Ron Burgundy, and Alex Jones. For one thing, Mr. Swann sure does love him some conspiracies, and he sure is susceptible to antivaccine nonsense, no matter how nonsensical. I first saw him in action nearly three months ago, when he credulously regurgitated the antivaccine talking points on…
oracknows | January 15, 2016I feel as though I'm experiencing an acid flashback to 2011, and I've never in my entire life once tried acid—or any mind-altering substance other than booze.
What am I talking about? Let's take a trip down memory lane, if you will, back to those halcyon days of—oh—five years ago. That was the time when I first took an interest in the Polish oncologist wannabe named Stanislaw Burzynski. Although I had mentioned him before because he featured prominently in Suzanne Somers' 2009 paean to quackery Knockout: Interviews with Doctors Who Are Curing Cancer–And How to Prevent Getting It in the First…
oracknows | January 12, 2016Every so often there are studies that I really mean to write about but, for whatever reason, don't manage to get to. Sometimes I get a chance to get back to them. Sometimes I don't. This time around I'm getting back to such a topic. This time around it's a topic I've been meaning to write about is based on a couple of studies that came out three weeks ago that illustrate why, even if a patient ultimately comes around to science-based treatment of his cancer, the delay due to seeking out unscientific treatments can have real consequences.Consider this (probably) the last unfinished bit of…
oracknows | January 7, 2016It's an understatement to say that I'm not exactly a fan of the National Center for Complementary and Integrative Health (NCCIH), the institute formerly known as the National Center for Complementary and Alternative Medicine (NCCAM) and, even a year after its name change, probably still better known by its old moniker. Just type "NCCAM" or "NCCIH" into the search box of this blog if you don't believe me. Basically, it's an institution forced upon the National Institutes of Health in the 1990s by Senator Tom Harkin (D-IA), a woo-friendly senator who believed that bee pollen cured his allergies…
oracknows | December 28, 2015Several years ago, Harriet Hall coined a term that is most apt: Tooth fairy science. The term refers to clinical trials and basic science performed on fantasy. More specifically, it refers to doing research on a phenomenon before it has been scientifically established that the phenomenon exists. Harriet put it this way:
You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is…
oracknows | December 28, 2015I've frequently noted that one of the things most detested by quacks and promoters of pseudoscience is peer review. Creationists hate peer review. HIV/AIDS denialists hate it. Anti-vaccine cranks like those at Age of Autism hate it. Indeed, as blog bud Mark Hoofnagle Mark Hoofnagle, pointed out several years ago, pseudoscientists and cranks of all stripes hate it. There's a reason for that, of course, namely that it's hard to pass peer review if you're peddling pseudoscience, although, unfortunately, with the rise of "integrative medicine," it's nowhere near as difficult as it once was.
Be…
oracknows | December 21, 2015One of the best things about blogging is that I don't feel obligated to cover a topic completely in one post because I know I can always write another one or revisit the topic later. It also allows me to look at what I like to call "variations on a theme" of various kinds of quackery (or anything else, for that matter). View this as a post looking at one such variation on a theme.
The theme this time is the tendency of antivaccine activists to demonstrate their utter cluelessness when it comes to designing clinical studies. This cluelessness virtually always manifests itself in the frequent…
oracknows | December 18, 2015One of my favorite television shows right now is The Knick, as I described before in a post about medical history. To give you an idea of how much I'm into The Knick, I'll tell you that I signed up for Cinemax for three months just for that one show. (After its second season finale airs next Friday, I'll drop Cinemax until next fall.) The reason why I'm bringing up The Knick (besides I love the show and need to bring it up at least once a year) is because an article by Malcolm Gladwell published earlier this week in The New Yorker entitled Tough Medicine, which is a commentary based on a new…
oracknows | November 24, 2015It is an article of faith among the antivaccine movement that vaccines are degrading the health of our children, such that vaccines cause autism, asthma, diabetes, and a number of other chronic diseases. You won't have to look far on most antivaccine websites to find claims that today's children are the sickest in history and insinuations, if not outright statements, that vaccines are at least part ofthe cause. If you've been following the antivaccine movement as long as I have (more than a decade) or even if you've only been following it one tenth as long, you are probably aware that one of…
oracknows | November 17, 2015The other day, I suddenly realized that it's been a long time since I've written about the Polish expat doctor in Houston who treats patients with advanced brain cancer with a concoction that he dubbed antineoplastons (ANPs). I'm referring, of course, to Stanislaw Burzynski who, despite the fact that he has no training in medical oncology, has treated thousands of cancer patients with ANPs beginning back in the late 1970s. Somehow, despite the fact that he's never even come close to showing that ANPs are effective and safe against the cancers for which he uses it, the FDA has, with a brief…
lborkowski | November 2, 2015The National Institutes of Health (NIH) has long been a key source of funding for medical research, but it wasn’t until 1986 that the agency formally established a policy of including women in clinical research. For decades, women received drugs and therapies that had been tested only on men, even though the same diseases can affect men and women differently, and women may metabolize drugs differently than men do.
