Clinical trials
oracknows | August 26, 2012If there's one thing I've been railing about for the last few years, it's how scientific and medical studies are reported in the lay press. It seems that hardly a week passes without my having to apply a little Insolence, be it Respectful or not-so-Respectful, to some story or another, usually as a result of the story having caught my interest, leading me to look up the actual study in the peer-reviewed literature. This is something I've learned the hard way that I have to do, having been burned a couple of times in my early blogging career. Sometimes, even now, I forget. For example,…
oracknows | August 22, 2012Houston, we have a problem.
Oh, wait. I'm not talking about Stanislaw Burzynski this time. But we do still have a problem, and it's a problem that resembles the Burzynski problem I recently discussed. Specifically, it's a problem of unethical clinical trials somehow winning approval from institutional review boards (IRBs). In academia, IRBs are basically ethics boards whose purpose is to protect the human subjects who agree to take part in clinical trials and other research from harm and from being subjected to experimental therapies in which the risk-benefit ratio isn't sufficiently…
oracknows | August 15, 2012It's been a long time, been a long time, been a long lonely, lonely, lonely, lonely time.
Well, not really, although it has been a while since I've discussed Dr. Stanislaw Burzynski. Specifically, I last dedicated a post to him following the death of one of his famous patients, Billie Bainbridge, who incidentally had become famous because her family had managed to raise hundreds of thousands of pounds with the help of some U.K. celebrities. Burzynski, as regular readers will recall, became a frequent topic on this blog last fall after one of his lackeys decided to issue vacuous legal threats…
oracknows | August 1, 2012Dying of cancer can be a horrible way to go, but as a cancer specialist I sometimes forget that there are diseases that are equally, if not more, horrible. One that always comes to mind is amyotropic lateral sclerosis (ALS), more commonly known as Lou Gehrig's disease. It is a motor neuron disease whose clinical course is characterized by progressive weakness, muscle atrophy and spasticity, with ultimate progression to respiratory muscles leading to difficulty breathing and speaking (dysarthria) and to the muscles controlling swallowing. The rate of clinical course is variable, often…
oracknows | July 27, 2012It's known as "targeted" therapy, and it's the holy grail of cancer research these days. If you listen to its most vocal proponents, it's the path towards "personalized medicine" that improves survival with much lower toxicity, in which, instead of using the hammer that is chemotherapy, precisely targets specific molecular abnormalities that drive cancer growth. With the advent of the revolution in genomics that has transformed cancer research over the last decade, including the petabytes of sequence and gene expression data that pour out of universities and research institutes, the promise…
oracknows | May 31, 2012I've pointed out before that pover the last couple of years I've become a bit of a fan of old time radio, having discovered Radio Classics on Sirius XM Radio. I don’t remember how I discovered it, but I rapidly became hooked on shows like Suspense, Yours Truly, Johnny Dollar, The Whistler, Gunsmoke, Dragnet, The Six Shooter, and The Adventures of Sam Spade (the Howard Duff episodes, of course). Then, of course, there's The Story of Dr. Kildare. This particular radio show stared Lew Ayres as Dr. Kildare and Lionel Barrymore as the irascible Dr. Leonard Gillespie (the latter of whom was…
oracknows | April 29, 2012Remember Vox Day?
Sure, I bet you do, at least if you've been a regular reader of this blog more than a year or two. If you're a really long-timer, you probably remember him even better. Let's just put it this way. Vox is a guy who has a much higher opinion of his intellectual prowess when it comes to science than is warranted by the bleatings that he calls a blog would warrant. I do have to thank him though. Besides giving me occasional material to apply some well-deserved not-so-Respectful Insolence to from time to time, on rare occasions he even points me in the direction of interesting…
oracknows | April 23, 2012The U.S. is widely known to have the highest health care expenditures per capita in the world, and not just by a little, but by a lot. I'm not going to go into the reasons for this so much, other than to point out that how to rein in these costs has long been the proverbial political hot potato. Any attempt to limit spending or apply evidence-based guidelines to care runs into a buzz saw of criticism.
Indeed, most of the resistance to the Patient Protection and Affordable Care Act (PPACA), otherwise known in popular parlance as "Obamacare," has been fueled by two things: (1) resistance to the…
oracknows | March 27, 2012This week, the Supreme Court is hearing a case that can only be described as historic. Any of you out there (in the U.S. anyway; I realize that my readership is international) who have paid even a passing attention to the news can't help but avoid reporting, debate, and polemics related to the Patient Protection and Affordable Care Act (PPACA), which is often disparagingly referred to as "Obamacare." If the law is upheld, or even if most of the law is upheld, it will radically reshape health insurance in this country. Having spent 13 years in the trenches at cancer centers that see a high…
oracknows | March 18, 2012About a month ago, I wrote about a study that looked at metrics of patient satisfaction and compared them to hard outcomes often used to evaluate quality of care, including frequency of emergency room usage, frequency of hospitalization, and overall mortality. Even though these days there appears to be an implicit assumption that increased patient satisfaction comes about as a result of better quality of care (or at least that patient satisfaction correlates with quality of care), this study found almost exactly the opposite. Patients who were in the highest quartile for patient satisfaction…
oracknows | February 19, 2012If there's one thing that purveyors of "complementary and alternative medicine" (CAM)--or, the preferred term these days, "integrative medicine" (IM)--and hospital administrators seem to agree on, it's that "patient satisfaction" (whatever that means) is very, very important. Hospital administrators live and die by patient satisfaction surveys, in particular a common measurement derived from Press-Ganey surveys. In fact, Press-Ganey itself sells its services as "driving performance excellence" in health care. The inherent assumption is that if patients are satisfied then they are doing a good…
oracknows | February 12, 2012If there's one form of so-called "complementary and alternative medicine" (CAM) that I find more tolerable than most, it's massage therapy. The reason, of course, is that, whatever else anyone claims about massage, there's no doubt that it feels good.
