Tag Archives: medicine

Labelling Homeopathic Products

Earli­er this year the UK’s MHRA opened a con­sulta­tion to help them decide how homeo­path­ic products should be labelled when sold to the pub­lic. As expec­ted, Ben Gol­dacre — devoted crit­ic of homeo­pathy, pseudos­cience and gen­er­al quack­ery — sug­ges­ted a label of his own and asked his read­ers for fur­ther sug­ges­tions.

Some of the sug­ges­tions were truly fant­ast­ic (and proved that I could­n’t come up with an ori­gin­al joke, no mat­ter how hard I tried), and so Gol­dacre pub­lished some of the best sug­ges­tions for homeo­path­ic labelling in his column for The Guard­i­an:

On instruc­tions, we have “take as many as you like”, since there are no ingredi­ents. The pro­posed bel­ladonna homeo­pathy pill ingredi­ents label simply reads “no bel­ladonna”, which is a con­ven­tion the MHRA could adapt for all its dif­fer­ent homeo­pathy labels. Oth­er sug­ges­tions include “none”, “belief”, “false hopes”, “shattered dreams”, and “the tears of uni­corns”.

For warn­ings, we have: “not to be taken ser­i­ously”, “in case of over­dose, con­sult a life­guard”, and “con­tains chem­ic­als, includ­ing dihydro­gen monox­ide”. This, of course, is a scary name for water, which became an inter­net meme after Nath­an Zohner­’s school sci­ence pro­ject: he suc­cess­fully gathered a peti­tion to ban this chem­ic­al on the grounds that it is fatal when inhaled, con­trib­utes to the erosion of our nat­ur­al land­scape, may cause elec­tric­al fail­ures, and has been found in the excised tumours of ter­min­al can­cer patients.

The com­ments on both art­icles are real gems for those in need of a laugh today.

via @IrregularShed

Medicine, Specialism, and the Scientific Education

In the com­mence­ment speech he delivered to the gradu­ates of Stan­ford’s School of Medi­cine earli­er this year, Atul Gawande elo­quently (as ever) examined the state of mod­ern medi­cine (in the U.S. spe­cific­ally, the world gen­er­ally), the prob­lem with spe­cial­ism, and the prob­lem of spe­cial­ists try­ing to fit into a sys­tem not neces­sar­ily designed for it.

I par­tic­u­larly like Gawande’s ana­logy on the exper­i­ence of a sci­entif­ic edu­ca­tion:

The exper­i­ence of a med­ic­al and sci­entif­ic edu­ca­tion is trans­form­a­tion­al. It is like mov­ing to a new coun­try. At first, you don’t know the lan­guage, let alone the cus­toms and con­cepts. But then, almost imper­cept­ibly, that changes. Half the words you now routinely use you did not know exis­ted when you star­ted: words like arter­i­al-blood gas, naso­gast­ric tube, microar­ray, logist­ic regres­sion, NMDA recept­or, vel­lu­vi­al mat­rix.

O.K., I made that last one up. But the vel­lu­vi­al mat­rix sounds like some­thing you should know about, does­n’t it? And that’s the prob­lem. I will let you in on a little secret. You nev­er stop won­der­ing if there is a vel­lu­vi­al mat­rix you should know about.

via Intel­li­gent Life

The Evidence For (and Against) Health Supplements: a Visualisation

After col­lat­ing the res­ults of over 1,500 stud­ies and meta-stud­ies (only “large, human, ran­dom­ized placebo-con­trolled tri­als” were included), Inform­a­tion is Beau­ti­ful’s Dav­id McCand­less col­lab­or­ated with Andy Per­kins to pro­duce a com­pre­hens­ive data visu­al­isa­tion map­ping the the effect­ive­ness (or not) of a wide range of health sup­ple­ments (there’s a stat­ic image and inter­act­ive Flash ver­sion avail­able).

Some of the find­ings:

  • Green tea has been shown to lower cho­les­ter­ol in a large num­ber of stud­ies, but there’s no sign of can­cer pre­ven­tion prop­er­ties.
  • There’s strong evid­ence show­ing Omega 3’s cho­les­ter­ol-lower­ing abil­it­ies and good evid­ence indic­at­ing it can help improve some ADHD beha­viour and lower blood pres­sure. In terms of pre­vent­ing arth­rit­is and can­cer, and in reliev­ing depres­sion, the evid­ence is con­flict­ing.
  • Fish oil has been shown to help lower blood pres­sure and the risk of sec­ond­ary heart dis­ease, but the evid­ence for it improv­ing gen­er­al health isn’t strong (but is prom­ising).
  • Vit­am­in D is fant­ast­ic: great for all-round gen­er­al health and can­cer pre­ven­tion.
  • Vit­am­ins A and E aren’t bene­fi­cial for much at all, while Vit­am­in C stud­ies are some­what con­flict­ing.
  • Beta carotene’s pos­i­tion sur­prised me: there is little-to-no evid­ence of any health bene­fits. The same goes for acai and goji ber­ries, ginkgo biloba and cop­per.