In 1993, the NIH Revitalization Act put into law the requirement for women’s inclusion in NIH-funded clinical research. In 2010, the Institute of Medicine reported, “women’s health…
oracknows | October 26, 2015I like to point out from time to time that arguably the most striking difference between science-based medicine (and the evidence-based medicine from which we distinguish it) and alternative medicine, "complementary and alternative medicine" (CAM), or (as it's called now) "integrative medicine" is a concerted effort to change practice for the better based on science and evidence. In other words, in SBM, we are continually doing studies to improve practice. These studies take on two general forms: Comparing new treatments with old to determine if the new treatments work better and, as has…
oracknows | October 21, 2015One of the things that feels the weirdest about having done the same job, having been in the same specialty, for a longer and longer time is that you frequently feel, as the late, great Yogi Berra would have put it, déjà vu all over again. This is particularly true in science and medicine, where the same issues come up again and again and again, often with the same arguments on either side. Sometimes the same players are even involved. So it is with mammography recommendations. Indeed, I'm feeling déjà vu all over again right now, as I read headlines like Women advised to get mammograms later…
oracknows | October 13, 2015When last I discussed the cruel sham that is the tide of "right-to-try" laws that has been flowing through state legislatures to become law over the last year and a half. "Right-to-try" laws, as I pointed out when I first noted the earliest ones being promoted in Colorado, Louisiana, Arizona, and Missouri, referring to them as Dallas Buyers Club bills based on their seeming inspiration from that movie and pointing out how they are very, very bad policy that, contrary to the claims of its proponents, are far more likely to harm patients than help them. In every state in which such bills have…
oracknows | October 7, 2015Earlier this week, the Nobel Prize in Physiology or Medicine was awarded to Youyou Tu for her discovery of the anti-malaria compound Artemisinin, as well as to William C. Campbell and Satoshi Ōmura for their discovery of a novel therapy for roundworm. Artemisinin, as some of you might know, is a compound derived from traditional Chinese medicine, which is why, to my irritation, it didn't take long for headlines like How traditional Chinese medicine finally won its Nobel Prize, What the 2015 Nobel Prizes mean for traditional Chinese medicine, and A Medical Breakthrough Made Possible By Ancient…
oracknows | October 2, 2015I've written many times about how the relationship between the early detection of cancer and decreased mortality from cancer is not nearly as straightforward as the average person—even the average doctor—thinks, the first time being in the very first year of this blog's existence. Since then, the complexities and overpromising of various screening modalities designed to detect disease at an early, asymptomatic phase have become a relatively frequent topic on this blog. Even more than ten years ago, I noted that screening MRI for breast cancer and whole body CT scans intended to detect other…
oracknows | September 25, 2015Yesterday, I wrote about how pediatric neurosurgeon turned presidential candidate Ben Carson is an excellent example demonstrating how the vast majority of physicians and surgeons, even highly accomplished ones admired as being at the top of their professions, are not scientists and how many of them are disturbingly prone to buying into pseudoscience. In Dr. Carson's case, that tendency to believe in pseudoscience derives from his fundamentalist religion that led him to reject evolution and accept arguments against evolution every bit as ignorant as the ones Kent Hovind or Ken Ham serves up…
oracknows | September 12, 2015NOTE: Orac is on vacation recharging his Tarial cells and interacting with ion channel scientists, as a good computer should. In the meantime, he is rerunning oldies but goodies, classics, even. (OK, let's not get carried away.) Here's one from all the way back in 2007. Notice how, the more things change, the more they stay the same.
Evidence-based medicine is not perfect.
There, I've said it. Like anything else humans do in science or any other endeavor, evidence-based medicine (EBM) has its strengths and its weaknesses. On the whole, I consider it to be potentially vastly superior to the…
oracknows | September 8, 2015I am fortunate to have become a physician in a time of great scientific progress. Back when I was in college and medical school, the thought that we would one day be able to sequence the human genome (and now sequence hundreds of cancer genomes), to measure the expression of every gene in the genome simultaneously on a single "gene chip," and to assess the relative abundance of every RNA transcript, coding and noncoding (such as microRNAs) simultaneously through next generation sequencing (NGS) techniques was considered, if not science fiction, so far off in the future as to be unlikely to…
oracknows | August 21, 2015I've written more times than I can remember about the phenomenon of overdiagnosis and the phenomenon that is linked at the hip with it, overtreatment. Overdiagnosis is a problem that arises when large populations of asymptomatic, apparently healthy people are screened for a disease or a condition, the idea being that catching the disease at an earlier stage in its progression will allow for more successful treatment. Two prominent examples include—of course—screening for breast cancer with mammography and screening for prostate cancer with prostate-specific antigen (PSA) testing, and I've…