All too often, however, massage therapists ruin a perfectly good massage by imposing pseudoscientific and quack claims on it, such as claims that they are stimulating acupressure points or their adoption of the language of "energy healing." So it was with a bit of trepidation (but also more than a bit of interest) that I took a look at some…
oracknows | January 8, 2012Three and a half years ago, I bought a new car. The reason why I mention this as a means of beginning this post is because that car had something I had never had in a car before, namely Sirius XM satellite radio preinstalled. Curious, I subscribed, and I now barely listen to regular radio anymore. A couple of years after I had bought the car, a new channel was added to the lineup, a channel called Radio Classics. I don't know how I discovered it, but I rapidly became hooked on what's commonly referred to as old time radio. Basically, that's classic radio of the sort that was broadcast between…
oracknows | January 4, 2012Let's face it. The vast majority of "complementary and alternative medicine" (CAM) or "integrative medicine" (IM) therapies are nothing more than placebo medicine. This should be so abundantly clear to readers who have followed this blog, Science-Based Medicine, and/or Neurologica Blog more than a few weeks that I shouldn't have to repeat it yet again, but I feel that it bears repeating today as an introduction to today's subject matter. CAM/IM is almost all placebo medicine, and placebos effects are poorly understood (or even misunderstood), even among physicians. It is this misunderstanding…
oracknows | January 2, 2012I kind of miss Peter Lipson on ScienceBlogs and wish he were still around. I realize it's been nearly a year and a half since he departed, but it's been a bit lonely here being the only physician blogging about quackery, the role of science in medicine, and other skeptical topics related to medicine. This point was driven home when I happened to come across a post he wrote the other day entitled Another crack at medical cranks. In it, Dr. Lipson discusses one characteristic that allows medical cranks and quacks to attract patients, namely the ability to make patients feel wanted, cared for,…
oracknows | December 15, 2011I thought I'd be leaving the topic of Dr. Stanislaw Burzysnki and his combination of Personalized Cancer Therapy for Dummies-level "personalized, gene-targeted cancer therapy" coupled with his "cancer-curing" antineoplastons, which have morphed into an orphan HDAC inhibitor used off-label as part of his pricey everything-but-the-kitchen-sink" combination of targeted therapies and old-fashioned chemotherapy. After all I figured that there would probably be nothing new to say before sometime in January, when he is schedule to appear before the Texas Medical Board to answer for his dubious…
oracknows | December 12, 2011I've made no secret of my admiration for Trine Tsouderos. Whether it be her investigations into the rank quackery of prominent members of the mercury militia wing of the anti-vaccine lunatic fringe, Mark and David Geier, who seem to think that chemical castration is a perfectly fine and dandy treatment for autism because testosterone binds mercury (it doesn't under physiological conditions) and prevents it from being removed by chelation therapy, the equally rank quackery that is the "autism biomed" movement, or the chronic Lyme disease underground, Tsouderos is one of the rare journalists…
oracknows | December 11, 2011Over the last couple of weeks, I've been spending a lot of time (and, characteristically, verbiage) analyzing the phenomenon known as Dr. Stanislaw Burzynski, his "cancer cure" known as antineoplastons, and his incompetent version of "personalized gene-targeted cancer therapy." In this third and final part, I want to come back to antineoplastons, because it has been pointed out to me that there is an aspect of this story that has received little attention. One of my readers in particular has helped enormously. I wish I could credit this person by name to express my gratitude, but, for reasons…
oracknows | December 6, 2011One thing I've learned over the years is that there is a palpable hostility in the "alternative" medicine world towards chemotherapy. Many are the times I've posted examples, including rants by Mike Adams, cartoons, and a post about what I like to call the "2% gambit" that claims that chemotherapy only contributes 2% to survival in cancer. Basically, that last gambit uses and abuses a rather mediocre study whose design almost seemed intended to minimize any detected benefit from chemotherapy. On second thought, strike the word "seem." It was pretty much designed to minimize any apparent…
oracknows | November 27, 2011Over the Thanksgiving holiday weekend, I was simultaneously alarmed and amused at how someone named Marc Stephens, who claims (although presents no evidence for his claim) that he represents the rogue physician and "researcher" Dr. Stanislaw Burzynski, had taken to threatening skeptical bloggers who criticize Dr. Burzynski's highly dubious cancer therapy, a therapy Burzynski dubbed "antineoplastons." In particular, Mr. Stephens threatened a blogger by the name of Andy Lewis, whose nom de blog is Le Canard Noir and whose blog and website, The Quackometer, I've followed for years now. As a…