Bioethics
oracknows | October 9, 2017I've written on quite a few occasions about a pair of scientists beloved by the antivaccine movement. I'm referring, of course, to Christopher Shaw and Lucija Tomljenovic. Whether it is their publishing dubious "evidence" that HPV vaccines cause premature ovarian failure or even death or demonizing aluminum as a vaccine adjuvant, Shaw and Tomljenovic publish nothing but antivaccine pseudoscience that antivaxers love to cite whenever they dump some turd of a study on the medical literature.
Just last month, they dumped their latest turd of a study, in which they basically tortured mice in the…
oracknows | September 21, 2017
"Why, oh, why do I have to die in the cause of such crappy science?"
For antivaxers, aluminum is the new mercury.
Let me explain, for the benefit of those not familiar with the antivaccine movement. For antivaxers, it is, first and foremost, always about the vaccines. Always. Whatever the chronic health issue in children, vaccines must have done it. Autism? It’s the vaccines. Sudden infant death syndrome? Vaccines, of course. Autoimmune diseases? Obviously it must be the vaccines causing it. Obesity, diabetes, ADHD? Come on, you know the answer!
Because antivaxers will never let go of…
oracknows | September 8, 2017As a medical blogger with a skeptical bent and a rather aggressive proclivity towards defending science-based medicine, I generally like STAT News. Sure, it's occasionally screwed up royally (e.g., its credulous false balance reporting on a patient of cancer quack Stanislaw Burzynski named Neil Fachon), but in general it's usually a good source of medical news and analysis. No publication is perfect, of course, but STATNews is generally better than average, and I appreciate that.
That's why I was disappointed to see how thoroughly a pharma-backed astroturf group whose mission is to loosen…
oracknows | August 29, 2017I've caught a fair amount of flak over my opposition to so-called "right-to-try" laws. Right-to-try laws have proliferated throughout the US like so much kudzu over the last three and a half years, to the point where 37 states now have some version of these profoundly anti-patient laws on the books. At the federal level, three weeks ago the Senate passed a federal version of right-to-try, with the House scheduled to take up the bill when Congress returns from recess next week. Granted, it's watered down and therefore less horrible than the original version, which Senator Ron Johnson (R-WI_…
oracknows | June 2, 2017I've discussed several times over the last several years my impression that the media have become in general less tolerant of antivaccine views. At least, the media seem less willing to indulge in "tell both sides" false equivalence. Back when I started blogging, I routinely used to bemoan how news stories about vaccines or autism would almost inevitably include obligatory quotes from antivaxer like J.B. Handley, Jenny McCarthy, and sometimes even Andrew Wakefield. More recently, over the last five years or so, such tropes seem a lot less common. I don't have any solid evidence to back up my…
oracknows | March 7, 2017Massive is the misinformation promulgated by the antivaccine movement, and many are its lies. For example, antivaxers claim that, in some way or other, vaccines cause autism, autoimmune diseases, sudden infant death syndrome (SIDS), cancer, and a wide variety of other conditions and diseases when there is no credible evidence that they do and lots of evidence that they don’t. One of the favorite tropes used by antivaxers to frighten parents out of vaccinating their children is known as the "toxins" gambit, in which antivaxers cite lists of scary-sounding ingredients in vaccines like…
oracknows | February 10, 2017It always amuses me how antivaccine activists have such a love-hate relationship with academia, particularly the higher echelons of academia. On the one hand, they routinely denigrate academics because inevitably well-designed, well-executed epidemiological studies testing the hypothesis that vaccines are correlated with the risk of autism always come up empty. That's because vaccines don't cause autism. I used to hedge a bit when I said that, but over the 12 years I've been doing this, I've covered more studies than I can remember testing this very hypothesis, and a clear pattern has emerged…
oracknows | January 19, 2017So I was distracted yesterday from what I had intended to write about by an irresistible target provided me courtesy of Toby Cosgrove, MD, CEO of The Cleveland Clinic, who bemoaned all those nasty pro-science advocates who had had the temerity to link the antivaccine rant by the director of the Clinic's Wellness Institute to the quackery practiced there of whose affinity for antivaccine quackery Cosgrove appears to be oblivious. So I took care of that target, and now I'm back to the topic I had wanted to apply some Insolence to. Yes, there was no way I was going to allow this pseudoscientific…
oracknows | December 7, 2016Well, it’s done.
