Clinical trials
oracknows | September 5, 2008I've railed on more than one occasion about how much I detest science by press release. For one thing, it bypasses the peer review process and reports results directly to the public, which to me is a strike against any study. Indeed, releasing results by press release or using a press release to tout a study before it's even published is, as far as I'm concerned, quite dubious, and when I see it I'm automatically way more suspicious of whether the study represents good (or even OK) science.
One form of science by press release that can be a bit more subtle than, say, the cold fusion guys…
oracknows | September 3, 2008Some people should keep their "gut feelings" to themselves.
You know the type: People who have no knowledge about a topic or, even worse, just enough knowledge to sound as if they have a clue about it to people who don't have a clue but who are at the same time easily spotted as utterly and completely clueless by people who do have a clue. These people often think they've discovered something that scientists, in all their blindness have missed, and have a burning urge to share their "gut feeling" about what they think they have discovered as though it's some revelation, a bolt out of the blue…
oracknows | September 2, 2008ResearchBlogging.org, that aggregator for blogging about peer-reviewed scientific research, has been given a makeover and a major overhaul. New features include:
There will be much, much more on our official launch date of September 2, but here is a partial list of new features:
Multiple language support (and 30 new German-language bloggers!)
Topic-specific RSS feeds
Post-by-post tagging with topics and subtopics
"Recover password" feature
Email alerts when there is a problem with posts
Users can flag posts that don't meet our guidelines
Customized user home pages with bios and blog…
oracknows | August 29, 2008The single most necessary task for a physician practicing science- and evidence-based medicine is the evaluation of the biomedical literature to extract from it just what science and the evidence support as the best medical therapy for a given situation. It is rare for the literature to be so clear on a topic that different physicians won't come to at least somewhat different conclusions. Far more common is the situation where the studies are conflicting, although usually with a preponderance of studies tending to support one or two interventions more than others, or where there are few or…
oracknows | August 28, 2008Believe it or not, there was one area of so-called "alternative" medicine that I used to be a lot less skeptical about than I am now. Homeopathy, I always realized to be a load of pseudoscientific magical thinking. Ditto reiki, therapeutic touch, and other forms of "energy healing." It didn't take an extensive review of the literature to figure that out, although I did ultimately end up doing fairly extensive literature reviews anyway. Then, the more I looked into the hodge-podge of "healing" modalities whose basis is not science but rather prescientific and often mystical thought, the less…
oracknows | August 21, 2008I must be slipping.
Well, not really. It doesn't bother me that blog bud and fellow skeptical physician PalMD beat me to an important publication that came out a couple of days ago in the Annals of Internal Medicine. I'm a surgeon and a translational/basic scientist; so Annals is not usually one of the journals I read regularly. I usually read individual studies as I find out about them referenced elsewhere, usually Eureka Alert! or when an Annals study sufficiently interesting to motivate me to surf on over to the website and download the article. Be that as it may, this article is highly…
oracknows | August 18, 2008In complaining about the infiltration of pseudoscience in the form of "complementary and alternative medicine" (CAM) into academic medicine, as I have many times, I've made the observation that three common modalities appear to function as "gateway woo, if you will, in that they are the tip of the wedge (not unlike the wedge strategy for "intelligent design" creationism, actually) that slip into any defect or crack it can find and widen it, allowing entrance of more hard core woo like homeopathy behind them.
All of these modalities fall under the rubric of "energy healing" in that the…
oracknows | August 14, 2008It's been quite a while since I wrote about this topic, but, quite frankly, I didn't think anything new was likely to come up that would interest me sufficiently to take it on again. I was almost right; it's been well over two years since the last time I discussed the issue of whether or not vitamin C has any role in treating cancer.
When last I left the topic, two studies had been released that were being widely cited as a "vindication" of Linus Pauling. As you may recall, Pauling was the Nobel Laureate who succumbed to what's sometimes called the "Nobel disease" in that he turned into a…
oracknows | July 31, 2008Has it really been a whole year? The longer I blog, the faster time seems to fly. Or maybe it's just because I'm getting older. Whatever the case, you may (or may not) recall that about a year ago I got into a little tussle with a certain Libertarian comic and some smoking cranks over the issue of whether secondhand smoke is a health threat. The discussion escalated a bit, and some serious smoking cranks entered the fray, complete with quote-mining. I ended up discussing a couple of studies that claimed to have found a decrease in hospital admissions for acute coronary syndrome (colloquially…
oracknows | July 30, 2008With all the negativity around this blog lately, thanks to the continued moronic antics of the anti-vaccine contingent, which have irritated me more than they do usually, so much so that I can't recall a time since Jenny McCarthy's "Green Our Vaccine" anti-vaccination-fest nearly two months ago that they've been so flagrant in their lies, I thought it was time for some good news for a change. Fortunately, by way of the latest issue of The Lancet, some good news showed up in the form of a study. This study, reported late last week by the Antiretroviral Therapy Cohort Collaboration, a…
oracknows | July 9, 2008I've said it before, and I'll say it again. J.B. Handley, that bull-in-a-china-shop general in the mercury militia who detests me intensely, is about as ignorant as they come when it comes to science and clinical trials. Yesterday, he provided yet more evidence of his cluelessness in his latest piece posted to that repository for all things antivaccine, Age of Autism.