The raw data used to gen­er­ate the visu­al­isa­tion is available–along with citations–in a Google doc­u­ment that is occa­sion­ally being updated.

The Anti-Vaccine Movement and the Rejection of Science

Already covered to death, it’s been on my book­marks list since I read the fol­low­ing from Wired edit­or Mark Horow­itz on it’s day of pub­lic­a­tion:

Best/worst day. Story I am proudest of assign­ing and edit­ing at Wired goes live today. […] But I also lose job. Bum­mer!

That story is a fant­ast­ic­ally well writ­ten and researched art­icle look­ing at the snake oil peddled by the anti-vac­cine crowd and why people listen to, and fall for, their pseudo-sci­ence (i.e. per­ceived risk and irra­tion­al­ity).

The rejec­tion of hard-won know­ledge is by no means a new phe­nomen­on. In 1905, French math­em­atician and sci­ent­ist Henri Poin­caré said that the will­ing­ness to embrace pseudo-sci­ence flour­ished because people “know how cruel the truth often is, and we won­der wheth­er illu­sion is not more con­sol­ing.” Dec­ades later, the astro­nomer Carl Sagan reached a sim­il­ar con­clu­sion: Sci­ence loses ground to pseudo-sci­ence because the lat­ter seems to offer more com­fort. “A great many of these belief sys­tems address real human needs that are not being met by our soci­ety,” Sagan wrote of cer­tain Amer­ic­ans’ embrace of rein­carn­a­tion, chan­nel­ing, and extra­ter­restri­als. “There are unsat­is­fied med­ic­al needs, spir­itu­al needs, and needs for com­mu­nion with the rest of the human com­munity.”

Look­ing back over human his­tory, ration­al­ity has been the anom­aly. Being ration­al takes work, edu­ca­tion, and a sober determ­in­a­tion to avoid mak­ing hasty infer­ences, even when they appear to make per­fect sense. Much like infec­tious dis­eases them­selves — beaten back by dec­ades of effort to vac­cin­ate the popu­lace — the irra­tion­al lingers just below the sur­face, wait­ing for us to let down our guard.

I post this now as in recent days Andrew Wake­field—the phys­i­cian who linked the three-in-one MMR vac­cine to aut­ism—has had his ori­gin­al art­icle fully retrac­ted by the med­ic­al journ­al The Lan­cet after the Gen­er­al Med­ic­al Coun­cil found he acted “dis­hon­estly and irre­spons­ibly” with “cal­lous dis­reg­ard” and had a con­flict of interest in his study.

The Health Care Debate To Date

For the health care debate that has been raging in Amer­ica of late, I have sub­scribed to the same philo­sophy as Ben Cas­nocha:

I’ve decided I’m just going to read it about once it’s resolved.

You can­’t keep up with everything. Rather than lightly fol­low along and skim art­icles and pre­tend to be informed, I’m con­sciously opt­ing out. I rarely do this when it comes to cur­rent affairs – I’m kind of a junkie – but I must say, this time around, it feels lib­er­at­ing.

The debate was also covered widely here in the UK and cov­er­age has, at last, died down. As such I decided it was time to start read­ing about the pro­gress to date, and came across Dav­id Gold­hill’s extens­ive and pen­et­rat­ing piece in The Atlantic that, as Alex J Mann rightly says, con­tains “everything you need to or should know [about the health care debate]”.

The piece begins with this admis­sion;

I’m a busi­ness­man, and in no sense a health-care expert. But the per­sist­ence of bad industry practices—from long lines at the doc­tor’s office to ever-rising prices to aston­ish­ing num­bers of pre­vent­able deaths—seems bey­ond all nor­mal logic, and must have an under­ly­ing cause. There needs to be a busi­ness reas­on why an industry, year in and year out, would be able to get away with poor cus­tom­er ser­vice, unaf­ford­able prices, and uneven results—a reas­on my fath­er and so many oth­ers are unne­ces­sar­ily killed.

and con­tin­ues with the fol­low­ing state­ment that really won me over:

So before explor­ing altern­at­ive policies, let’s reex­am­ine our basic assump­tions about health care—what it actu­ally is, how it’s fin­anced, its account­ab­il­ity to patients, and finally its rela­tion­ship to the etern­al laws of sup­ply and demand.