Today, the Senate passed the 21st Century Cures Act, a bill designed to weaken the FDA and empower pharmaceutical companies, sending it to President Obama’s desk. There’s no way Obama won’t sign it, as it contains provisions funding his Precision Medicine Initiative, and he supported it all along. For all its flaws, I knew the bill’s passage was inevitable since after the election, when Senate Majority Leader Mitch McConnell stated that the bill was a priority. I knew it even more when the Senate linked the bill to the “Cancer Moonshot” initiative spearheaded by Vice…
oracknows | November 21, 2016One of the great things about America has been the First Amendment, particularly the right to freedom of speech and freedom of assembly. These are rights allow us to gather together to protest when we see something that we don’t think is right and want to change. Unfortunately, there is one downside to these freedoms, and that is that cranks, quacks, and outright twits have just as much right to free speech as anyone. Fortunately, my right to free speech allows me to ridicule these twits for annoying people, endangering public health, and in general making publicly making idiots of themselves…
oracknows | October 9, 2016There's a misconception that I frequently hear about evidence-based medicine (EBM), which can equally apply to science-based medicine (SBM). Actually, there are several, but they are related. These misconceptions include the idea that EBM/SBM guidelines are a straightjacket, that they are "cookbook medicine," and that EBM/SBM should be the be-all and end-all of how to practice clinical medicine. New readers might not be familiar with the difference between EBM and SBM, and here is not the place to explain the difference in detail because this post isn't primarily about that difference. The…
oracknows | October 5, 2016Whenever we discuss vaccines and vaccine hesitancy, thanks to Andrew Wakefield the one vaccine that almost always comes up is the MMR, which is the combined measles-mumps-rubella vaccine. In 1998, Wakefield published a case series of cherry-picked patients in which he strongly inferred that the MMR vaccine was associated with autism and “autistic enterocolitis.” Of course, even the way Wakefield spun it, this wasn’t enough evidence to link the MMR vaccine to autism, which is no doubt why Wakefield never explicitly said that it did in the paper describing his case series. My guess has always…
oracknows | September 29, 2016One of the things that first led me to understand the dangers of quackademic medicine was a trial known as the Trial to Assess Chelation Therapy, or TACT. Chelation therapy, as you might recall, is the infusion of a chelating agent, or a chemical that binds heavy metals and makes it easier for the kidney to secrete them, in order to treat acute heavy metal poisoning. Unfortunately, quacks of all stripes have latched on to chelation therapy to treat a number of diseases and conditions. For instance, antivaccine quacks like to use chelation therapies to treat autistic children using the…
oracknows | August 18, 2016I’ve been debating whether to write about this for a while now, given that the first article that I noticed about it was first published a week and a half ago. Part of the reason for my reluctance is that it would be too easy for politics to be dragged into this more than I generally like. Of course, I don’t make a secret of my political leanings, but I usually don’t go out of my way to be an explicitly political blogger. I do, however, frequently write about areas where science and medicine intersect, and when I do I always come down on the side of science and rationality.
This brings us to…
oracknows | June 6, 2016One major thing that differentiated science-based medicine (SBM) from alternative medicine and quackery is that in SBM there is a generally accepted standard of care. This was even the case back in the days before the proliferation of evidence-based guidelines, in which professional societies and expert panels try their best to synthesize what is often an unwieldy mass of sometimes conflicting studies into guidelines on best care practices for different conditions. True, back then there was wider latitude because each physician was largely left to fend for himself in applying the medical…
oracknows | May 20, 2016it was less than a year ago that I described a bill wending its way through Congress called the 21st Century Cures Act “old vinegary wine in a new bottle.” The reason I characterized the bill that way was because it really was nothing new and it rested on a very old fallacy, namely that the only way to speed up medical “innovation” is to weaken the FDA and its standards for drug and medical device approval, which is exactly what the 21st Century Cures Act would do if passed into law. It’s basically the American cousin to the British Saatchi Bill, which in essence proposed to do very similar…
oracknows | July 23, 2015Back when I started this blog, I hadn't yet become aware of the phenomenon known as quackademic medicine. This phenomenon, as you recall, is the infiltration of academic medical institutions that should be bastions of science- and evidence-based medicine by outright quackery. In quackademic medicine, we see Very Respectable Academic Physicians and Scientists wasting their time studying faith healing like healing touch and reiki, prescientific medicine based on primitive vitalism such as traditional Chinese medicine and (of course) acupuncture, and even sympathetic magic like homeopathy. It's…
oracknows | July 9, 2015As much as I write about the foibles, pseudoscience, and misadventures of cranks and quacks that endanger patients. However, never let it be said that I don't also pay attention to the foibles and misadventures of real doctors that endanger patients. Sometimes that occurs due to incompetence. Sometimes it's due to the persistent use of invasive modalities that have been shown not to work far longer than they should have been abandoned (e.g., vertebroplasty). Sometimes it's poor judgment. Of course, because I'm a surgeon, I tend to gravitate towards discussions of surgery when I leave my usual…
oracknows | June 19, 2015Even if you're a relative newbie to this blog, you probably wouldn't be particularly surprised to learn that I don't much like Dr. Mehmet Oz, a.k.a. "America's Doctor." Of course, I refer to him as something slightly different, namely "America's Quack," for a whole host of reasons, including his featuring psychic mediums like John Edward and Theresa Caputo, faith healers, Ayurveda, homeopaths, dubious dietary supplements, and even antivaccine loons like Robert F. Kennedy, Jr. Indeed, when about a year ago Senator Claire McCaskill (D-MO) hauled him in front of her Senate committee over his…
oracknows | May 25, 2015Last year, I did several posts on what I consider to be a profoundly misguided and potentially harmful type of law known as "right-to-try." Beginning about a year and a half ago, promoted by the libertarian think tank known as the Goldwater Institute, right-to-try laws began popping up in state legislatures. I wrote about how these laws are far more likely to do harm than good, and that is a position that I maintain today. The idea behind these laws is to give terminally ill patients access to experimental drugs—in some cases drugs that have only passed phase I testing—that might help them.…