Mr. Handley's all in a lather because the Associate Press published a story yesterday about a proposed NIH-sponsored clinical trial of chelation therapy for autism entitled Fringe autism treatment could get federal study.…
oracknows | July 8, 2008Having lived in Ohio for eight years and married a woman from the Toledo area, I had come to think that Ohioans had more common sense. I guess I was wrong.
On the other hand, I should have realized that I was wrong. After all, Ohio is home to The Ohio State University Center for Integrative Medicine and the Cleveland Clinic Department of Integrative Medicine. So much for hard-nosed Midwestern skepticism, I guess. My only consolation as a University of Michigan graduate is that Ohio seems to be trying to surpass Michigan for promoting woo in academia. Or it would be were it not that a major…
oracknows | July 7, 2008Last week, The New York Times started a rather unusual series in its medical section entitled, The Evidence Gap, described thusly:
Articles in this series will explore medical treatments used despite scant proof they work and will consider steps toward medicine based on evidence.
When I first saw the series, I was prepared for a crapfest. My experience has generally been that when reporters start examining the evidence for and against a treatment they usually do a pretty lousy job. This is most obvious when it comes to "complementary and alternative medicine" (CAM), where we are routinely…
oracknows | July 2, 2008In the eyes, of anti-vaccine advocates, vaccines bear the brunt of blame for a variety of conditions, including autism, asthma, neurodevelopmental disorders, autoimmune disorders and a wide variety others. Often this link is based on retrospective data, in which parents or patients recall and self-report how many vaccines they've had and which ones. This self-recall is then correlated with the health condition under study, and sometimes correlations are found. However, it's long been known that self-reporting has a tendency to be unreliable, with a tendency to conflate incidents that may or…
oracknows | June 23, 2008If there's one thing that lay people (and, indeed, many physicians) don't understand about screening for cancer is that it is anything but a simple matter. Intuitively, it seems that earlier detection should always be better, and it can be. However, as I explained in two lengthy posts last year, such is not always the case. To understand why requires an understanding of cancer biology. The reason is the extreme heterogeneity of tumor behavior and prognosis. This variability was well described in a study from about a month ago, in which it was observed that the doubling time of breast cancers…
oracknows | June 16, 2008...is one of my favorite surgeon-bloggers Sid Schwab when he discusses what happens when naturopaths actually subject their "healing art" to scientific examination. In the wake of the rather--shall we say--vigorous discussion that ensued after my post last week about the recently passed law in the State of Minnesota to license and regulate naturopaths, today I can't resist taking a look at the widely publicized study of St. John's Wort for Attention-Deficit Hyperactivity Disorder (ADHD) that by coincidence was published in JAMA last week and that Sid discusses.
What he's discussing is a study…
oracknows | June 15, 2008Several people have been sending me either links to this paper or even the paper itself:
Young HA, Geier DA, Geier MR. (2008). Thimerosal exposure in infants and neurodevelopmental disorders: An assessment of computerized medical records in the Vaccine Safety Datalink. J Neurol Sci. 2008 May 14 [Epub ahead of print]. (Full text here.)
Some have asked me whether I was planning on deconstructing it, given that the mercury militia has apparently been promoting it as "evidence" that it really, truly, and honestly was the mercury in vaccines after all that caused autism. I did mention it about…
oracknows | June 12, 2008From my perspective, one thing that's always been true of surgery that has bothered me is that it is prone to dogma. I alluded to this a bit earlier this week, but, although things have definitely changed in the 20 years since I first set foot, nervously and tentatively, on the wards of the Cleveland VA Medical Center for my first ever surgical rotation, some habits of surgeons die hard.
Of course, regardless of the tendency towards dogma, one thing that differentiates evidence- and science-based medicine from pseudoscientific woo is that studies do make a difference. In general and…
terrasig | May 31, 2008Our quick post yesterday cited Jonathan Alter's Newsweek essay this week on the sad state of cancer research funding in the context of Hamilton Jordan's recent death and Ted Kennedy's recent glioblastoma diagnosis. Like many areas of US federal research funding, cancer research support has been flat under the Bush administration and, in fact, declined in real dollars since 2004.
But when one hears a federally-funded researcher like me whining about this situation, one might think I am solely acting in a self-serving fashion, caring only about the preservation of my career and that of my…
oracknows | May 28, 2008I sometimes wonder if the world is laughing at me.
Let me explain. A while ago I compiled a list of academic medical institutions that--shall we say?--are far more receptive to pseudoscientific and downright unscientific medicine in the form of so-called complementary and alternative medicine (CAM), otherwise known as "integrative medicine." I dubbed this list my Academic Woo Aggregator, and lamented how big it was with much wailing and gnashing of skeptical teeth. Indeed, more than once I have reluctantly concluded that woo is fast becoming the future of American medicine. High up on the…